An Overview of Perioperative Medicine 2025:

From Outpatient Preoperative Assessment to Inpatient Postoperative Care

Meritage Resort & Spa, Napa, CA and LIVESTREAM

**All times noted are Pacific Time (PT)**

October 27– 31, 2025

 MONDAY, OCTOBER 27, 2025                                                                                                                                       

6:30 a.m.            Registration and Continental Breakfast

                                       Perioperative Medicine Panel #1 and Anesthesia Topics  

7:00 a.m.            Welcome and Course Overview

7:15 a.m.            Perspectives on the Multi-Disciplinary Approach to Perioperative Medicine

Moderator: Margaret Beliveau, M.D.

Panel: John Bundrick, M.D., Adam Jacob, M.D., and Krystin A. Hidden, M.D

• What are the roles of the medical consultant?
• What should a preoperative evaluation include?
• How can a multidisciplinary approach optimize patient care?

7:45 a.m.            Anesthesia Alerts for the Non-Anesthesiologist

Douglas Pfeil, M.D., Ph.D.

• Is general anesthesia more risky than spinal anesthesia for some patients?
• How do I counsel my patients about energy drinks, alcohol, nicotine the night before surgery?
• What should I tell the patient about fasting?
• How do I accurately assign an ASA score?
• What are some of the post-anesthesia issues you might encounter?
• What should the consultant know about tranexamic acid intraoperatively?

                                                        Cardiovascular Medicine Topics, Part 1                                                       

8:30 a.m.            Cardiac Risk Assessment: Using Guidelines to Direct Practice

Karen F. Mauck, M.D.

• How do I apply the current ACC/AHA guidelines to preoperative cardiac risk assessment?
• Should I use risk calculators?
• Which patients should have NT-PROBNP and/or Troponins preoperatively?

9:15 a.m.            Cardiac Risk Reduction Strategies – Medical and Interventional

Howard H. Weitz, M.D.

• What are the risks of general vs spinal anesthesia with respect to cardiac outcomes?
• What is the evidence for perioperative beta-blocker, statin and alpha-2-agonist use?
• When is cardiac revascularization indicated prior to non-cardiac surgery?
• How long should patients wait to have surgery after MI or revascularization?

10:00 a.m.          Question and Answer Session

Karen F. Mauck, M.D. and Howard H. Weitz, M.D.

10:15 a.m.          Refreshment Break

                                     Cardiovascular Medicine Topics, Part 2 and Clinical Shorts        

10:30 a.m.          Management of Non-CAD Heart Disease in Non-Cardiac Surgery

Howard H. Weitz, M.D.

• How do I manage a patient with valvular heart disease perioperatively?
• How soon after valve replacement can non-cardiac surgery be performed?
• What issues need to be considered for a patient with heart failure preoperatively?
• What are the issues with preoperative hypertension?
• What are the preoperative issues for patients with chronic atrial fibrillation?
• What perioperative issues need to be considered in a patient with hypertrophic cardiomyopathy?
• What are the indications for a temporary pacemaker in the perioperative period?
• How do I manage pacemakers and CIEDs in the perioperative period?

11:30 a.m.         Myocardial Injury after Non-Cardiac Surgery (MINS)

Dennis W. Regan, M.D.

• What is the prognostic significance of MINS?
• How do I identify MINS in the postoperative setting?
• Which patients should be surveilled for MINS?
• Is there any evidence-based treatment?

                                                                                Clinical Shorts                                                                               

12:00 p.m.          Cardiac Stress Tests

Christopher A. Dinh, M.D.

• How do I choose a cardiac stress test?

Preoperative ECG and Echocardiogram

Brian M. Dougan, M.D.

• When are preoperative ECGs and echocardiograms indicated?
• What is the role of AI in ECG interpretation?

Pulmonary Hypertension

Kathryn T. del Valle, M.D.

• What perioperative issues need to be considered in a patient with secondary pulmonary hypertension
• How do I approach a patient with elevated right sided pressures on TTE?

12:45 p.m.         Question and Answer Session

Howard H. Weitz, M.D., Christopher A. Dinh, M.D., Brian M. Dougan, M.D., Dennis W. Regan, M.D., and Kathryn T. del Valle, M.D.

1:00 p.m.            Challenge the Experts Case #1, Cardiac Conundrums

Moderator: Margaret Beliveau, M.D.

