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Welcome to another episode of Vital Times, the CSA podcast!
I'm your host, Dr. Rita Agarwal, and today we’re revisiting an important topic: mentorship. We've discussed mentoring before, but its significance in the lives and careers of anesthesiologists makes it worth exploring again.

Strong mentorship can have a transformative impact, especially for early career anesthesiologists. Yet, despite its many benefits, building effective mentorship programs continues to be a challenge. In this episode, we’ll focus on how mentorship can help young professionals truly thrive.

We’re joined by two outstanding guests:

Dr. Titi Aina-Jones, Associate Professor of Anesthesiology at Texas Children’s Hospital. She trained at the University of Connecticut, University of Florida, and Boston Children’s Hospital, and is currently pursuing a Master’s in Medical Education at the University of Pennsylvania.

Dr. Ioana Pasca, Associate Professor at Riverside and Loma Linda University Medical Center in the Department of Anesthesiology, Critical Care, and Neurocritical Care. She also serves as Associate Program Director and Director of Neuroanesthesia at Riverside University Health System, and like Dr. Aina-Jones, is currently enrolled in the Medical Education Master’s Program at the University of Pennsylvania.

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In this episode of the CSA Vital Times podcast, host Dr. Ludwig Lin explores the role of Certified Anesthesiologist Assistants (CAAs). He speaks with anesthesiologists who have experience working alongside CAAs and navigating the legislative efforts to establish a CAA system in clinical practice. The episode also features a CAA who is a leader in education and practice management. This introductory conversation aims to familiarize California listeners with the CAA model, share key insights, and spark interest in this emerging aspect of anesthesiology care. 

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Catch this episode where *both* of the Vital Times podcast hosts, Drs. Rita Agarwal and Ludwig Lin, show up, and discuss how they fell in love with Anesthesiology, and podcasting.

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We were all shocked by the murder of Brian Thompson the United Health Care CEO in early December. What was just as surprising was the comments deny, delay and depose written on the bullets. Once the alleged shooter was arrested, information started to trickle out that he suffered from low back pain and spondylisthesis. Speculation ran rampant that the problems with his back, inadequate treatment, or repeated insurance denials were in some way the catalyst for this terrible crime. These are not questions we know the answers to, but we thought it would be interesting to explore the causes, treatments and epidemiology of low back pain, especially in young people. 

Dr. Amber Borucki, a pediatric anesthesiologist and pain specialist from Stanford School of Medicine and Dr. Rahki Dayal, Chair of the CSA’s Pain Committee and an anesthesiologist and pain specialist at the University of California in Irvine are joining us today to discuss pain management for back pain. 

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For Black History Month, Dr. Ludwig Lin is honored to speak with someone who’s been through all of it. Dr. Marilyn Hill Harper, raised in the South, educated at a HBCU and then training in the Midwest, joined the prestigious UCSF faculty in the 1970s, at a time when both women and Black physicians were rare. Her story is ever relevant.

To read the UCSF profile on Dr. Harper, click here. 

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Host: Rita Agarwal, MD, FAAP, FASA

Guests: Rakhi Dayal, MD, and Amber Borucki, MD

Welcome to another episode of Vital Times, the California Society of Anesthesiologists’ Podcast with your host Dr. Rita Agarwal.

Pain is the most common reason that people seek medical care and since the beginning of time, we have searched for better ways to treat pain. For many years opium and its derivatives were the mainstay of pain management, with local anesthetics making an appearance in this country in the past century or so. While scientists, physicians, researchers, and industry have sought to find better medications and approaches, the onset of the opioid crises in early 2000s really sped up that mandate. The FDA has committed resources and funding to help these new treatments and as a result there are now several new drugs on the market.

Joining me today to explore these new modalities are Dr. Rahki Dayal who is a Professor at the University of California, Irvine, double board-certified in anesthesiology and pain medicine. She chairs the Pain Committee for the California Society of Anesthesiologists and is the Program Director of Pain Medicine at UCI. Dr. Amber Borucki is an Associate Professor of Anesthesiology at Stanford University and a pediatric anesthesiologist and pain specialist from Stanford School of Medicine. She is also the newly elected Sectrtary/Treasurer of the Society for Pediatric Pain Medicine.

