University HospitalBasel

40th Myron B. Laver InternationalPostgraduate CourseUnresolved Issues in Anesthesiology and Critical Care

Dear Participant

On the occasion of our 40th Myron B. Laver International Postgraduate Course, we are taking the opportunity to focus on topics we are all familiar with but which have failed to progress over the last 15 (if not forty) years. Our speakers have been asked to highlight the controversial and unsatisfying aspects of their topics and, where possible, show hopeful new developments.

The theme of this year’s meeting leaves considerable room for creativity given the number of unresolved issues in our field. As such, we have selected topics covering all of perioperative medicine, from basic pharmacology, to prehospital emergency medicine, intraoperative management, critical care medicine, and pain management. As always, the Friday sessions will focus on anesthesia, and the Saturday session will focus on unresolved issues in critical care medicine.

One of today’s major challenges in the Swiss health care system is the move from in-patient care to ambulatory medicine. Many questions, e.g. regarding training and reimbursement, remain unresolved. The guest speaker of this year’s MBL is the Medical Director of a truly innovative ambulatory surgical center. Under his leadership, his center has managed to take ambulatory surgery for cancer patients to a new level. His talk will focus on the key factors for the successful change from in-patient to outpatient surgery.

After 40 years of hosting the MBL, we feel the time has come to revisit and possibly adapt the form of the meeting. Adult education has moved away from “ex cathedra” lectures to innovative formats sometimes including participation of the audience or a shift to workshops with hands-on practical content. We will certainly organize a postgraduate course in 2021, but it may look quite different from what we have become used to. We will do our best to surprise you.

Luzius Steiner

Session I: Basics and Prehospital

Moderator: L. A. Steiner

Friday, February 7, 2020 (Morning Session)

08.15 – 09.00 Registration in the ZLF lobby

09.00 – 09.15 Welcome/Introduction

09.15 – 09.45 Mechanisms of Action of General Anesthetics N. P. Franks London, UK

09.45 – 10.15 Does Anesthetic Technique Modify Outcome? M. Filipovic St. Gallen, Switzerland

10.15 – 10.45 Management of Coagulopathy in Severe Trauma D. Bolliger Basel, Switzerland

10.45 – 11.15 Coffee Break (sponsored by OrPha Swiss)

11.15 – 11.45 Cardiac Arrest Research: Are We Getting K. Sunde Wiser or Being Fooled by Pragmatic RCTs? Oslo, Norway

11.45 – 12.15 How to Prevent Acute Postoperative Pain E. K. Aasvang from Becoming Chronic Pain? Copenhagen, Denmark

12.15 – 13.00 Discussion with all speakers

Friday, February 7, 2020 (Afternoon Session)

14.15 – 14.45 Perioperative Fluid Therapy: TBA What Is Too Much and What Too Little?

14.45 – 15.15 Intraoperative Ventilation: M. J. Schultz Does the Setting Really Matter? Amsterdam, Netherlands

15.15 – 15.45 Are Opioids Indispensable for T. D. Egan General Anesthesia? Salt Lake City, UT, USA

15.45 – 16.15 Coffee break

16.15 – 16.45 Malignant Hyperthermia: P. M. Hopkins Significance and Unresolved Issues in 2020 Leeds, UK

16.45 – 17.15 Spinal Induced Hypotension During W. D. Ngan Kee Cesarean Section: Unresolved Issues Doha, Qatar

17.15 – 17.45 Discussion with all speakers

17.45 – 18.30 Guest lecture: "Complex Cancer Surgery B. A. Simon in the Ambulatory Setting" New York, NY, USA

18.30 Close of scientific session

18.30 Alumni dinner (for those who have reserved)

Session II: Perioperative Management

Moderator: M. Kaufmann

Saturday, February 8, 2020

08.15 – 09.00 Coffee and croissants

09.00 – 09.30 Multimodal Monitoring in Traumatic Brain Injury: G. Meyfroidt Fancy Goody for Doctors or Real Benefit Leuven, Belgium for Patients?

