Dr Robert Veselis interviewed by Professor Michael Wang at the MAA 10 Conference
Peer reviewed publications relevant to the topics of this interview:
Veselis, R. A. (2015). "Memory formation during anaesthesia..." Br J Anaesth 115 Suppl 1
Smith, S. M. (1947). "The use of curare in infants and children." Anesthesiology 8(2): 176-180.
Veselis MAA10 Interview Transcript 1 of 3.pdf
| Robert Veselis Interview M Wang MAA10 6.19.17.part I | ||
| time start clip: mins | ||
| Topic: | adequate general anesthetic | 0:45 |
| Topic: | patient in pain/distress subsequently to be amnesic | 2:41 |
| Topic: | amnesic vs. not amnesic | 2:56 |
| Topic: | Is amnesia alone adequate? | 6:05 |
| Topic: | trainee who targets amnesia | 6:46 |
| Topic: | acceptability of awareness with amnesia | 7:56 |
| Topic: | train people to be aware of awareness | 8:34 |
| Topic: | definition: adequate anesthetic: oblivion | 9:20 |
| Topic: | unethical to target amnesia | 9:40 |
| Topic: | Larger doses anesthetics harmful in certain patient populations ? | 10:04 |
| Topic: | Is there hard evidence: overdosing causing neurotoxicity? | 11:01 |
| Topic: | Is there evidence of any negative outcome with unrecalled consciousness or awareness or responsiveness during anesthesia ? | 11:40 |
| Topic: | choice of two anesthetists: one always target amnesia, and one target oblivion ? | 13:03 |
| Topic: | Would you choose an anesthetist who feels amnesia in the absence of any other modality is sufficient anesthesia ? | 13:40 |
| Topic: | balancing act of anesthesia, between oblivion and awake recall | 14:06 |
| Topic: | comparison between regional anesthesia and general anesthesia: POD (postoperative cognitive deficit) rates | 15:18 |
| Topic: | very large study in progress: if that study shows that there’s no difference in the two outcomes then I would be certainly more in favor of oblivion |
16:10 |
Part 1 of 3
Part 2 of 3
Veselis MAA10 Interview Transcript 2 of 3.pdf
| Robert Veselis Interview M Wang MAA10 6.19.17.part 2 | ||
| time start clip: mins | ||
| Topic: | studies : emotional negative effects of intraoperative distress + explicit amnesia vs. neurotoxicity | 0:05 |
| Topic: | inhalational school definitions of anesthesia: persistent unconsciousness, optional muscle relaxation, analgesia | 0:55 |
| Topic: | definitions of an adequate anesthetic: controversial | 2:00 |
| Topic: | use terms not neutral, general public people different interpretations | 2:22 |
| Topic: | If no neuromuscular blockade, what would you make of movement on the table? | 3:46 |
| Topic: | Is there an objective measure of how we titrate our medication ? | 4:06 |
| Topic: | Is there an algorithm to treat movement ? | 4:16 |
| Topic: | Does movement indicate lightening of the anesthetic state ? | 4:53 |
| Topic: | examples of interventions to treat movement | 4:58 |
| Topic: | Can isolated forearm technique be used in USA ? | 5:43 |
| Topic: | Is the comparison between intraoperative trauma in the presence of amnesic medication, and the comparison with date rape valid ? | 7:50 |
| Topic: | intentions of the perpetrator of date rape comparing that with the intentions of the anesthesiologist | 9:10 |
| Topic: | both situations: individual experiencing a trauma for which they haven’t consented | 9:43 |
| Topic: | important point: consent: be in distress and pain | 9:56 |
| Topic: | how do we talk to our patients about the possibility of a rare event of awareness after the surgery ? | 10:37 |
| Topic: | break through memory, emotional memory , date rape | 11:28 |
| Topic: | general anesthesia: patient becomes conscious with distress and subsequently has explicit amnesia compared to breakthrough memory dtae rape | 11:52 |
| Topic: | intraoperative emotional trauma | 12:47 |
| Topic: | Propofol: ablating explicit recall but also implicit recall | 13:31 |
| Topic: | benzodiazepines: ablate explicit recall, not implicit recall | 13:31 |
| Topic: | date rape scenarios: benzodiazepine category | 13:31 |
| Topic: | breakthrough memory from the implicit memory system | 13:55 |
| Topic: | clinical practice evidence: breakthrough memory post operative period | 14:03 |