Howard H. Weitz, M.D., Karen F. Mauck, M.D., Douglas Pfeil, M.D., Ph.D.

1:15 p.m.            Adjourn

 TUESDAY, OCTOBER 28, 2025                                                                                                                                    

6:30 a.m.            Breakfast with the Professor featuring Tuesday’s Course Faculty

• Come with questions, discussion and your tough cases for the course faculty!

                                                  Pain Management and Substance Use Topics                                    

7:00 a.m.            Pain Management in the Perioperative Period

Korey Marshall, M.D.

• What are the key issues in patients on chronic opioids preoperatively?
• What are the common PCA doses for postoperative pain control?
• What are some of the basics for use of ketamine and multimodal analgesia postoperatively?
• What are the commonly used opioids in the postoperative setting and how do I choose (elderly, renal failure, liver disease)?
• How should patients on multiple sedating medications postoperatively be monitored?
• What are some important tips for using suzetrigine postoperatively?

7:45 a.m.            Managing the Patient with Perioperative Substance Use Disorders

Charles P. Reznikoff, M.D.

• How do I efficiently screen for substance use preoperatively?
• What are the perioperative issues with the use of common substances such as methamphetamine, heroin, and cocaine?
• When should surgery be delayed our postponed in patients with substance use?
• How do I manage patients on Suboxone and methadone perioperatively?
• How can I use prescription monitoring programs in the perioperative setting?

8:30 a.m.            Question and Answer Session

Korey Marshall, M.D. and Charles P. Reznikoff, M.D.

                                                                                Clinical Shorts                                                                               

8:45 a.m.            Non-Cardiac Device Management

Adam K. Jacob, M.D.

• How do I manage non-cardiac devices perioperatively, such as deep brain stimulators, pain pumps, acupressure devices, etc?

Cannabis in the Perioperative Period

Charles P. Reznikoff, M.D.

• Are there drug interactions with cannabis and what are the other perioperative considerations in patients with regular or recent cannabis use?

Laparoscopic Surgery and Patient Positioning – Why it Matters

Adam K. Jacob, M.D.

• What are the physiologic effects of intraoperative positioning and insufflation?

Alcohol Use Disorder in the Perioperative Setting

Charles P. Reznikoff, M.D.

• How should I manage patients with AUD in the perioperative setting?

Physiologic Effects of Anesthetic Drugs

Douglas Pfeil, M.D., Ph.D.

• What does the medical consultant need to know about the paralytic agents and the physiologic effects of anesthesia?

10:00 a.m.          Question and Answer Session

Adam K. Jacob, M.D, Charles P. Reznikoff, M.D., Douglas Pfeil, M.D., Ph.D.

10:15 a.m.          Refreshment Break

                                                             Perioperative Medicine Panels #2                                                            

10:30 a.m.          Stop or Go? Perioperative Show Stoppers

Moderator: Rick Silbert, M.D.

Panel: Karen Mauck, M.D., Adam Jacob, M.D., Joan M. Irizarry Alvarado, M.D., Dennis Regan, M.D.

• What patients are not appropriate for outpatient surgery?
• Outpatient preop for next day surgery – who should be delayed?
• First case! Are there hospitalized patients with an urgent surgical indication who would benefit from 24-48 hours of medical optimization?
• What are some of the issues that justify delaying surgery?

11:00 a.m.          Preoperative Surprises: What to do?

Moderator: Bright P. Thilagar, M.D.

Panel: Aditya P. Devalapalli, M.D., David Raslau, M.D., M.P.H., Luke T. Matzek, M.D.

• • What ECG findings merit additional evaluation preoperatively and which do not?
  • What laboratory results should be further investigated prior to surgery?
  • Which patients need to see an anesthesiologist prior to the day of surgery?

                                                                           Infectious Disease                                                                          

11:30 a.m.         Perioperative Infectious Disease Issues

Mary J. Kasten, M.D.

• How do I approach the postoperative fever workup?
• Which patients need antibiotic prophylaxis perioperatively and for how long?
• Do I need to order a urinalysis and culture prior to total joint surgery?
• Is there a role for the use of probiotics to prevent postoperative infections?
• What are the key issues in perioperative COVID-19?

12:15 p.m.         Challenge the Experts Case #2

Moderator: Karna K. Sundsted, M.D.

