Accreditation and CE

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Texas Medical Association (TMA) through the joint providership of the Texas Pain Society and the Ophthalmic Anesthesia Society. The Texas Pain Society is accredited by TMA to provide continuing medical education for physicians.

The Texas Pain Society designates this live activity for a maximum of 12.75 AMA PRA Category 1 Credit(s)™. (18.75 AMA PRA Category 1 Credit(s)™ with Orbital Block Workshop) Physicians should claim only credit commensurate with their participation in this activity.

This activity contributes to the CME component of The American Board of Anesthesiology® Maintenance of Certification in Anesthesiology® (MOCA®) program, known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0® requirements. Maintenance of Certification in Anesthesiology® and MOCA® are registered certification marks of the American Board of Anesthesiology®. MOCA 2.0® is a trademark of the American Board of Anesthesiology®.

OBJECTIVES

• Compare and contrast the key responsibilities and requirements of ophthalmologists and anesthesiologists and identifying critical areas of collaboration and communication necessary for optimal patient care.
• Examine the benefits of using the Rouse Needle for Subtenon's Block by learning the tenon anatomy, discerning efficacy factors, recognizing potential complications, and evaluating operational impacts within the operating room setting, ensuring enhanced safety and efficiency in clinical practice.
• Analyze the implications of marijuana use in anesthesia and surgery, discerning its effects on the increased dosage requirements of anesthetics, evaluating postoperative complications, and strategizing effective pain management amidst marijuana consumption, thereby optimizing patient care and safety in surgical settings.
• Formulate evidence-based strategies to address persistent opioid use in cataract surgery, specifically among elderly patients with opioid use disorder (OUD), critically evaluating the necessity of post-cataract surgery prescriptions, and analyzing prescribing and abuse patterns to develop preventive measures against substance use disorder (SUD).
• Analyze the dynamics of active shooter situations within healthcare settings, identifying key risk factors, communication strategies, and emergency response protocols to enhance preparedness and safety measures within their practice.
• Identify ways to execute practical drills and simulations designed to simulate active shooter scenarios, applying learned response tactics, prioritizing safety protocols, and effectively coordinating with colleagues and authorities to mitigate potential threats and ensure swift and coordinated responses.

• Analyze the latest SAMBA (Society for Ambulatory Anesthesia) guidelines through the dissection of the panel's recommendations, fostering a deep understanding of ambulatory anesthesia practices for improved patient safety and perioperative management.

• Participate in an active discussion based on real scenarios of patient symptoms and the pros/ cons of treatment based on the new guidelines.

• Learn about international mission work in ophthalmology, assess preventable blindness, and administering regional eye blocks for manual small incision cataract surgery (MSICS) in underserved regions, enabling them to contribute effectively to global efforts in addressing vision impairment and promoting eye health worldwide.

• Examine significant differences in anatomy, physiology, and pharmacology between pediatric and adult patients undergoing ophthalmic surgery, recognizing the challenges associated with administering safe anesthesia to children, anesthesia-related morbidity and mortality rates are elevated.
• Explain risk stratification, preoperative anxiety management, anesthesia techniques affecting intraocular pressure, and postoperative complication management in pediatric patients undergoing eye surgery.
• Analyze the causes, implications, and preventive measures concerning malpractice claims in anesthesia and surgery within ophthalmology, fostering a comprehensive understanding to improve patient safety and optimize care delivery.

