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THE TOP 10 LIVING ANESTHESIOLOGISTS 2022

THE ANESTHESIA CONSULTANT 2 Comments
THE ANESTHESIA CONSULTANT
THE ANESTHESIA CONSULTANT
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
emailrjnov@yahoo.com
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TheAnesthesiaConsultant.com presents its 2022 ranking of The Top 10 Living Anesthesiologists. These individuals made significant original contributions to the practice and/or education of anesthesiologists throughout the world. As a physician anesthesiologist who has attended to patients in the 1980s, 1990s, 2000s, 2010s, and now the 2020s, in both university and community settings, I’m uniquely qualified to identify and honor the leaders in our field over this time. 

Here’s the list:

David Gaba MD

#10. David Gaba MD, Stanford University School of Medicine. Dr. Gaba developed the anesthesia crisis simulator, and his group developed the Stanford Anesthesia Emergency Manual. Both are landmark contributions toward reducing medical errors by anesthesia providers and improving patient outcomes. Dr. Gaba has authored 242 publications in major medical journals.  He is a Professor at the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine, and the Associate Dean for Immersive and Simulation-Based Learning at the Stanford University School of Medicine. 

James Eisenach, MD

#9. James Eisenach MD, Wake Forest University.  Dr. Eisenach served as Editor-in-Chief of Anesthesiology for 10 years from 2007-2016, and in 2016 became the President and CEO of the Foundation for Anesthesia Education and Research (FAER), a key organization supporting research in our field. Dr. Eisenach has authored 562 publications in major medical journals and is nationally renowned for his research on the mechanisms of pain.  Dr. Eisenach is a Professor of Anesthesia at Wake Forest University.

Robert Stoelting MD

#8. Robert Stoelting MD, University of Indiana. https://patientsafetymovement.org/speaker/robert-k-stoelting-md/   Dr. Stoelting is the author of the textbook Pharmacology and Physiology in Anesthetic Practice, co-author of the textbooks Basics of Anesthesia and Anesthesia and Co-Existing Disease, and co-editor of the textbook Clinical Anesthesia. During his 19 years as President of the Anesthesia Patient Safety Foundation, Dr. Stoelting was instrumental in developing and expanding the APSF as a leading publication in the anesthesia literature.  Dr. Stoelting is a Professor Emeritus and Past Chair, Department of Anesthesia, Indiana University School of Medicine (1977-2003).

Brian Bateman MD

#7. Brian Bateman MD, Stanford University. Dr. Bateman is the current Chairman of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford. An expert in obstetric anesthesia, Dr. Bateman was the Chief of Obstetric Anesthesia at the Brigham and Women’s Hospital in the Harvard system until 2021 when he moved to Stanford. He is an Editor for Anesthesiology, the world’s leading journal in our specialty. Dr. Bateman has over 200 peer-reviewed publications.

Jonathan Benumof MD

#6. Jonathan Benumof MD, University of California San Diego.  Dr. Benumof was the main originator of the American Society of Anesthesiologists Difficulty Airway Algorithm, first published in 1996. The Difficult Airway Algorithm described pathways to safe airway management, and its application has saved countless lives that might have been lost to mismanaged airway disasters. He also single-authored the textbook Anesthesia for Thoracic Surgery as well as 311 publications in major medical journals. Dr. Benumof is an Emeritus Professor of Anesthesiology at the University of California San Diego School of Medicine. 

Dr. Steven Shafer testifying at the Michael Jackson manslaughter trial

 

#5. Steven Shafer MD PhD, Stanford University.  Dr. Shafer’s area of expertise is the pharmacology of intravenous anesthetic drugs. He was the Editor-in-Chief of Anesthesia and Analgesia for 10 years and authored 293 publications in major medical journals, many of them the initial studies on the pharmacokinetics of propofol. He is currently the Editor-in-Chief of The ASA Monitor. Dr. Shafer appeared as an expert witness in the Michael Jackson manslaughter trial, in which Dr. Conrad Murray was convicted of the inappropriate administration of propofol in Jackson’s bedroom. Dr. Shafer is a Professor Emeritus at the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine. 

Lee Fleisher MD

#4. Lee Fleisher MD, University of Pennsylvania.  Dr. Fleisher authored the textbooks Anesthesia and Uncommon Diseases, and Complications in Anesthesia, as well as 421 publications in major medical journals, with a concentration in the preoperative evaluation of the surgical patient. His most noteworthy contribution was the classic paper Preoperative Cardiac Evaluation for Noncardiac Surgery, published in 1992 in Anesthesia and Analgesia. This paper set the standards for how anesthesiologists should approach the preoperative cardiac evaluation of their patients. Dr. Fleisher was the long-term Chair of the Department of Anesthesiology and Critical Care (2004-2020), and the Robert Dunning Dripps Professor of Anesthesia at the University of Pennsylvania Health System. He is currently the Chief Medical Officer and Director of The Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS). 