On January 30 the FDA approved a new non-opioid pan medication for moderate to severe pain. In the past few years several new classes and types of medications have also been approved for use. These include Zynrelef-a combination of bupivacaine ( a long acting local anesthesthetic ) and meloxicam ( a long lasting NSAID), and Vocacapsacian a prodrug to capasacian that in at ;east one study has been shown to provide up to 96 hours of pain relief , when injected locally after bunionectomy surgery.

Join us as we explore these medications and the newly released suzetrigine (Journavx) with our 2 experts. 

References

Newly Approved Painkiller Provides Relief Without Addiction

https://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain 

A new long-acting analgesic formulation for postoperative pain management.

Zhang W, Wu M, Shen C, Wang Z, Zhou X, Guo R, Yang Y, Zhang Z, Sun X, Gong T.Int J Pharm. 2024 Oct 25;664:124599. doi: 10.1016/j.ijpharm.2024.124599. Epub 2024 Aug 16.PMID: 39154917 Bupivacaine + meloxicam-~3 days duration-also for bunionectomy

Safety and Efficacy of Vocacapsaicin for Management of Postsurgical Pain: A Randomized Clinical Trial.

Shafer SL, Teichman SL, Gottlieb IJ, Singla N, Minkowitz HS, Leiman D, Vaughn B, Donovan JF.Anesthesiology. 2024 Aug 1;141(2):250-261. doi: 10.1097/ALN.0000000000005027.PMID: 38662910

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There have been a lot of questions recently regarding the appropriateness of patients scheduled for care in an ambulatory surgical center (ASCs). It appears that sicker and more complex patients are being scheduled for care in an ASC, and many anesthesiologists are increasingly concerned about the safety of anesthetizing these patients in locations that may lack resources to escalate care if needed. In today’s episode we are going to discuss some of these issues with two experts in ambulatory to help navigate this quandary. Welcome Drs. Christina Menor and Basem Abdelmalak. 

The discussion was fascinating and informative. Starting with why surgeons and proceduralists may want to schedule patients in an ASC, to factors that might affect the decision to safely care for a particular patient in a particular location. Along the way specific examples of patients with complicated medical conditions were presented and discussed in depth.

For full guest bios and resources discussed during the podcast, click here. 

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Drs. Charles Hummel and Jason Cheng explain the origin story behind their involvement in founding the drive toward collegiality for a major healthcare system in California, Kaiser Permanente.  Take a listen and be inspired by the immense possibilities when physicians join forces in the name of empathy and humanity.

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Your host Dr. Rita Agarwal is joined today by two outstanding guests who have an interest in preventing and treating women’s pain. Drs. Anita Gupta and Stephanie Cizek. 

At the California Society of Anesthesiologists’ Annual Meeting in Anaheim, in April 2024, there were several posters authored by Dr. Anita Gupta looking at the literature surrounding IUD insertion pain and potential treatments for that pain. Several months later the new CDC recommendations were released recommending improved pain management techniques in patients undergoing IUD placement. Around the same time there was increased media attention to IUD related pain and the fact that women’s pain has historically often been dismissed, minimized or ignored. In this episode, we discuss all of this and more! 

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Your host Dr. Rita Agarwal is joined by two wonderful guests to talk about climate change and what anesthesiologists can do about it.

Climate change is one of the defining challenges of our time with far reaching implications. There is evidence of the increasing numbers of deaths directly related to heat in the USA, but even more across the rest of the world. This doesn’t include deaths related to the consequences of climate change such as more profound and extreme weather events, rising sea level, disruptions to ecosystems and agriculture, drought, and famine. Addressing climate change involves action at local, national, global levels and includes the efforts of individuals, society, businesses, governments, and health care and other institutions.

Both guests are individuals who are committed to addressing efforts to reduce greenhouse gases at the individual, institutional, and local levels.

