SleepTalker October 2017

SleepTalker

Volume 28 Number 4 Stony Brook, NY  <       October 2017       > 
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Alumni Reception STARS Kudos Research News
Mario Rebecchi Retires Family News Welcome Farewells
Division Chief's Corner CA-3 Resident Spotlight! ASA Presentations New Publications
Where is That? Monthly Muscle Chillaxant

Jeremy Poppers, MD, PhD

    I want to acknowledge the supreme efforts of a few members of our department that were made Sunday, September 17 while caring for a very sick patient. Early in the day, a young patient suffered a VF arrest at home and again in the CCU. As I was driving to the hospital, Dr. Diana "I'm not THAT" Escobar was setting up the room and Dr. Kseniya "storm cloud" Khmara, was stabilizing him in the CCU, having just intubated the patient. He was emergently brought to the OR for ECMO and a possible CABG. Upon arrival to the OR, he arrested once again. Dr. Tommy "I never met a rib I cannot break" Corrado was there performing effective chest compressions and helping me run the code. This was, without a doubt, a team effort: nurses, perfusionists, cardiologists, surgeons and anesthesiologists. But without the fluid team dynamics of this group of anesthesiologists, this patient would not have been resuscitated as well and efficiently. I am grateful and indebted to Drs. Escobar, Khmara and Corrado for their expertise and dedication.

Tommy Corrado, MD

    Its always a pleasure to watch a team of people performing smoothly, especially when someone as good as Dr. Jeremy Poppers is at the helm. If anyone ever needs a lesson in both brilliant clinical care and effective OR communication they need only watch Jeremy take control of a room. It was an honor and pleasure to be part of such an effective team.

Stephen A. Vitkun, MD, MBA, PhD

   On Thursday 9/21 we had an ACLS class at the ASC. We had 23 anesthesiology faculty, CRNAs take the class. I would like to thank Amelia Williams (our POS Clinician/Nurse Manager) and Ellen Robertson (our ASC Clinical Specialist/Educator) for joining me as instructors for the class. I also want to thank Dr. Barry Florence and Tom Halton for arranging for use of the ASC facilities. Without all of them it would have not been possible. Due to the success of the class and several other faculty asking for an ACLS class, we are planning another class in the near future.

F Barry Florence, MB, ChB

   Thanks to Dr. Steve Vitkun, Ellen and Amelia. The course was education and fun. (A rare combination) Everyone commented that this was the best that we have done. I hope that I passed the test!

Patient comments about our staff from the Press Ganey questionnaires:

   All of the anesthesiologists were outstanding! I have a number of medical issues that made anesthesia more complex & they were extremely professional & knowledgeable.

   Anesthesiologist was courteous patient, and performed their job very well.

   Dr. Paul Willoughby was very friendly and relatable to both the child patient & the parents.

   Dr. Lauren Fleischer was great.

   No one likes to have surgery. However, the professionalism and kindness of the staff made the experience much more tolerable.


   CA-3 Resident Dr. Justin Smith and graduated resident Dr. Scott Licata were coauthors with Dr. Vahe Tateosian on an "Images in Anesthesiology" contribution that will appear in an upcoming issue of Anesthesiology. The image shows two rapidly expanding intracranial arterial aneurysms of the left posterior cerebral artery (A) and left internal carotid artery (B) in a 4.7-kg, 2-month-old, full-term female with SCALP (sebaceous nevus syndrome, CNS malformations, aplasia cutis congenita, limbal dermoid, and pigmented nevus) syndrome.

   CA-1 Resident Dr. Ehab Al Bizri is a co-author with Attendings Drs. Rany Makaryus and Stephen Probst and Adjunct Faculty member Dr. Helene Benveniste on a paper to be published in Anesthesiology. The paper concerns the effects of dexmedetomidine and isoflurane on solute transport via the glymphatic pathway. See image under New Publications below.