Daniel Sessler MD

#3. Daniel Sessler MD, Cleveland Clinic. Dr. Sessler has authored an astounding total of 1089 publications in major medical journals, and has raised total extra-mural research funding of $65 million so date. Dr. Sessler is an editor for Anesthesiology and serves as a reviewer for more than 50 journals. He has given invited lectures at more than 350 institutions.  His papers have been cited more than 37,000 times, making him the world’s most published and cited anesthesiologist. Dr. Sessler is currently Professor and Chairman, Department of Outcomes Research, Anesthesiology Institute at the Cleveland, and Clinical Professor of Anesthesiology at Case Western Reserve University. 

Dr. Archie Brain and his invention, the LMA

#2. Archie Brain MB, London Hospital, Whitechapel, England. Dr. Brain is the British anesthesiologist who invented the laryngeal mask airway (LMA), which he patented in 1982. Dr. Brain’s objectives for the LMA were to provide a better method of maintaining a patient’s airway than by face mask, with the benefit that the LMA was less hemodynamically stressful than the insertion of an endotracheal tube. The LMA has been used over 300 million times worldwide in elective anesthesia and emergency airway management, and is one of the most significant anesthesia inventions in the last 50 years. The LMA Classic was sold by LMA International NV, a company which sold to Teleflex Inc in 2012 for $276 million.

 

Ronald Miller MD

#1. Ronald Miller MD. University of California San Francisco. Dr. Miller is best known as the initial lead author of Miller’s Anesthesia, the most widely used textbook of anesthesiology in the world, first published in 1981 and now in its Ninth Edition. https://anesthesia.ucsf.edu/news/ronald-d-miller-distinguished-professorship  Dr. Miller was the Chairman of Anesthesia at UCSF from 1983-2009,  and built what was arguably the finest anesthesiology department in the world, with a particular focus on research, as well as expanding the role of anesthesiologists in the pain clinic and in the intensive care unit.

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NOTE: This list does not include the inventor of the GlideScope, the first commercial video laryngoscope (developed in 2001 and an outstanding contribution to the field of anesthesiology), because Dr. John Allen Pacey, the inventor of the GlideScope, was not an anesthesiologist but a vascular and general surgeon at the University of British Columbia. 

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NOTE: This list of The Top 10 Living Anesthesiologists does not contain any females or diversity. All ten nominees are white males. Such was the state regarding the advances in our specialty over the past five decades. Future lists may honor females or diversity, depending on the state of career achievements over the coming years.

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ANESTHESIA EMERGENCY GUIDEBOOK

THE ANESTHESIA CONSULTANT 1 Comment
THE ANESTHESIA CONSULTANT
THE ANESTHESIA CONSULTANT
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
emailrjnov@yahoo.com
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An anesthesia emergency occurs without warning. Your patient’s vital signs are dropping. As the anesthesiologist, it’s your job to make the correct diagnosis and act promptly to save your patient. You need the ultimate anesthesia emergency guidebook.

That ultimate guidebook is the Stanford Emergency Manual of Cognitive Aids for Perioperative Critical EventsS, written by the Stanford Anesthesia Cognitive Aid Group.

Consider the following situations:

  1. You’re an anesthesia professional, and your patient has a sudden unexpected complication (think unstable cardiac rhythm, unanticipated difficult airway, anaphylaxis, hypotension, hypoxemia, malignant hyperthermia, local anesthetic toxicity, or transfusion reaction) in the operating room or Post Anesthesia Care Unit. You react quickly to support Airway –Breathing- Circulation and apply all your knowledge of the appropriate diagnostic and therapeutic action steps. Will you perform perfectly? Will you remember every detail without fail?
  2. It’s the day before your American Board of Anesthesiology oral board exam, you’re completing your final review, and you’re looking for comprehensive listings of how to manage the array of medical emergencies the Board Examiners may present to you.
  3. You’re a Medical Director or medical educator, and you’re scheduled to deliver a lecture on the management of two or three common operating room emergencies. You’re searching for a concise and accurate listing of the management such emergencies.
  4. You’re an expert witness or a member of your hospital’s Quality Improvement committee, charged with reviewing the unfortunate outcome of an operating room medical complication. You’re searching for an algorithm listing the standard of care in managing that specific emergency.

What do you do in situations 1 – 4 above?

I recommend you consult a new publication, the Emergency Manual of Cognitive Aids for Perioperative Critical Events.

Anesthesia practice is described as 99% boredom and 1% panic. In those emergency moments which coincide with the 1% panic, anesthesiologists must respond with exacting skill. My colleagues at Stanford University have developed the Emergency Manual of Cognitive Aids for Perioperative Critical Events, a useful adjunct in managing critical events during the perioperative period. This Manual is described in detail on the website http://emergencymanual.stanford.edu, and the Manual is available for free download at this location.

