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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

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!