SleepTalker May 2020

SleepTalker
Volume 33 Number 5 Stony Brook, NY  <       May 2020       > 
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Chairman's Message Pandemic Activities at SB Anesthesia Education During the Pandemic Research During the Pandemic
Academics During the Pandemic Covid Young Artists Challenge Stony Brook Anesthesiology COVID 19 Video PhD Thesis Defense
CA-3 Resident Spotlight! Anesthesia Technician News New Publications Where is That?
Chairman's Message

TJ Gan, MD, MHS, FRCA, MBA

   Today marks the 25th day since Stony Brook Hospital reached its peak of over 500 COVID-19 + PUI cases. We have seen a gradual decline in the total number of COVID patients and those needing ICU care. Faculty, residents and staff are still being re-deployed to take care of COVID patients in the ICU as well as 24/7 airway teams. With the reduction in ICU patients, the ASC which was converted to ICU is now closed. The old CTICU has been converted to a non-COVID unit under the supervision of MICU staff. Our team is being re-deployed to take care of COVID patients on 11S.

   Though we are not ready to resume elective surgery, the perioperative team is working on a plan to get us there when we meet the various criteria mandated by the DOH. Amongst them are the availability of 30% of the hospital and ICU bed capacity from the peak, a change of fewer than 10 hospitalizations of COVID-19 patients at the hospital in the previous 10 days, as well as the availability of personnel, PPE and testing capability.

   I would like to thank all of you for the excellent job you are doing during this COVID-19 pandemic. Many of you have gone above and beyond your normal duties to help take care of ICU patients, most are very sick, with high mortality, and on the airway team, taking overnight calls, etc. The teamwork you have shown and the camaraderie among team members are truly amazing and I am very proud to lead Team Anesthesia as we provide the best compassionate care for the patients.

    Matthew, Dr. Schabel’s son, has very kindly put together a video (see below) capturing some of the moments during this pandemic. These moments reflect current everyday life in the fight against COVID-19 and attempts to capture the selfless and indomitable spirit of our Team Anesthesia family.

Pandemic Activities in the Department

James P. Dilger, PhD

    In this issue of SleepTalker, we feature some of the ways that members of the Department of Anesthesiology have responded to the pandemic, not only the all-important clinical care response. As you will read, teaching, research and academic clinical efforts have tackled some of the issues or have adapted in order to be able to continue. Their efforts are inspiring. This is followed by some of the artwork submitted to the Covid Young Artists Challenge.

    This section of SleepTalker concludes with Matthew Wang's awesome video! Thanks to everyone who contributed photos.

Education During the Pandemic

Dr. Patricia Tsui conducted her "Addiction and Pain" medical student selective course via Zoom
Maria Lagade, MD

    AT Interns Update. With the COVID-19 pandemic, all clinical students in the school and across the country are experiencing changes with their clinical education. The Anesthesia Technology Program Committee (Prof Deborah Zelizer; Shoba Sanu, CRNA; Melissa Day, CRNA; Stephen Vitkun, MD; Joy Schabel, MD; TJ Gan, MD and myself) took time to establish an alternative plan: A Virtual Distance Education for Anesthesia Technology Program at Stony Brook. The plan was approved by CAAHEP-ASATT organization for completion of AT internship and eligibility to national certification examination.

    After the spring break, the AT interns came back to a new Virtual Distance Education schedule as posted in the blackboard. Virtual HAN courses and clinical case simulation seminars are delivered via Zoom meetings and discussions. Weekly each AT intern is assigned to a clinical case scenario for journal report.

    The AT interns 2019-2020 are due to graduate on June 5th, 2020.

Research During the Pandemic

    Dr. Elliott Bennett-Guerrero has launched a randomized trial to determine whether blood plasma from people who have recovered from Covid-19 can help patients who currently have the disease. Approval for the study was fast-tracked by the FDA. Dr. Bennett-Guerrero hopes to enroll up to 500 patients for the study. The idea is that those who have had the disease, may have antibodies to fight it and tthese antibodies can be transferred to current patients. To maximize the opportunity of benefit, 80% of patients enrolled in the trial will receive the convalescent plasma and only 20% will receive plasma from non-Covid-19 volunteers.

   If you have recovered from COVID-19 and want to help others battling the disease by donating your blood plasma, please visit: stonybrookmedicine.edu/COVID_donateplasma to fill out an online survey for eligibility.

    Dr. Christopher Page and colleagues from the College of Engineering and Applied Sciences, Renaissance School of Medicine and School of Health Technology and Management designed, built, tested and refined a new ventilator over the course of 10 days in response to the COVID-19 crisis. Early in the crisis, Dr. Page saw the urgency to develop a simple but effective ventilator.

