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ASA Monitor Today

Monitor readers and editors know it’s impossible to attend every conference. Highlights from recent medical conferences are featured here. Contributions are welcome. Please send any conference reports and photos to asamonitor@asahq.org.


2024 – June 21  |  June 14


Re-convening in Ukraine and advancing pain relief

June 21

The war between Russia and Ukraine has been devastating. The number of deaths of Ukrainian service members is probably higher than U.S. deaths in the Korean War, Vietnam War and Operations Iraqi and Enduring Freedom combined. But the wounded far outnumber the dead, and these service members have to live with their injuries – physical and psychological – for the rest of their lives.

Chronic pain was one of the top reasons for medical evacuation from the operations in Iraq and Afghanistan, and the leading cause of service members being forced to leave the military in garrison. In the 2000’s, my colleagues and I were given access to the database of over 99% of medically evacuated service members and non-service members. We then categorized the reasons they were evacuated, and sought to determine their disposition (e.g., return to duty, medical board) along with factors affecting disposition. This led to the opening of the first pain clinic in a war zone, and helped shift the way militaries worldwide deal with the crisis of chronic pain.

The conflict in Eastern Europe is a tragedy of epic proportions. For perspective, in the Ukraine-Russia war, CNN estimates there to be up to 50,000 limb amputees on the Ukrainian side, while a recent May 2024 NATO meeting estimated the figure to up to 90,000 – about 50 times higher than in the entirety of the wars in Iraq and Afghanistan (asamonitor.pub/3xr1JYW). This is an estimate because the exact numbers are unknown because of the lack of a nationwide database or system-wide medical record system. There are also no pain fellowships in the country, sporadic communication between physicians treating chronic pain and other injuries, and little research being done on war injuries. Some of the major advances in treatment for conditions such as infection, traumatic brain injury, phantom limb pain and complex regional pain syndrome were achieved during wartime (Missouri Medicine 2016;113:336-40; Neurosurg Focus 2022; 53: E9; World Neurosurg 2020;134:233-9).

In February 2024, a physician from Ukraine contacted me regarding the “epidemic” of post-traumatic pain, especially phantom pain, that they faced. We arranged a meeting with several physicians from Ukraine, military personnel from the U.S., and the heads of several organizations such as Operation Smile with experience in providing medical care in austere environments. Through the help of COL (ret) Paul Pasquina, I was put in touch with Terry Rauch, who convinced me that we could make a profound difference in the lives of Ukrainians injured in the war. For me, this also had personal significance as my oldest son Berklee was about to enter the military on active duty. During his second year at West Point, Berklee sustained a traumatic brain injury. In late April through early May, with the sponsorship of the First Medical Union, Aspen Medical, Alcoa Foundation, and the Unbroken Foundation; co-sponsorship by ASRA-Pain Medicine, ESRA and the American Academy of Pain Medicine; and with the invaluable assistance of Terry Rauch and his team; the leadership of First Medical Union and UNBROKEN including Mariana Svirchuk, Nataliya Molinets, Oleh Berezyuk, and Roman Smolynets; and my research collaborator Dmytro Dmytriiev from the National Pirogov Memorial Medical University in Vinnitsa, Ukraine, we organized the largest pain conference in country to date, in Lviv. For the conference, entitled “Advancing Pain Relief & Rehabilitation: International Insights from Ukraine”, there were over 300 in-person and online participants who listened to Zoom talks from renowned speakers from all around the world including East Asia, South America, the Middle East, North America, and of course Ukraine, on topics related to pain management, trauma, and the organization of combat care.

Since there are no commercial or foreign military flights in or out of Ukraine, our land transportation was via Warsaw. Terry and I traveled with three nurses who travel around the world as part of their jobs at Belmont University providing simulation training in austere environments. In the past year alone, they’ve been to Krgyrgstan, Tanzania and Uganda. Our shuttle was supposed to leave at 5 a.m. the following morning, but my luggage was misplaced causing a five-hour delay. The land trip to Lviv was over six hours, and our hotel nearly empty. There was a bomb shelter which they showed us upon check-in, but we did not use it. Air sirens went off on most days signifying unauthorized foreign aircraft in the region, but there were no bombs dropped on the city while I was there. Despite several briefings, I never felt my life was in danger.