   Congratulations to CA-1 Resident Leif Ericksen for being the lead author of the monograph “Enhanced Surgical Recovery: From Principles to Standard of Care.” The article is featured in the latest publication of Congress Review, a supplement to Anesthesiology News. It is a review of the Annual Congress of Enhanced Recovery and Perioperative Medicine held on April 27-29, 2017 in Washington, DC.

Marjorie L. Lundgren, MBA

   Dr. Joshua Dubnau was just awarded $3,592,892 from the National Institute on Aging for his project, “A Systems Approach to Uncover Upstream Activators and Common Downstream Pathways of Neurodegeneration in a Drosophila Model.” The project will systematically investigate upstream environmental influences on TDP-43 protein pathology, and will also search for common downstream effects of these environmental perturbations. The hope is to identify underlying common cellular impacts that could inform clinical approaches. Congratulations!!
photo by Jeanne Neville
   Dr. Grigori Enikolopov was just awarded $3,201,552 from the National Institute on Aging for his project, “Nitric oxide-mediated changes in glymphatic and CSF systems in aging and Alzheimer’s disease.” The project goal is to understand the connection between the CSF and the glymphatic systems in the aging and diseased brain. Congratulations!!


James P. Dilger, PhD

   After 29 successful years as a Stony Brook faculty member, Dr. Mario Rebecchi has retired! The department hosted a luncheon for Mario and his wife Anna on September 29.

   Mario earned his bachelor's and master's degrees in biology from St. John's University. He then came to Stony Brook's department of Pharmacology to do his PhD research. This was followed by a fellowship in molecular biology at Memorial Sloan-Kettering Cancer Center. He joined the department of Physiology and Biophysics at Stony Brook in 1988 and migrated to our department in 1996.

   Mario directed NIH-supported research on the Regulation of Phosphoinositide Specific Phospholipase C and the Molecular Actions of Volatile Anesthetics on G-Proteins. He has authored more than 85 peer reviewed publications and many, many abstracts. His 2000 review article "Structure, function, and control of phosphoinositide-specific phospholipase C", written with Dr. Srinivas Pentyala, was called the "bible on PLC" according to an NIH researcher and has been cited over 1000 times.

Members of the Basic Research Gang. From left: Drs. Kevin Czaplinski, Grigori Enikolopov, Michelino Puopolo, Martin Kaczocha, Mario Rebecchi, Anna Rebecchi, James Dilger, TJ Gan, and Joshua Dubnau.

   Mario has tirelessly served Stony Brook and the department in many ways. He chaired the Institutional Animal Care and Use Committee for many years (a time- and patience- consuming job) and was Chairman of the Departmental Research Committee. Most importantly, he provided excellent mentorship to several of the beginning basic researchers in Anesthesiology and formed successful collaborations with others.

   Mario and Anna will be moving to the Boston area in the Spring of 2018 to be closer to their two daughters and two grandchildren. I am sure that he won't be a stranger to Stony Brook even after that. Best wishes for a happy retirement my friend!

Sabeen Rizwan, BA

   My sister, Afreen, got married September 2nd at Villa Lombardi’s. Congratulations to the new Mr. and Mrs. William Wright!


Deborah C. Richman, MBChB FFA(SA)

   Mazel Tov to Paul and Deborah Richman! Congrats to Nathan Richman and Kathryn Vollinger on their marriage earlier this month in New Hampshire. Longtime climbing partners, Kat and Nate skipped the rehearsal dinner and had a rehearsal climb instead. Then they did it again the next day, photographer on another rope, and climbed up to Cathedral Ledge, changed into wedding clothes in a tent on the top and tied the knot. Nate is the oldest of our kids. We wish them every happiness.

Joseph Gnolfo III, MS, CRNA

   We welcome three new CRNAs to our team this month. Jennie Blaha is from Southside Hospital and Quality Anesthesia. Jennie graduated in 2005 from SUNY Downstate. Elizabeth Rose-Gould is from NAPA and Northshore Surgi-Center. Elizabeth graduated in 2007 from Columbia University. Barbara Goldstein is also from NAPA. Barbara graduated in 2015 from Rutgers University.

