American Society of Regional Anesthesia and Pain Medicine February 2015 - (Page 22)

Scientist Spotlight-Dr. Guy Weinberg, Trailblazer in Patient Safety Colin J. McCartney, MBChB, FCARCSI, FRCA, FRCPC Chair, ASRA Research Committee Kathleen Nelligan, BSc MD Candidate 2016 Schulich School of Medicine and Dentistry University of Western Ontario 1990s, Dr. Weinberg was investigating mitochondrial metabolism of local anesthetics and, in his own words, was "hoping to understand why a patient with isovaleric acidemia and carnitine deficiency was super-sensitive to bupivacaine. She developed severe arrhythmias after receiving only 22 mg of bupivacaine in tumescence solution." In attempting to recreate the biochemical picture of carnitine deficiency at the cellular level, Dr. Weinberg infused lipid emulsion in a rat expecting a similar elevated sensitivity to bupivacaine but found exactly the opposite: "After lipids, a normally toxic dose of bupivacaine had no adverse effect." A nesthesiology and pain medicine is a field rich in history and discovery. Marked by the likes of Carl Koller, Virginia Apgar, and John Snow, the field has contributed not only to perioperative medicine but also epidemiology, neonatology, and intensive care. ASRA aims to continue this tradition by supporting physicians and scientists working within the subspecialty. Through awards such as the Carl Koller Memorial Research Grant, ASRA carries on this tradition. Now approaching its 29th year, it is time to shine the spotlight on some of the most notable research accomplishments achieved through ASRA's support. This discovery led to the first study of the mechanism of lipid rescue for local anesthetic systemic toxicity (LAST). Funded by the Koller Award in 2004, Dr. Weinberg investigated whether or not lipid infusion accelerated bupivacaine removal from a rat heart model. It did. Fast forward 10 years-not only have Dr. Weinberg's original results been replicated in an intact animal model, but there have also been countless case reports of successful lipid rescue, ranging from LAST to overdoses from many other drugs. However, improving care in rare events has been challenging. "The greatest challenge of rare events is convincing your potential audience of their clinical relevance," says Weinberg. "That audience could be physicians who don't see an event occurring at a rate of 1 in 1,000 as presenting a real danger to their practice. It could also be a grant reviewing agency that won't fund a project studying an event with that low an incidence. However, the reality of LAST is that while we would like it to be a 'never event,' 1 in 1,000 "Like many seminal discoveries in medicine, a chance observation was the trigger for an important discovery." Like many seminal discoveries in medicine, a chance observation was the trigger for an important discovery. Enter Dr. Guy Weinberg, anesthesiologist and scientist at the University of Illinois. In the late 22 2 American Society of Regional Anesthesia and Pain Medicine 2015

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2015

In Memoriam : Alon Palm Winnie, M.D., ASRA Founding Father
President’s Message
Editorial
40th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
Resident and Fellow Events at the 2015 Spring Meeting
How We Do It: Managing an Acute and Perioperative Pain Medicine (APPM) Service at the University of Florida
Ketamine—an Old Drug with New Tricks
Optimal Postcesarean Delivery Pain Management
Palliative Care and Pain Medicine—Beyond Intrathecal Pumps and Opioids
Scientist Spotlight—Dr. Guy Weinberg, Trailblazer in Patient Safety

American Society of Regional Anesthesia and Pain Medicine February 2015