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A Commentary:
MOCA Must Change Thomas Gallen, MD, MPH and Oren Bernstein, MD
A
cross all medical specialties, Maintenance of Certification (MOC) programs have become increasingly criticized for being too costly, overly burdensome and lacking evidence of benefit to physicians and patients. The American Board off Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology (MOCA) program requires its diplomates to participate in numerous exercises at great cost, none of which have any unbiased support. Although the American Board of Medical Specialties
Neuromuscular Blockade Helps Intubation in ICU Patients Phoenix—Despite the apparent risks, using a neuromuscular blocking agent (NMBA) before tracheal intubation improves the odds of first-attempt intubation success in critically ill ICU patients, a study has found. “The question of whether to paralyze or not to paralyze is clearly answered in the operating room and emergency department: Using a paralytic is the way to go if you want to increase your first-attempt success at intubation,” said Jarrod M. Mosier, MD, an assistant professor of medicine and emergency medicine at the University of Arizona, Tucson. “However,
see MOCA page 22
see ICU page 19
The Storm Abroad: Anesthesiology During Wartime Preparing for battle: anesthesia training for combat missions
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Lt. Cmdr. Jesse M. Ehrenfeld, Medical Corps, U.S. Navy
gleaned occasional insights into military medicine during the past seven years while serving as a medKandahar, Afghanistan—When most anesthe- ical reserve officer in the U.S. Navy. Since Septemsia providers think about keeping their skills up, they ber 2014, however, those insights have become much picture continuing medical education courses, brows- more profound as I have been deployed in Kandaing through the latest specialty journals, or perhaps har, Afghanistan at one of the world’s busiest military attending a national meeting. For military physi- combat trauma hospitals. I knew I would bring a world of relevant expericians, however, training for a day on the job takes on a whole different meaning. As an anesthesiologist who ence to my current mobilization from my civilian job, practices primarily at Vanderbilt University, I have see storm page 36
PAIN MEDICINE
Liposomal-encased bupivacaine is a good, costeffective choice for pain after breast surgery.
CLINICAL ANESTHESIOLOGY
Presenting a new, modified technique for US-guided penile nerve block for circumcision.
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PRN
Interview with Kelly McQueen, MD, on ASA’s committee on Global Humanitarian Outreach.
8 Perioperative Goal-Directed Therapy: Optimizing Fluid Management and Reducing Postoperative Complications
EDUCATIONAL REVIEW Current Concepts in the Management of the Difficult Airway, see insert at page 24.
for iPad see page 4