    Stony Brook University News has a detailed timeline of the project development from March 28 to April 6.

    Armen Enikolopov, son of Dr. Grigori Enikolopov, worked with a team at Columbia/NY Presbyterian (he received his PhD in neuroscience from there) that built a protective shield (“The Airway Shield)” for procedures such as intubation and extubation of COVID19 patients. Such a shield was requested by the doctors, anesthesiologists in particular, at NYP. Their team of doctors, scientists, and engineers built a passive shield and they are currently working on a negative pressure attachment. The passive shield is already at work at CUMC and the negative pressure version is now being tested with several doctors and patients at the hospital.

    Of course, the team built it with the idea that anybody interested in the shield is free to do so and can use their design and instructions for building their own devices. They’ve launched a website which contains information for clinicians as well as full production/manufacturing/assembly plans and files. At this point the site describes the passive version, but they will upload the negative pressure version once they and the clinicians are happy with the results.

    If interested, people are free to contact Armen at aenikolopov_at_gmail.com for recommendations on fabrication shops that can carry out manufacture.

Academics During the Pandemic

    Drs. Steven Probst and Sergio Bergese just published an editorial "Neurointervention for emergent large vessel occlusion during the covid-19 pandemic" in J Neurointerv Surg. The author list includes Dr. David Fiorella from Neurosurgery and Radiology at Stony Brook as well as physicians from Wake Forest University, Massachusetts General Hospital, University of Washington Seattle and the Barrow Neurological Institute in Phoenix, AZ.

    Drs. Tazeen Beg, Shaji Poovathoor and Sergio Bergese published an article "Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients with Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting" in the Annals of Surgery. The all-Stony Brook author list includes Drs. Jerry Rubano, Patrick Jasinski, Daniel Rutigliano, Apostolos Tassiopoulos, James Davis, Sahar Ahmad, Randeep Jawa, James Vosswinkel, and Mark Talamini,

Covid Young Artists Challenge
Joy Schabel, MD organized a "Covid Young Artists Challenge". Here are some of the entries.

  




  



Stony Brook Anesthesiology COVID 19
Matthew Wang

   


Dr. Justas Lauzadis


    Justas Lauzadis successfully defended his PhD thesis "Contribution of T-type Calcium Channels to Spinal Cord Injury Induced Hyperexcitability of Nociceptors" on May 1. He did his research in Dr. Michelino Puopolo's lab. He will continue research on these channels in the lab as a postdoc for a year. Congratulations!

CA-3 Resident Spotlight!
Meet Dr. Adam Wetcher

Ramanjot S. Kang, MD

Can you tell us a little about your background?
   I am originally from New Jersey and have lived on Long Island for approximately 8 years since I went to medical school on Long Island as well.

What attracted you to anesthesiology?
   The decisions made by the anesthesiologist in the operating room during cases often have immediate, measurable effects. There is also a great amount of independence in addition to teamwork.

How did you come to be a resident at Stony Brook (Why SB)?
   My immediate family is located in the Northeast so I wanted to stay in the area.

What do you like most about being a resident?
    That you can bounce ideas off attendings and the exposure to many different types of cases and settings.

What do you like least about being a resident?
   Often different attendings want completely, sometimes contradictory plans for the same type of case.

What pearls of wisdom would you like to share with your fellow junior residents to help them succeed in their time here and future careers?
    Don’t be afraid to try different techniques, anesthetic plans, and challenge yourself.

So what’s the next step you will be taking as you transition from the role of a resident to attending next summer?
    Studying for the boards, then private practice for now.


As you're soon to enter the real world of anesthesiology, what do you find most daunting?
    Being the one who has to make the final decision regarding the anesthetic plan.

If you could do it all over again (become a doctor), would you? Why or why not, and what would you have done differently?
   I am not sure to be honest. I like many things about being doctor and find the work interesting but the road is extremely long.

If you hadn't chosen to go into medicine, what career path might you have followed?
    Business or professional runner if I was much faster.

What has been your favorite residency memory of your 4 years here at Stony Brook?
   Impossible to pick out one but nearly all of them involve hanging out with fellow residents.

When you aren't running on around the hospital saving lives, how do you like to spend your free time?
   Hanging out with my girlfriend, friends, long distance running, golf, and watching sports.

What do you like the most (and least) about living on Long Island?
   I like the beaches and breweries.
   The traffic is awful.

What is your favorite type of food?
   All food

What's your favorite restaurant in LI/NYC?
   Sushi of Gari in NYC.

Where would you love to travel to next and why?
   Probably Spain because of the food and history.