Melissa A. Day, MS, CRNA, CCRN

   Please join me in welcoming two new members to our Anesthesia Tech Team. Lindsay Menno has a Bachelor in Speech Language Pathology and Audiology. She has worked as an Optometric Assistant, Oculoplastic Surgical Assistant and Technical Coordinator. Wilfredo (Will) Heredia has worked at Stony Brook for the past 13 years as a Clinical Nursing Assistant. Will has worked in the Operating room, Recovery room, Ambulatory Surgery Center and most recently Pre-Surgical Admissions.




   We bid a fond farewell to two faculty members in September. Dr. Thomas Floyd has moved to Dallas to become Professor of Anesthesiology & Pain Management at the University of Texas Southwestern Medical Center. Dr. Loreta Grecu is going to Duke University as Associate Professor of Anesthesiology. We wish both of them the best in their futures down south!

Tazeen Beg, MD

   Let me start with a little introduction of this division. Any provision of anesthesia outside of the Operating Room at the hospital is considered Off-site Anesthesia and the division has a new name: Non-Operating Room Anesthesia. It includes the Endoscopy Unit, EP Lab, TEE, ECT, Special Procedures, Radiation Oncology, CT Scan and MRI areas. We have a group of dedicated anesthesiologists who frequent these areas including the Cardiac and Pediatric anesthesiologists. To optimize the outcome and safety of patients undergoing a procedure requires collaboration and teamwork between the interventional proceduralists and the anesthesia providers including the nurse anesthetists; and we do that with great elan! (Well, most of the time...)

   Spotlight on Endoscopy

    So what do you expect to see when you arrive on 14North? A 72 y/o male with PMH of HTN, DM, CAD s/p CABG, stents (on Eliquis), Smoker, COPD admitted with hematemesis and suspected upper GI bleed for emergent EGD. Or a 50 y/o female for a screening colonoscopy. There might also be a 56 y/o male smoker sitting upright with a recently diagnosed obstructing right lung mass brought in from the floor waiting in the hallway for a Bronchoscopy and possible tracheal stent placement! Or a 75 y/o male with oro-pharyngeal cancer s/p resection and radiation with post radiation restricted neck mobility and esophageal strictures for EGD and dilation. Another 56 y/o gentleman with obvious jaundice who went to his PMD because his friend said he looked a 'little yellow' and is now here for an EUS/ERCP. Just a snapshot of the typical cases on the Endoscopy Unit!

    There are six state-of-the-art procedure rooms all equipped with an Anesthesia Machine (with an EMR), Pyxis machine and the anesthesia cart. There is a Pre-op area and a post-op Recovery Room. Each Anesthesia Attending covers 3 rooms with 3 CRNAs. However, now with the ACGME requirements of two week NORA rotation for the residents, we will have the residents rotating there too. We will also have an online study system with lectures and case studies, which is in the process of development.

    In the Endoscopy Unit, we are equipped to handle all sorts of challenging situations, emergency and otherwise, including difficult airways. Remember that there are fiberoptic endoscopes available (especially the pediatric ones) and most GI attendings are better at using them than us! Bronchoscopes are available in the unit as well since we have Pulmonary cases. And we have a Thoracostomy cart too..... just in case!

   With the increase in the severity and complexity of cases and move towards minimally invasive procedures, the case load has been climbing. We get complicated cases some of whom are not even considered a surgical candidate-for example, a pancreatic cancer patient with mets s/p Whipple with continued obstruction from strictures for an ERCP and stent. Most of the cases are done with Propofol including ERCPs, esophageal dilations and stents, Bronchoscopies/EBUS(usually done with an LMA with TIVA) and even the Intragastric Balloon placement procedures in the morbidly obese.

   The Endoscopy Unit is a busy, rapid turnover place with 50-60 cases as the daily average. Our gastroenterologists and pulmonologists are very accomplished and communicate well with us and so is the nursing staff. It has come a long way from just one anesthesiologist covering a few requested cases in 2004 (when I was first sent there as a brand new attending!) to its present status with 100% coverage. The Gastroenterologists like us but the patients LOVE us and that is all that we care about. We strive to keep our patients safe and satisfied!