Mary J. Kasten, M.D., Charles P. Reznikoff, M.D. insert pain speaker

12:30 p.m.         Adjourn

                                    Optional Workshop with Lunch (pre-registration required)                 

12:50 p.m. -       Optional Workshop: The Multidisciplinary Approach to Perioperative Medicine

3:30 p.m.           Adam K. Jacob, M.D.; Karna K. Sundsted, M.D.; Karen F. Mauck, M.D., Geno J. Merli, M.D., Margaret Beliveau, M.D., Joan M. Irizarry Alvarado, M.D., Lisa M. Belch, APRN, C.N.P.; Jessica A. Gonzalez, APRN, C.N.P.; Shari M. Phelan, P.A.-C.

• • Review the role of NP/PAs, anesthesiologists, internists, and hospitalists in the continuum of perioperative care at Mayo
  • How do patients get triaged for video vs face-to-face visits?
  • How is the EMR used to perform the preoperative checklist?
  • Which patients require a more complex preoperative evaluation with an anesthesiologist or internist?
  • How does the patient flow work in the preop clinic?
  • How are patients with anemia or penicillin allergy managed preop?
  • How are complex postoperative patients managed in the inpatient setting?
  • How are learners incorporated in the perioperative setting?

 WEDNESDAY, OCTOBER 29, 2025                                                                                                                                    

6:30 a.m.            Breakfast with the Professor featuring Wednesday’s Course Faculty

• Come with questions, discussion, and your tough cases for the course faculty!

                              Cardiovascular Part 3, Medication and Fluid Management Topics                             

7:00 a.m.            Managing Postoperative Cardiac Complications

Howard H. Weitz, M.D.

• Which patients should have an ECG and/or troponin surveillance for postoperative MI?
• How do I manage hyper- and hypotension postoperatively?
• What are the precipitating factors for postoperative arrhythmias and conduction disorders and how do I manage them?
• Which surgeries and patients have high risk for postoperative atrial fibrillation? Are there ways to prevent postoperative atrial fibrillation? How do I manage postoperative atrial fibrillation?
• How do I diagnose and manage postoperative myocardial ischemia and infarction?
• How important is “troponin leak” postoperatively?
• What special perioperative management is needed for patients with heart failure (systolic heart failure and heart failure with preserved ejection fraction)?

7:45 a.m.            Understanding Perioperative Fluid Management

John B. Bundrick, M.D.

• What is unique about fluid management perioperatively?
• Which is better-- liberal or restrictive fluid management?
• What type of fluid is optimal?
• How can POC ultrasound be helpful in fluid management?

8:15 a.m.            Perioperative Medication Jeopardy

Host: Christopher R. Stephenson, M.D.

• What overarching issues need to be considered for perioperative medication management?
• Test your knowledge of the how to manage common perioperative medications!
• Learn how to manage herbals/supplements, weight loss drugs and ICIs
• Apply the SPAQI consensus statements to perioperative medication management

9:15 a.m.            Question and Answer Session

Howard H. Weitz, M.D., John B. Bundrick, M.D., and Christopher R. Stephenson, M.D.

9:30 a.m.            Refreshment Break

                                                               Rheumatology and Hip Fracture                                                              

9:45 a.m.            Perioperative Rheumatology Considerations

Ashima Makol, M.B.B.S.

• How do I manage DMARDS and other rheumatologic medications in patients who require surgery?
• How do I diagnose and manage acute crystalline arthritis in the surgical patient?

10:15 a.m.         Perioperative Management of Hip Fractures: Internal Medicine and Orthopedic Surgery Perspectives

Karna K. Sundsted, M.D. and Krystin A. Hidden, M.D.

• What are the areas of collaboration and controversy in the management of patients with hip fracture?
• How long do we have for medical optimization of hip fracture patients?
• What are some hip fracture basics that are helpful to the internist?

11:00 a.m.         Perioperative POCUS, Applications for Practice

Panel: John B. Bundrick, M.D., Meltiady Issa, M.D. and Joshua Overgaard, M.D.

• What are the basics of IVC assessment perioperatively?
• How is gastric ultrasound used preoperatively?
• How do I assess pulmonary edema or pleural effusions postoperatively?

11:30 a.m.          Question and Answer Session

Ashima Makol, M.B.B.S., Karna K. Sundsted, M.D. and Krystin A. Hidden, M.D. John B. Bundrick, M.D., Meltiady Issa, M.D., M.B.A. and Joshua Overgaard, M.D.