| Topic: | Propofol, Midazolam: single drug studies | 14:26 |
| Topic: | no evidence for implicit memory assumption: | 14:46 |
| Topic: | ablate explicit memory not implicit memory | 14:50 |
| Topic: | if give more medication: ablate implicit memory | 15:00 |
| Topic: | Fact: sensory perception is intact during anesthesia | 15:05 |
| Topic: | implicit memory system may be active, not ablated during anesthesia | 15:15 |
| Topic: | drugs targeting aversive emotional memory system: | 15:50 |
| Topic: | beta blockers vs. deeper anesthesia | 15:55 |
| Topic: | prevent emotional breakthrough: no data guide clinical practice | 16:05 |
Part 3 OF 3
Veselis MAA10 Interview 3 of 3 Transcript.pdf
| Robert Veselis Interview M Wang MAA10 6.19.17.part 3 | ||||
| time start clip: mins | secs | fraction sec | ||
| Topic: | debate amnesia as a adequate goal of anesthesia | 0 | 0 | 0 |
| Topic: | neutral terms to describe patients' postoperative reports | 1 | 50 | |
| Topic: | Recovered memory | 2 | 20 | |
| Topic: | implicit emotional memory | 4 | 49 | 7 |
| Topic: | implicit emotional memory Vs. vivid awake memory: supression | 6 | 20 | |
| Topic: | childhood experiences of awareness as an adult vs. as child; | 7 | 9 | 13 |
| Topic: | Differentiating explicit from implicit memory | 8 | 45 | 1 |
| Topic: | Pediatric anesthetists & the prevention of childhood awareness | 9 | 43 | 7 |
| Topic: | Differentiating spinal cord reflex vs voluntary movement | 10 | 0 | |
| Topic: | How can you be certain that a spinal cord reflex can not be associated with voluntary movement? | 10 | 29 | |
| Topic: | Can spinal cord reflex movement progress to voluntary movement? | 10 | 47 | 28 |
| Topic: | Expert opinion: excessive use of neuromuscular blocking aganets (NMBs)/muscle relaxants (MRs) | 11 | 14 | 1 |
| Topic: | Is there an evidence based algorithim on how to diagnose types of patient movement: spinal cord reflex vs voluntary movement? | 11 | 14 | 1 |
| Topic: | The first TIVA technique that enables titration with no NMBs or MRs to ablate patient movement: propofol & remifentanil | 12 | 4 | 28 |
| Topic: | Is the use NMBs/MRs required in robotic surgery? | 13 | 29 | 23 |
| NMBs: neuromuscular blocking agents; | ||||
| MRs: muscle relaxants are an informal description of NMBs |
Robert A. Veselis
Professor of Anesthesiology, Department of Anesthesiology, Weill Cornell Medical College, New York, NY ◾ Vice Chair for Research ◾ Department of Anesthesiology & Critical Care Medicine ◾ Memorial Sloan-Kettering Cancer Ce nter 1275 York Ave., New York, NY BIOGRAPHY AND AREAS OF RESEARCH: Dr. Veselis received his MD degree from the University of Toronto, anesthesia training at Duke University, North Carolina, and Critical Care Fellowship at University of Virginia, Charlottesville. Dr. Veselis has spent most of his career at MSKCC, developing a research program focused on mechanisms of the amnestic actions of anesthetic drugs, as investigated in healthy human volunteers. Recently Dr. Veselis has focused on more clinical aspects of cognition in the peri-operative period, including delirium, anesthesia related outcomes, pediatric sedation, and neuromonitoring. He is currently Vice Chair for Research in the Department of Anesthesiology/Critical Care Medicine.
Michael Wang
Michael Wang is Emeritus Professor of Clinical Psychology in the College of Medicine, Biological Science and Psychology, University of Leicester UK, and Honorary Consultant Clinical Psychologist in Anaesthesia, Critical Care and Pain Management at Leicester Royal Infirmary UK. He is a former Chair of the Division of Clinical Psychology of the British Psychological Society. He has worked as a clinical psychologist for more than 35 years, treating patients with PTSD, anxiety disorders, depression, obsessional compulsive disorder, and in particular, psychological problems arising from unplanned anaesthetic and surgical incidents.
Anthony Messina
Anthony Messina, MD, MSPH, MBA is a retired Adjunct Professor of Healthcare Management at the Jindal School of Management, University of Texas at Dallas and anesthesiologist.