   The upcoming Journal Club on Thursday, Oct 5th will feature articles on patient safety during sedation provided by anesthesia personnel versus GI and a meta-analysis on the use of Propofol as a sedative during GI procedures. It will surely be interesting so please be there.

   Stay tuned for snippets on other NORA sites around the hospital in upcoming issues of Sleeptalker.

Shivam Shodhan, MD, MBA

Can you tell us a little about your background (hometown, college, medical school, etc.)?
   I’m from Marietta, GA, and I went to college at Kennesaw State University. Afterwards, I continued my education to Medical College of Georgia.

What attracted you to anesthesiology?
   Spending more time taking care of the patient than writing notes and rounding

How did you come to be a resident at Stony Brook (Why SB)?
   Luck of the the residency match!

What do you like most about being a resident?
   As a resident, you always get the opportunity to keep learning new things.

What do you like least about being a resident?
   The variability of answers regarding topics when asking from one attending to another.

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?
   Read books, pass exams, show up to work!

What advice do you have for medical students looking to pursue a career in anesthesiology?
   The specialty is pretty good overall.

So what’s the next step (academic attending, private practice, research) you will be taking as you transition from the role of a resident to attending next summer?
   I'll be doing a cardiothoracic anesthesiology fellowship in Los Angeles at the University of Southern California.

As you're soon to enter the real world of anesthesiology, what do you find most daunting?
   Working by myself at middle of the night...

If you could do it all over again (become a doctor), would you? Why or why not, and what would you have done differently?
   Of course! However my backup was being a trailer truck driver.

When you aren't running on around the hospital saving lives, how do you like to spend your free time?
   I'd happily be sleeping!

What do you like the most (and least) about living on Long Island?
   The summer and winter.

What is your favorite type of food?
   Korean BBQ

What's your favorite restaurant in LI/NYC?
   Butcher’s Bar in Flushing

Where would you love to travel to next and why?
   I'm excited for my move to CA next year.

What's your favorite Tourist Activity in LI/NYC?
   Exploring NYC.

Describe yourself in three words?
   Man speaks few (words).

Who is/are your role(s) models and why?
   That's a hard one, as it changes from time to time.

If you could make one wish, what would it be?
   Obviously to grant more wishes!

If you could leave us with one of your favorite quotes, what would that be?
   Nothing comes easy if it is worth having.

   Department members will be making presentations and moderating sessions at the annual meeting of the American Society of Anesthesiologists. The meeting will be held in Boston from October 21-25.
   Please visit our Presenters while you are at the ASA meeting. And, don't forget to take photos of department members standing in front of posters! We can use these in November's issue of SleepTalker, on our website and in the library display case.