Dr. McGain is an MBBS and PhD who practices in anesthesia and intensive care at Western Health, St Albans, Victoria, Canada and in Australia as the Associate Dean of Sustainable Healthcare at the university of Melbourne. Dr McGain has spoken and published over 100 articles on the topic of greenhouse gases, reducing carbon footprint and bringing the scientific method to comparing the environmental impact of different practices. In fact, it was as a result of an editorial that he and Drs. Gordon and Debnath Chatterjee wrote, and a presentation from my other guest Dr. Lin, that Dr. Rita Agarwal finally stopped using nitrous oxide for mask induction in children after 30 + years of practice. She had given up desflurane, embraced low flow gases, and minimizing volatile agents, but honestly thought you would have to pry nitrous oxide out of her cold dead hands, before she stopped using it. They convinced her otherwise and hopefully will convince all of you as well

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With ketamine being very prominent in the news recently, lots of questions arise about its use. Is it safe enough to be used the way it is? Why are patients being prescribed it? What are the safety guidelines, and are they being met?
The California Society of Anesthesiologists’ Vital Times Podcast talks with anesthesiologists and pain specialists Drs. Amber Borucki, Rakhi Dayal and Rita Agarwal to talk this over. This is a must-listen for everyone. 

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Cryoneurolysis has rapidly evolved and refined itself as a viable technology for postoperative and chronic pain. Its specifications mean greater efficacy for certain scenarios, and active research means its application is about to enter warp-speed. In this episode of Vital Times, we speak with Dr. John Finneran, of UCSD, who is actively conducting research trials with this technique. Get up to date and get inspired.

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Welcome to another episode of Vital Times the CSA Podcast. I am your host, Rita Agarwal. For this episode we went back to the basics and talked about something that all anesthesiologists care deeply about – managing the challenging airway. Joining me is a former colleague and friend who is an attending anesthesiologist at one of the busiest trauma centers in the country - Denver Health Medical Center. 

Dr. Alma Juels is an Associate Professor of Anesthesiology at the University of Colorado School of Medicine and the Director of Quality, Safety and Improvement, and the Director of OB Anesthesia at Denver Health Medical Center. She is also an Expert Consultant for the Colorado State Medical Board and has lectured extensively, presented workshops and cared for many patients with difficult airways. In this podcast, she will share some of her scarier and/or more interesting experiences. 

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Dr. Ludwig Lin has a blast discussing LGBTQ and its impact on various anesthesiologist leaders within academia and politics; drop in and listen to them discuss how this one element of their lives adds meaning and purpose to all of their pursuits. This episode features Travis Reece-Nguyen, MD, Arthur Chyan, DO, and Maricela Sanchez, MD. 

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There has been much noise about famous scientists reckoning with past publications with data integrity issues. The pressures of “publish or perish”, and the need for oversight of a busy lab, are tricky. Dr. Lin talks with Harriet Hopf, MD, FASA, and Elizabeth Whitlock, MD - two lauded NIH-funded anesthesiologists-scientists to get the scoop. 

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Mentorship has long been recognized as a crucial component of training physicians. Benefits of mentorship in medicine include increased productivity, improved career satisfaction, expansion of professional networks, reduction in stress, and better work-life balance. Mentorship has also been shown to aid recruitment and retention of a diverse physician workforce. The establishment of mentorship programs has been proposed as a mechanism for promoting inclusivity and diversity within academic medicine, but setting up successful programs can be challenging.

Today’s podcast features 3 accomplished anesthesiologists at different stages of their careers who will discuss the benefits of good mentorship programs and how to start successful programs in both academic and private practice.

Scott Markowitz, MD, MSOL, is Professor of Anesthesiology and Vice-Chair for Professional Development and Diversity, Equity, and Inclusion at Washington University in St. Louis. Dr Markowitz focuses on leadership development, promoting a diverse and inclusive leadership and workplace, and promoting meaningful engagement among department members.  He serves on the ASA’s ad hoc Committee on Harassment, Incivility, and Disrespect, and also works closely with other leaders on the national initiative, Raising Anesthesiology Diversity and Anti-Racism (RADAR). 

 Ioana Pasca, MD, is an Associate Professor, Associate Program Director and Director of Neuroanesthesia at Riverside University Health System. She is also a faculty member at the LLUMC Department of Anesthesiology, Critical Care, and Neurocritical Care UCR School of Medicine Adjunct Associate Professor and Anesthesia Interest Group Advisor. 

Paul Yost, MD, FASA, is the ASA Assistant Secretary, past CSA President, and past ASA Director. He trained in pediatrics at Jackson Memorial in Miami and Anesthesiology at UCLA.  He has worked at Children’s Hospital Orange County and St Joseph’s in private practice for 32 years.  Served as Chair of pediatric anesthesia at CHOC , Chief of Staff ad hoc, and co-director of Pediatric and Adult Cardiac Anesthesia. Additionally, he served 10 years in city government including 8 years on city council and a couple of terms as mayor of Seal Beach.  