What's your favorite Tourist Activity in LI/NYC?
   South Shore beaches and state parks

Describe yourself in three words:
   Approachable, hard worker

Who is your role model and why?
   My grandfather because of his work ethic and generosity.

If you could make one wish, what would it be?
   To have my student loans paid off.

If you could eat lunch with one person (fictional/alive/dead/etc), who would it be?
   Steve Prefontaine.

What are you looking forward to doing once you start receiving "attending" salary?
   Home gym and maybe a day trading “fund”.

Anesthesia Technician News
Melissa Day, CRNA

   Please join me in welcoming Sarvajit Kaur, Anesthesia Technician to our Anesthesia Technician team. Sarv has been an Anesthesia Technician for over 4 years working with various OR cases to include a high volume cardiac service. She has experience working with the IABP, Rapid Infusers and Cell Saver. Sarv has a Bachelors of Science in Chemistry and is a NYS Certified Histological Technician.

   My apologies for the delay in welcoming Sarv to our awesome Anesthesia Technician team. She started this new position at the start of COVID 19 and has done a great job of adapting to our every changing and challenging environment during these unprecedented times. Welcome to the Anesthesia Technician Team Sarv!

New Publications

Figure from McInerney et al

  • McInerney HJ, Lee M, Saunders T, Schabel J, Adsumelli RSN. Symptomatic Intrathecal Hematoma following an Epidural Blood Patch for an Obstetric Patient with Postdural Puncture Headache: A Case Report and Synthesis of the Literature. Case Rep Anesthesiol. 2020 Mar 18;
  • Noll E, Shodhan S, Romeiser J, Bennett-Guerrero E. Reply to: acupressure and quality of recovery after surgery. Eur J Anaesthesiol. 2020 May;37(5):419-420
  • Carr BM, Lyon JA, Romeiser J, Talamini M, Shroyer ALW. Laparoscopic versus open surgery: a systematic review evaluating Cochrane systematic reviews. Surg Endosc. 2019 Jun;33(6):1693-1709
  • Demumieux F, Ludes PO, Diemunsch P, Bennett-Guerrero E, Lujic M, Lefebvre F, Noll E. Validation of the translated Quality of Recovery-15 questionnaire in a French-speaking population. Br J Anaesth. 2020 Apr 14
  • Khanna AK, Bergese SD, Jungquist CR, Morimatsu H, Uezono S, Lee S, Ti LK, Urman RD, McIntyre R Jr, Tornero C, Dahan A, Saager L, Weingarten TN, Wittmann M, Auckley D, Brazzi L, Le Guen M, Soto R, Schramm F, Ayad S, Kaw R, Di Stefano P, Sessler DI, Uribe A, Moll V, Dempsey SJ, Buhre W, Overdyk FJ; PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Collaborators.. Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial. Anesth Analg. 2020 Apr 16
  • Gan TJ, Wase L. Oliceridine, a G protein-selective ligand at the μ-opioid receptor, for the management of moderate to severe acute pain. Drugs Today (Barc). 2020 Apr;56(4):269-286
  • Fiorella D, Fargen KM, Leslie-Mazwi TM, Levitt M, Probst S, Bergese S, Hirsch JA, Albuquerque FC. Neurointervention for emergent large vessel occlusion during the covid-19 pandemic. J Neurointerv Surg. 2020 Apr 20
  • Martin GS, Kaufman DA, Marik PE, Shapiro NI, Levett DZH, Whittle J, MacLeod DB, Chappell D, Lacey J, Woodcock T, Mitchell K, Malbrain MLNG, Woodcock TM, Martin D, Imray CHE, Manning MW, Howe H, Grocott MPW, Mythen MG, Gan TJ, Miller TE. Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance. Perioper Med (Lond). 2020 Apr 21;9:12
  • Liu H, Dilger JP, Lin J. Effects of local anesthetics on cancer cells. Pharmacol Ther. 2020 Apr 25:107558
  • Rubano JA, Jasinski PT, Rutigliano DN, Tassiopoulos AK, Davis JE, Beg T, Poovathoor S, Bergese SD, Ahmad S, Jawa RS, Vosswinkel JA, Talamini MA. Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients with Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting. Ann Surg (in press)
Where on Campus is That?

James P. Dilger, PhD
SleepTalker, the Stony Brook Anesthesiology Newsletter is published by the Department of Anesthesiology
Stony Brook Medicine, Stony Brook, NY
Tong Joo Gan, M.D., MHS, FRCA, MBA, Chairman
Editorial Board: James P. Dilger, Ph.D.; Stephen A. Vitkun, M.D., M.B.A., Ph.D.; Marisa Barone-Citrano, M.A.; Ramanjot S. Kang, M.D.