Medically Challenging Cases
Adrahtas D, Azim S. Multi-trauma patient with deteriorating mental status in PACU: Isolated Cerebral Fat Embolism
Escobar D, Scott BH. Unilateral Tympanic Membrane Rupture During Robotic-Assisted Laparoscopic Prostatectomy
Georges R, Schabel J, Wang M. Convulsive Syncope vs Eclampsia
Licata S, Tateosian V. Difficult Airway Management in a 21 Month Old with Cornelia de Lange Syndrome
Na Javeed S, Azim S. Cardiac Arrest after Tourniquet Release for Knee Arthroplasty or Anaphylaxis
• Ni S, Hua B, Schabel J. Ephedrine-Induced Myoclonus in a Parturient
Smith J, Licata S, Tateosian V. Management of Two Large Intracranial Aneurysms in a 2-Month-Old Female
Thalappillil R, Azim S. Awake fiberoptic intubation in a morbidly obese male with large right submandibular and sublingual abscesses: a comprehensive, multimodal approach
Thalappillil R, Scott BH, Seifert FC. Resource utilization, Postoperative mortality and morbidity in octogenarians, our experience 10 years later
Thalappillil R, Izrailtyan I, McLarty HJ. Role of intraoperative TEE in identifying previously unrecognized RA thrombus prior to LVAD placement in patient with decompensated idiopathic dilated cardiomyopathy
Zia H, Oleszak SP, Andraous W. Complex Airway Management for Vocal Cord Lesion, Partial Glossectomy, Partial Palatectomy, Tonsillectomy, Pharyngectomy and Radical Neck Dissection combined
Posters
Liu L, He J, Zhu J, Rebecchi MJ. Age Associated Cardioprotection Differences by GSK3β Inhibitor in Rat Heart: Effects on Autophagy Pathways
• Viscusi ER, Skobieranda F, Soergel DG, Burt DA, Gan TJ. APOLLO-2: A Randomized, Double-Blind, Placebo- and Active-Controlled Phase 3 Study Investigating Oliceridine (TRV130), a Novel μ Receptor G Protein Pathway Selective (μ-GPS) Modulator, for the Management of Moderate to Severe Acute Pain Following Abdominoplasty
Richman D. Perioperative Medicine Poster Discussions (moderator)
Richman D. Perioperative Medicine Poster Presentations (moderator)
Panels
Gan TJ. Opioids in Acute Pain Management - Friend or Foe: An Evaluation of Safety and Utility
Gan TJ. The Role of Novel Analgesics and Monitors to Assess Pain
Workshops
Stellaccio FS. Difficult Airway Workshop With Simulation
Point Counterpoint
Gan TJ. Neuromonitoring Should Become a Standard of Care in the Ambulatory Setting
Clinical Forum
Willoughby P. My Patient is Shaking, Stiff and Won't Talk but It's Just Ambulatory Surgery: What Do I Do? (moderator)

Figure from Benveniste et al 2017

  • Tateosian VS, Smith J, Licata S. Large Intracranial Aneurysms in a 2-month-old Female: A Rare Occurrence with Serious Anesthetic Challenges. Anesthesiology. 2017 Sep 1
  • Bampoe S, Odor PM, Dushianthan A, Bennett-Guerrero E, Cro S, Gan TJ, Grocott MP, James MF, Mythen MG, O'Malley CM, Roche AM, Rowan K, Burdett E. Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures. Cochrane Database Syst Rev. 2017 Sep 21;9
  • Benveniste H, Lee H, Ding F, Sun Q, Al-Bizri E, Makaryus R, Probst S, Nedergaard M, Stein EA, Lu H. Anesthesia with Dexmedetomidine and Low-dose Isoflurane Increases Solute Transport via the Glymphatic Pathway in Rat Brain When Compared with High-dose Isoflurane. Anesthesiology. 2017 Sep 22
  • Jacob ZC, Fan R, Reinsel RA, Patel N, Chandrakantan A. Preliminary validation of transcutaneous CO2 monitoring in patients undergoing cardiac ablation using jet ventilation. Open Journal of Anesthesiology 2017; 7:315-327
  • Ericksen WL, Miller TE, Mythen M, Gan TJ. Enhanced Surgical Recovery: From Principles to Standard of Care. Anesthesiology News, August 14, 2017
James P. Dilger, PhD


Marisa Barone-Citrano, M.A.
   Luz, the wonderful person assigned to clean our department, is leaving us to pursue a career as a nursing assistant. We had a surprise party for her on September 25. We wish her the best in her new career!

Jean Abbott, BS, MT

    Darcy and I went to the Docs Who Rock fundraiser, where we listened to our very own Jamie Romeister as lead singer and keyboardist of the group Prognified. Jamie was great!

Adrian Fischl, MD
    Several members from the Stony Brook Anesthesiology team attended the annual Running of the Bull 5K in Smithtown. The runners were, from left to right: Gina Chen, Adrian Fischl, Jennifer Heinemann, Adam Wetcher, Carlos Sanchez, Manuel Lee, and Wesam Andraous. (Additional photo shows Steve Probst as well). The next run will be: The Town of Oyster Bay Supervisors 5K Run Saturday Oct 14 2017. If you are interested in attending or you know someone that is, please contact Steven Probst, Adrian Fischl, or Adam Wetcher for more details.

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