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CSA Vital Times tracked down some of the chairs running some elite Anesthesiology Departments - they just happen to be in California! They have survived and thrived the seismic changes occurring across all academic medical institutions, ie the increase in clinical need, with huge growths in anesthetic opportunities (and locations - see #NORA), the competition with community hospitals, and resulting impact on their staff. Dr. Michael Gropper (UCSF), Dr. Ron Pearl (recently retired Stanford chair), and Dr. Richard Applegate (UC Davis and now Loma Linda) get together with Dr. Ludwig Lin for an eye-opening and thought-provoking chat. 

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Dr. Rita Agarwal continues the conversation about sexual and gender harassment with fellow Drs. Christine Doyle, Sydney Thomson, and Alyssa Burgart.  

Gender and sexual harassment can be harmful in many ways and not just to the person/people being harassed. It can occur to all genders and is often associated with increased costs to the institution, intention to leave and job/career dissatisfaction. I discuss the problems and possible solutions with leaders from the California Society of Anesthesiologists and the American Society of Anesthesiologist, focusing on what is being done and what still needs to be done.

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To amplify the message of Black History Month, CSA Vital Times Podcast series revisits the talented Ashley Oliver, MD. We spoke with her in February 2022 when she was a cardiothoracic anesthesia fellow at UCLA, after having been a resident and Chief Resident at UCSF. Dr. Oliver is now a first-year faculty at UCLA’s cardiothoracic section, and we have a no-holds barred discussion about being a starting faculty, being a minority, building allies, representation, and the importance of building engagement via societies like CSA and ASA!

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A recent study from the Association of Academic Medical Colleges reported tht sexual harassment is common in the medical profession and that anesthesiologist (both men and women) reported the highest incidence of harassment. Harassment led to decreased morale, decreased engagement and a higher intention to leave. Join me for a fascinating and engaging conversation with Diana Lautenberger the author of the AAMC article for suggestion on how to prevent harassment.

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The utilization of physician extenders in the UK healthcare system has been quite controversial recently, with topics like training and validation requirements, impact on training and staffing, all bubbling to the surface. In addition, the lack of funding for physicians and residency slots has contrasted with the increasing spending on physician assistants. Dr. Ramey Assaf, resident and leader within Anesthetists United and Dr. Richard Marks, former Vice President for the Royal College of Anesthetists speak with Dr. Ludwig Lin on this topic. 

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US and Californian Maternal morbidity is alarmingly high, especially in Black and Hispanic women. How did this happen, and how do we become active change agents in reversing the trend?

Leaders in healthcare equity - Drs. Amanda Williams (OB), Jennifer Lucero (OB Anesthesia), and Mofya Diallo (Pedi Anesthesia) join host Dr. Ludwig Lin for this important podcast episode. 

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Dr. Rita Agarwal interviews Drs. Jay Brodsky and John Brock Utne, the authors of a new book on the history of anesthesia at Stanford during the Larson Years. They share funny and moving anecdotes about the people, the department, and the events that shaped one of the top anesthesia programs in the country. 

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October 1 was Latino Physician Day. For anyone interested in the health of Californians, this is important, because a large portion of our population is Latin-X, and the physicians who care for them should reflect that demographic. We at CSA are excited to bring together a panel of Latinx anesthesiologist at different stages and areas of their professional careers to speak on their journeys to Anesthesiology. This conversation is inspiring - for everyone - and is a call to action.

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Those few precious minutes in the Preoperative area spent speaking with a patient and their significant others are essential to the initiation of a successful anesthetic, as is the “vibe” generated during the entire time until the induction agent for General Anesthesia goes in. 
 
What are the keys to success? We speak with Dr. Phil Jones, a cardiac anesthesiologist now in Toronto, Canada, who nearly trained as an actor in Britain before enrolling in Medicine studies at Cambridge. He was a consultant in Anesthesia and Critical Care Medicine at the prestigious St. Bart’s Hospital in London. He is passionate about this topic, and about the importance of communication to improve the patient’s perioperative experience.
 
Follow Dr. Jones (@philjones6) and Dr. Lin (@LudwigLin) on Twitter.