The conference schedule was filled with speakers, with one or two patients coming in each day to fill slots for case-based learning discussions wherein their cases were presented in Ukrainian and translated to English, and the audience members and I would help formulate a pain treatment plan. Lectures in English were translated into Ukrainian and Ukrainian lectures translated into English, with our foreign colleagues giving their talks in English. Although we tried to accommodate speakers based on time zone, several such as Brian Ilfeld and Yian Chen spoke between the hours of 1 a.m. and 5 a.m. local time. We hired four interpreters. At the conclusion of the conference between 5 and 6 p.m., a multidisciplinary pain team consisting of physical and occupational therapists, neurologists and psychiatrists, anesthesiologists, surgeons and primary care doctors rounded on challenging cases. On several days, we saw patients before the conference. The days were long and exhausting but fulfilling. Grateful patients gave us food their relatives cooked and trinkets they made in arts and crafts. One special forces commander with an upper extremity amputation we identified as secondary to an ulnar nerve neuroma gave me his unit patch.

The conference had its glitches. Jee Youn Moon from South Korea had her lecture blacked out for a few minutes until an emergency generator kicked in. My conference co-chair, Dmytro Dmytriiev was supposed to arrive on Saturday for the last two days of the conference but a mass casualty from an attack by 13 drones prevented him from joining in person. On the last day, the after-action report found the Zoom link, which was changed daily, may have been compromised, which briefly interrupted the lecture of one of our Ukrainian speakers, Andriy Khomenko. The last days of the conference also overlapped with Easter Sunday, so the in-person attendance decreased significantly over the weekend though over 100 people still attended via Zoom. On Sunday, videos of some of the attendees showed them at Easter dinners.

I do not view this as a one-time endeavor. The 2024 National Defense Authorization Act mandated the investigation of war-related conditions such as traumatic brain injury, PTSD, and postamputation pain, and already money has been allocated to expand our existing studies to Ukrainian sites, to study therapies they are already using for postamputation pain, and to design new randomized studies to be conducted in Ukraine that seek to answer important questions on mechanisms and treatments. These efforts carry the potential to improve not only the lives of Ukrainian service members, but also those of American service members and those of our allies in future conflicts.

Steven P. CohenDr. Steven P. Cohen is the Vice Chair of Research and Pain Medicine and Edmund I. Eger Professor of Anesthesiology at the Northwestern University Feinberg School of Medicine, where he holds joint appointments in the Departments of Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery. He is also a Professor at the Uniformed Services University of the Health Sciences where he serves as Director of Pain Research at Walter Reed National Military Medical Center.

Examining a special forces soldier with a right upper (dominant arm) limb amputation during a conference case presentation
Examining a special forces soldier with a right upper (dominant arm) limb amputation during a conference case presentation (with permission).

Treating an infantry soldier with a left lower limb amputation during post-conference rounds
Treating an infantry soldier with a left lower limb amputation during post-conference rounds (with permission).

Treating a patient with refractory neuropathic pain after an incomplete spinal cord injury during a conference lunch break
Treating a patient with refractory neuropathic pain after an incomplete spinal cord injury during a conference lunch break (with permission).

A lecture on ketamine for acute and chronic pain
A lecture on ketamine for acute and chronic pain.

A Ukrainian war cemetery on Orthodox Easter Sunday
A Ukrainian war cemetery on Orthodox Easter Sunday.

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World Congress of Anesthesiologists

June 14

The 18th World Congress of Anaesthesiologists was held in Singapore in early March. Hosted by the World Federation of Societies of Anaesthesiologists (WFSA), the World Congress of Anaesthesiologists has the most global representation of any anesthesiology meeting. This year more than 140 countries were represented. The World Congress has typically been held every 4 years but was held virtually in 2020 because of the Covid-19 pandemic. Being the first in-person congress contributed to the palpable excitement of the 18th World Congress.

The Congress kicked off with the General Assembly, where delegates from all represented national societies voted on administrative and working resolutions. The delegates also elected WFSA leaders as regional representatives. The ASA was the largest society represented, with 34 voting delegates out of a total of around 200 delegates. Among the ASA delegates, Dr. Faye Evans was elected Director of Programmes and will serve on the WFSA Board. Dr. Elizabeth Drum will represent ASA on the WFSA Council as one of the two North American representatives. Many ASA members were confirmed during the General Assembly for committee positions in the WFSA.

The Assembly is also a forum for delegates to bring up important issues for the international community to address. One delegate called upon the WFSA to endorse access to emergency and critical care services in conflict zones. The delegate pointed out that several conflict zones have been accused of violating the Geneva Convention, with victims blocked from access to care, and patients and health care workers being actively targeted by combatants.