I had no role in authoring the Manual—my message here is to inform you that an important new medical reference guide exists, and to convince you to acquire it and use it. I can attest that the Manual is comprehensive, accurate, and valuable for education, preparation, and as a source of real-time checklists during perioperative emergencies that leave little room for error and little time to consult reference textbooks.

This emergency Manual evolved from decades of prior work on both Crisis Resource Management (CRM) concepts and cognitive aids for critical incidents. Dr. David Gaba, Dr. Steven Howard, and Dr. Kevin Fish of Stanford authored a 1994 book entitled Crisis Management in Anesthesiology, and their work and publications involving teaching via an anesthesia simulator led to the development of cognitive aids for operating rooms in the Palo Alto VA Hospital and also a national VA project.

Drs. Kyle Harrison, Sara Goldhaber-Fiebert, Geoff Lighthall, Ruth Fanning, Steven Howard, and David Gaba observed during simulator sessions that practitioners often missed key actions under stress. They developed several versions of pocket cards for perioperative critical events. In 2004 Dr. Larry Chu, also at Stanford, conceived of adapting crisis management cognitive aids into a new book. This became The Manual of Clinical Anesthesiology, published in 2011.

To create the current Emergency Manual of Cognitive Aids for Perioperative Critical Events, the Stanford Anesthesia Cognitive Aid Group was formed. Dr. Larry Chu, director of the Stanford Anesthesia Informatics Management (AIM) lab, provided the graphics and layout. Drs. Sara Goldhaber-Fiebert, Kyle Harrison, Steven Howard, and David Gaba worked together to provide the content, including the exact phrasing, ordering, and emphasis, as well as simulation testing to revise both content and design elements. The Stanford Anesthesia Cognitive Aid Group observed how teams of anesthesiologists used cognitive aids during hundreds of simulated crises. These simulator sessions were crucial for pilot testing of the algorithms in the emergency Manual. Stated goals of the Manual are to support education and patient safety efforts in pre-event review, post-event team debriefing, and during actual critical event management.

The content of the Manual is exhaustive, covering treatment for Advanced Cardiac Life Support (ACLS) arrhythmias as well 18 non-ACLS critical events including unanticipated difficult airway, anaphylaxis, hypotension, hypoxemia, malignant hyperthermia, local anesthetic toxicity, and transfusion reaction.

Each page of the Manual presents an algorithm printed in a prominent font containing, for example, SIGNS, TREATMENT, DIFFERENTIAL DIAGNOSES, and POST EVENT checklists. In an era when pre-operative surgical Time Outs are mandated and the best-selling book The Checklist Manifesto by Dr. Atul Gawande touts the value of checklists in medical care, the Emergency Manual of Cognitive Aids for Perioperative Critical Events is a valued addition to quality care for your surgical patients.

On their website, the authors cite the following Reasons for Implementing an Emergency Manual:

  1. In simulation studies, integrating emergency manuals results in better management during operating room critical events. NOTE: Familiarization and training in why and how to use EMs appears to be key for success.
  2. Pilots and nuclear power plant operators use similar cognitive aids for emergencies and rare events, with training on why & how to use them.
  3. During a critical event, relevant detailed literature is rarely accessible.
  4. Memory worsens with stress & distractions interrupt planned actions.

Expertise requires significant repetitive practice, so none of us are experts in every emergency.

A hard copy of the Emergency Manual of Cognitive Aids for Perioperative Critical Events hangs in the central operating room hallway at the surgery center in Palo Alto where I am the Medical Director. A copy of the Manual hangs in every operating room at Stanford Hospital.

I carried a copy of The Washington Manual of Medical Therapeutics in the pocket of my white coat for three years while I was an internal medicine resident at Stanford. My Washington Manual became dog-eared, underlined, and worn because I knew it was an invaluable resource. The Stanford Manual now occupies this role for the management of perioperative emergencies.

I recommend the Emergency Manual of Cognitive Aids for Perioperative Critical Events at the highest level of enthusiasm. It will help guarantee excellence of care for your patients. It’s free, and the benefit/risk ratio of consulting this Manual approaches infinity.

Download it now at http://emergencymanual.stanford.edu

Appropriate citation of this Emergency Manual:

Stanford Anesthesia Cognitive Aid Group*. Emergency Manual: Cognitive aids for perioperative critical events. See http://emergencymanual.stanford.edu for latest version. Creative Commons BY-NC-ND. 2014 (Version 2) (http://creativecommons.org/licenses/by-nc-nd/3.0/legalcode). 
*Core contributors in random order: Howard SK, Chu LF, Goldhaber-Fiebert SN, Gaba DM, Harrison TK.