09.30 – 10.00 Chronic Critical Illness: A. A. Hope Challenge of the 21st Century Bronx, NY, USA 10.00 – 10.30 Delirium in the ICU: 20 Years Later J. R. Maldonado Stanford, CA, USA 10.30 – 11.00 Elderly Patients and Limitation of Intensive Care B. Guidet Paris, France

11.00 – 11.30 Discussion with all speakers

11.30 Close of scientific session

Session III: Intensive Care

Moderator: H. Pargger

Faculty

(in alphabetical order)

Eske Kvanner Aasvang, MD, DMSci, Associate Professor, Anesthesiological Department, Centre for Cancer and Organ Dysfunction, Rigshospitalet, University of Copenhagen (Depart-ment of Clinical Medicine), Denmark

Daniel Bolliger, MD, Professor, Head of Ambulant Anesthesiology, Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland

Talmage D. Egan, MD, Professor and Chair, K. C. Wong Endowed Professorship, Department of Anesthesiology, University of Utah Health Sciences Center, Salt Lake City, UT, USA

Miodrag Filipovic, MD, Professor, Deputy Head of the Clinic for Anesthesiology, Intensive Care, Rescue and Pain Medicine, Cantonal Hospital St. Gallen, Switzerland

Nicholas (Nick) P. Franks, FRSB, FRCA, FMedSci, FRS, Professor of Biophysics and Anaes-thetics, Sir Ernst Chain Building, Wolfson Laboratories, Imperial College, South Kensington, London, United Kingdom

Bertrand Guidet, MD, Professor and Director of Medical Intensive Care, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-An-toine, Paris, France

Aluko A. Hope, MD, Associate Professor, Department of Medicine (Critical Care), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

Philip M. Hopkins, MB, BS, MD, FRCA, Consultant Anaesthetist, Leeds Teaching Hospitals; Director, Leeds MH Investigation Unit Chair, European Malignant Hyperthermia Group; Professor of Anaesthesia, Leeds Institute of Medical Research at St James’s, School ofMedicine, University of Leeds, St. James’s University Hospital, Leeds, United Kingdom

Mark Kaufmann, MD, Professor, Head of Operating Theaters East, Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland

José R. Maldonado, MD, FAPM, FACFE, Professor of Psychiatry and, by courtesy, of Internal Medicine, Surgery, Emergency Medicine & Law; Medical Director, Psychosomatic Medicine Service; Medical Director, Emergency Psychiatry Service; Consultation-Liaison Psychiatry Training Program Director, Stanford University School of Medicine, Stanford, CA, USA

Geert Meyfroidt, MD, PhD, Associate Professor, Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University of Leuven (KU Leuven), Belgium; Chef du Clinique, Department of Intensive Care, University Hospitals Leuven, Belgium

Warwick D. Ngan Kee, BHB, MBChB, MD, FANZCA, FHKCA, FHKAM, Chair, Department of Anesthesiology, Sidra Medicine, Doha, Qatar; Professor of Anesthesiology, Weill Cornell Medicine - Qatar, Doha, Qatar Hans Pargger, MD, Professor, Head of Intensive Care Unit, University Hospital Basel, Switzerland

Marcus J. Schultz, MD, PhD, Professor of Experimental Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), University of Amsterdam; Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands; Nuffield Department of Medicine, University of Oxford, UK; Mahidol–Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Brett A. Simon, MD, PhD, Director, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center; Professor of Anesthesiology, Weill Cornell College of Medicine, New York, NY, USA

Luzius A. Steiner, MD, PhD, Professor and Chairman, Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland

Kjetil Sunde, MD, PhD, FERC, Professor, Group Leader, Oslo Cardiopulmonary Resuscitation Research Network (OSCAR), Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital; Institute of Clinical Medicine, University of Oslo, Norway

General Course Information

Hosted by: Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy University Hospital Basel Basel, Switzerland Address for 40th MBL International Postgraduate CourseCorrespondence: Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy University Hospital Basel CH-4031 Basel, Switzerland Phone: +41 61 265 72 58 Fax: +41 61 265 73 20 E-mail: myronblaver@usb.ch Website: www.usb.ch/mbl

Language: English (no simultaneous translation will be available)

On-line Registration: www.usb.ch/mbl (online registration is preferred)

On-site Registration begins on Friday, February 7, 2020 at 8:15 a.m. in theRegistration and foyer of the „Zentrum für Lehre und Forschung“ (ZLF), Hebelstrasse 20.Information: The registration and information desk will be open during the entire

proceedings. Information The cost of the course is CHF 400. Please register by January 24, Registration Fee: 2020 so that we can give an approximate number to the caterers. A

payment invoice will automatically be issued to your billing address upon registration.

Note: Credit cards cannot be accepted for the registration fee.

Lunch Ticket: Lunch tickets for Friday are available for CHF 30. If you wish to attend, this cost should be included with your registration fee.

Alumni Dinner: An alumni dinner will be served at Restaurant Safran Zunft, Gerber-gasse 11, 4001 Basel for faculty and participants immediately after the last session on Friday. The cost of CHF 60 should be included with your registration fee if you plan to attend. Limited space is available.