• Analyze the proportion of East African refugees affected by ophthalmic problems, characterize the demographics of affected individuals, identify common types of eye problems among the refugee population, and assess the healthcare-seeking behaviors and current landscape of care for those with eye issues.
• Develop strategies to optimize operating room efficiency, encompassing pre-operative preparation techniques, timely scheduling practices, streamlined OR flow management, and effective turnover processes, aimed at enhancing operational performance and translating efficiency improvements into cost-saving measures.
• Develop expertise in the latest advances in Glaucoma Surgery, particularly Minimally Invasive Glaucoma Surgery (MIGS) procedures, to enhance skills in patient management, surgical techniques, and outcomes in the evolving landscape of glaucoma treatment.
• Examine new headache treatments, including emerging medications, neuromodulation devices, complementary therapies, and the evolving roles of ophthalmologists and anesthesiologists in headache management.
• Analyze considerations for hemostasis in oculoplastic surgery, including identifying potential issues, evaluating real scenarios, assessing bleeding risks and contributing factors, implementing intraoperative strategies, and applying postoperative techniques to optimize patient outcomes and minimize complications.
• Differentiate between the techniques and nuances of incision-free eye blocks, incorporating both British and American approaches, to elevate competency in pain management and enhance patient outcomes in ophthalmic procedures.
• Compare and contrast the risks associated with various anesthesia techniques, including Peribulbar, Sub-tenon, retrobulbar, and other ophthalmic regional anesthesia methods, facilitating informed decision-making to optimize patient safety and procedural efficacy.
• Analyze the impact of comorbidities and high-risk medications on surgical decision-making, incorporating real-life scenarios to enhance clinical assessment and risk management strategies.
• Evaluate the importance of patient comprehension in surgical decision-making, identifying strategies to improve patient education and informed consent processes to ensure optimal patient outcomes.
• Evaluate the considerations surrounding the administration of anticoagulants in patients requiring nerve blocks, distinguishing between different types and determining appropriate management strategies, including continuation, cessation, or modification of technique.
• Assess current practices and trends regarding the use of GLP1 medications in patients undergoing sedation versus general anesthesia, analyzing potential challenges and exploring effective approaches to ensure patient safety and procedural success from the perspective of varying georgraphical surgical practices.
• Examine approaches to managing elevated blood pressure and blood sugar levels on the day of surgery, exploring the existence of hard cutoffs and best practices for preoperative optimization, while also addressing considerations for NPO/fasting guidelines in sedation cases and the necessity and variations in preoperative history and physical assessments for cataract surgery under sedation versus general anesthesia.
• Analyze orbital anatomy to facilitate safe nerve block procedures in patients concurrently prescribed anticoagulants and platelet inhibitors, optimizing patient care and minimizing procedural risks.

• Examine orbital anatomy, including the identification and function of extraocular muscles, retractor muscles of the eyelids, muscles of the eyelids, cranial nerves innervating ocular structures, vascular supply, fascial sheaths, and the anatomical features of the orbital fossa.
• Illustrate knowledge of orbital anatomy to clinical scenarios, distinguishing between the structures involved in orbital pathologies, surgical interventions, and nerve block procedures, facilitating precise diagnosis, treatment planning, and procedural safety in ophthalmology practice.
• Differentiate between retrobulbar block techniques including extracanal and infratemporal intracanal approaches, and supratemporal and infratemporal extracanal methods, integrating knowledge of the Atkinson technique and medial caruncle extraconal peribulbar injections for safe and effective orbital anesthesia.
• Explain administering orbital blocks, particularly focusing on the Orbicularis Oculi anesthetic technique, applying a comprehensive understanding of orbital anatomy and injection methods to optimize patient comfort and procedural outcomes in ophthalmic surgeries.
• Participants will engage in hands-on simulation training to proficiently perform the Intraconal Infratemporal approach, Extraconal Infratemporal approach, and Extraconal Medial Caruncle approach for orbital blocks, integrating anatomical knowledge and procedural skills to ensure accurate needle placement and effective anesthesia delivery.
• Through interactive workshop sessions, participants will refine their technique and enhance procedural competence in administering orbital blocks, specifically focusing on the Intraconal Infratemporal, Extraconal Infratemporal, and Extraconal Medial Caruncle approaches, fostering confidence in providing safe and precise anesthesia for ophthalmic surgeries.

TARGET AUDIENCE

Ophthalmologists, Anesthesiologists, CRNAs, PAs, AAs, RNs, Administrators, Surgical Techs.

DISCLOSURES TO THE LEARNER

1. Notice of requirements for successful completion of continuing education activity:

• Register for the course
• Attend the live presentation in its entirety
• Complete the Evaluation

2. This live course has received no commercial support.

3. Disclosure of financial relationships to learner. The speakers and planning committee members have disclosed the following relationships:

Maggie Jeffries, MD- Course Director| Moderator| Presenter/ Author / Speaker. Consultant: Imprimis and Melt Pharmaceuticals.

Effie Rahman, MD- Presenter/ Author / Speaker. Consultant: Iveric Bio.

Stacy Smith, MD- Presenter/ Author / Speaker. Speaker’s Bureau 2022: Teva, Lilly, Abbvie, Biohaven.

Randy Harvey, BS, RRT, APRN, CRNA, FAANA- Presenter/ Author / Speaker. Owner: Orbital Compliance Group

Fiaz Zaman, MD- Presenter/ Author / Speaker. Consultant: Abbvie, Istar

All of the relevant financial relationships listed for these individuals have been mitigated.

All other planners, faculty, committee, board, and moderators for this educational activity have NO relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

4. Non-endorsement Statement: Accredited status does not imply endorsement of any commercial products or services by the Texas Pain Society, Ophthalmic Anesthesia Society or the Texas Medical Association.

5. Off-Label Use: There will be no discussion of off-label use during this presentation.

Certified Registered Nurse Anesthetists