The scientific program draws on internationally recognized experts. Drs. Jannicke Mellin-Olsen and Kevin Fong gave keynote addresses on patient safety and harm reduction. The plenary session is expected to be available on the WFSA YouTube channel this fall. We encourage everyone to watch it! Many ASA members participated as speakers and workshop leaders. The ASA had an exhibit presence in the International Village, promoting ASA’s Anesthesiology meeting, Anesthesiology, the ASA Monitor, and ASA educational programs, and the availability of ASA membership to the international community.

The WFSA is responsible for multiple global initiatives. This year the WFSA launched its Peri-operative Patient Blood Management (P-PBM) program. This program seeks to improve blood management by early detection and treatment of anemia and coagulopathy, and implementation of strategies to reduce intraoperative blood loss. Patient blood management programs have been shown to dramatically decrease rates of mortality, length-of stay, transfusion rates, and complications. These programs have been endorsed by the World Health Organization (WHO).

The WFSA has also been an active promoter of the Essential Emergency and Critical Care (EECC) network. This network of clinicians with expertise in emergency and critical care medicine promotes early intervention to detect and treat illness before patients require intensive care.

Reflecting the global perspective of the WFSA, these initiatives provide guidelines based on the resources available to health-care providers in their local settings.

The ASA is the largest component society within the WFSA. The expertise and resources of the ASA contribute to the addressing global issues, including drug shortages, humanitarian crises, essential medicines, controlled substances policies, and workforce funding priorities.

Through the WFSA, the ASA is also an active contributor to global health issues addressed by the WHO and other international societies. Just recently, ASA President Ronald Harter was invited to participate in the World Health Assembly as a guest of the WFSA. The recent publication of the WFSA’s updated global workforce survey of anesthesia providers was celebrated and discussed as a major source of information to inform funding priorities for workforce training and infrastructure at global levels including through the WHO and UNICEF. ASA members can be proud of the global reach of our advocacy on behalf of patients worldwide, and advocacy made possible by our role within the WFSA.

The WCA will now convene every two years, next in Marrakech, Morocco in April 2026. These meetings provide perspective of our role in global perioperative care. They are opportunities to teach, and learn, from our colleagues worldwide. We encourage you to attend.

The following members are WFSA delegates:

Donald Arnold, MD, FASA
Lundy Campbell, MD
Faye Evans, MD
Elizabeth Drum, MD, FASA
Jodi Sherman, MD
Michael Lipnick, MD
Julia Weinkauf, MD
Rose Berkun, MD, FASA
Maxime Cannesson, MD, PhD
Steven Gayer, MD, MBA, FASA
Andrew Herlich, MD, FASA
Karen Nanji, MD
Greg Sund, MD
James Philip, MD, DABA, MEE, FACA, FASA
Elizabeth Rebello, MD, FASA
Steven Schulman, MD, MHA, FASA
Cynthia Wong, MD, FASA

Aryeh Shander, MD, FCCM, FCCP, FASA
James Rathmell, MD
Veronica Carullo, MD, FASA
Ana Crawford, MD, MSc, FASA
Odinakachukwu Ehie, MD, FASA
Adrian Gelb, MBBCh, FRCPC
Ronald Harter, MD, FASA
Michael Champeau, MD, FASA
Kumar Belani, MS, BS, MB, FACA
Pamela Flood, MD, MA
Carin Hagberg, MD, FASA
Edward Mariano, MD, FASA
Sheela Pai Cole, MD, FASE, FASA
Beverly Philip, MD, FACA, FASA
Deb Rusy, MD, MBA, FASA
Steven Shafer, MD, FASA
Girish Joshi, MD, MB, BS, FCAI, FASA

Michael Champeau, MD, FASA, Sheela Pai Cole, MD, FASE, FASA, Ana Crawford, MD, MSc, FASA, and Edward Mariano, MD, FASA
ASA delegates Michael Champeau, MD, FASA, Sheela Pai Cole, MD, FASE, FASA, Ana Crawford, MD, MSc, FASA, and Edward Mariano, MD, FASA from the California Society of Anesthesiologists (CSA) capture the moment during the delegate orientation.

ASA's booth
ASA’s booth in the Global Anaesthesia Village.

Drs. James Rathmell, Laszlo Vutskits, and Andrew Davidson
Dr. James Rathmell, Anesthesiology Editor-in-Chief, with Drs. Laszlo Vutskits and Andrew Davidson, Anesthesiology Executive Editors during a journal event held during the WCA 2024.

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