General Course Information

Swiss Credit Points: SSAR/SGAR: 11.5 points SGI: 10 points

Hotel Reservations: Basel Tourismus Tel: +41 (0) 61 268 68 68 or http://www.baseltourismus.ch

Venue: Small Auditorium University Hospital Basel Congress Center Zentrum für Lehre und Forschung (ZLF) Hebelstrasse 20 CH-4031 Basel, Switzerland Phone +41 (0) 61 265 72 54

Travel by Train: Arriving at Basel SBB: Take Bus 30; get off at the stop “Bernoullianum”. Head down the hill, taking a right onto Hebelstrasse. The venue will be labeled.

Travel by Car: Arriving via expressway to Basel City, then follow road sign labeled „Universitätsspital“. Limited parking is available in City Parking on Klingelbergstrasse 20 / Schanzenstrasse 48 with a pedestrian entry / exit at Hebelstrasse 20.

Travel by Air: Arriving at EuroAirport Basel-Mulhouse-Freiburg: Take Bus 50 to the stop “Bahnhof SBB”; change to Bus 30; get off at the stop “Bernoullia-num”. Head down the hill, taking a right onto Hebelstrasse. The venue will be labeled.

Allison DwileskiDepartment for Anesthesia, PrehospitalEmergency Medicine and Pain Therapy

University Hospital BaselCH-4031 Basel, SwitzerlandPhone: +41 61 265 72 58 Fax: +41 61 265 73 20E-mail: myronblaver@usb.chWebsite: www.usb.ch/mbl

The 40th Myron B. Laver International Postgraduate Course is supported in part by:

MBL

Resolve Catecholamine-RefractoryHypotension in Septic Shock 1,2,3

References 1 Product information Empressin®, www.swissmedicinfo.ch 2 Dünser M.W. et al.: Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation. 2003;107(18):2313-2319 3 Russell JA: Bench-to-bedside review: Vasopressin in the management of septic shock. Crit Care. 2011;5(226):1-19. 4 Landry DW et al.: Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95:1122-1125. 5 Russel JA: Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock. N Engl J Med. 2008;358:877-87.Empressin® concentrate for solution for infusionAI: Argipressin (vasopressin) 40 I.U./2 ml. I: Catecholamine refractory hypotension following septic shock in patients over 18 years. D: By continuous i.v. infusion of 0.01 I.U./min. Increase of the dose depending on the clinical response; max. 0.03 I.U./min. Use only in addition to conventional catecholamine vasopressor therapy. CI: Hypersensitivity to the active substance or to any of the excipients. W: Must not be administered as a bolus. Use only in intensive care units under close supervision and only if no sufficient perfusion pressure can be reached despite adequate volume substitution and administration of catecholaminergic vasopressors. Particular caution should be taken in the case of cardiova-scular diseases, epilepsy, migraine, asthma, heart failure or diseases where a rapid increase in extracellular water poses a risk (water intoxication). Contraindicated in chronic neph-ritis with nitrogen retention until appropriate nitrogen blood levels are reached. Not recommended for use in children, infants and newborns. IA: Carbamazepine, chlorpropamide, clofibrate, urea, fludrocortisone or tricyclic antidepressants may potentiate the antidiuretic effect. Demeclocycline, norepinephrine, lithium, heparin or alcohol may decrease the antidiuretic effect. Furosemide reduces the excretion of Argipressin in the urine. Ganglionic blockers can cause an increase in sensitivity to the pressor effect of Empressin. Tolvap-tan and Argipressin can each reduce the diuretic and antidiuretic effects of the other. Blood pressure-increasing/-decreasing drugs can increase or decrease the increase in blood pressure caused by Argipressin. P/L: No studies available. Do not use during pregnancy unless clearly necessary. Caution when breastfeeding. Most common ADR: Arrhythmias (life-threatening), angina pectoris, myocardial ischemia, cardiac arrest, peripheral vasoconstriction, necrosis, perioral pallor, abdominal cramps, intestinal ischemia, skin necrosis, digital ischemia, increase in bilirubin levels and transaminases, and decrease in plasma platelets. Also intestinal necrosis (uncommon), anaphylaxis (rare). Category: A. MAH: OrPha Swiss GmbH, 8700 Küsnacht. Date of revision: March 2019. The complete summary of product characteristics is published at www.swissmedicinfo.ch

OrPha Swiss GmbH, Untere Heslibachstrasse 41a, Postfach, CH-8700 Küsnacht ZHE-Mail: info@orphaswiss.com, Web: www.orphaswiss.com

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Better survival in patients with moderate septic shock 3,5

Decreasing Noradrenaline-dose and -adverse eventswith early use of Vasopressin 3

Reversing relative deficiency of physiological Vasopressin 4

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