11:45 a.m.         Lunch On Your Own

                                                               Pulmonary and Geriatric Topics                                                              

1:15 p.m.           Preoperative Pulmonary Risk Stratification, Risk Reduction and Postoperative Management Strategies

Sandeep R. Pagali, M.D.

• Which factors contribute to pulmonary risk in non-cardiac surgery?
• Which pulmonary risk index best predicts postoperative pulmonary complications?
• When is pulmonary testing recommended preoperatively?
• What measures can be employed to help minimize postoperative pulmonary complications in at-risk patients?
• How should I approach a new oxygen requirement postoperatively?

1:45 p.m.                          Perioperative Care of the Elderly Patient

Margaret Beliveau, M.D.

• How old is too old to consider surgery?
• What are the risk factors and preventive measures for postoperative delirium?
• What diagnostic workup is recommended for patients with suspected postoperative delirium?

• Do DNR orders need to be suspended prior to surgery and if so, when should DNR orders be reinstituted postoperatively?

2:15 p.m.                   Recognizing and Addressing Frailty

Donna Miller, M.D.

• How is the frailty index used to identify patients at risk of postoperative complications?
• Are there preoperative management strategies to address frailty?
• How should frailty be managed in the postoperative period to minimize risk?

2:45 p.m.               Question and Answer Session

Sandeep R. Pagali, M.D., Margaret Beliveau, M.D., and Donna Miller, M.D.

                                                                                Clinical Shorts                                                                               

3:00 p.m.            Prehabilitation

Margaret Beliveau, M.D.

• Does prehabilitation have a role in some patients prior to surgery?

Postoperative Hypertension

Deanne T. Kashiwagi, M.D

• How should I approach and treat postoperative hypertension?

Postoperative Urinary Retention (POUR)

TBD Maleka Khambaty, M.D.

• Which patients are at risk for POUR and how should it be managed?

Preoperative Anemia and Iron Therapy

Margaret Beliveau, M.D.

• When should I consider perioperative iron therapy and how is it administered?

4:00 p.m.            Attendee Reception

4:30 p.m.            “Consult Guys” Presentation:

(CME credit will not be provided for this session)

Geno J. Merli, M.D. and Howard H. Weitz, M.D.

5:00 p.m.            Adjourn

 THURSDAY, OCTOBER 30, 2025                                                                                                                                    

6:30 a.m.            Breakfast with the Professor featuring Thursday’s Course Faculty

                                                         Sleep Medicine and Neurology Topics                                                        

7:00 a.m.            Management of Documented or Suspected Obstructive Sleep Apnea in Patients Undergoing Noncardiac Surgery

Eric Olson, M.D.

• What are the consequences of OSA in the perioperative period?
• What factors increase risk of postoperative complications in patients with OSA?
• How should patients be screened for OSA?
• What are the risks of obesity hypoventilation syndrome?
• Which patients need to be tested prior to surgery to decrease the risk of potential complications?

• Which patients can be treated as “presumed” OSA and proceed with surgery with additional precautions?
• Are there guidelines available to help guide management of patients with OSA in the perioperative period?
• What postoperative monitoring is recommended for patients with suspected or confirmed OSA?

7:45 a.m.            Managing Patients with Neurologic Disease in the Perioperative Period

Andrea N. Leep Hunderfund, M.D., MHPE (*virtual)

• How do I manage patients with seizure disorder in the perioperative period?
• How do I manage patients with Parkinson’s disease perioperatively?
• What do I do if I find an asymptomatic carotid bruit during a preoperative evaluation?
• How do I determine appropriate timing for elective surgery after ischemic stroke?

8:15 a.m.            Question and Answer Session

Eric Olson, M.D. and Andrea N. Leep Hunderfund, M.D., MHPE

                                             VTE Prophylaxis, Nephrology and Anticoagulation            

8:30 a.m.            DVT/PE Prophylaxis in the Surgical Patient I: The Internist’s Perspective

Geno J. Merli, M.D.

• What are the patient- and surgery-related risk factors for perioperative DVT; what tool should I use to calculate risk?
• What guideline should I use for DVT prophylaxis in surgical patients?
• When is extended DVT prophylaxis indicated?
• How does renal function affect the management of DVT prophylaxis?
• How do I determine which patients are at increased risk of postoperative bleeding?

9:00 a.m.            DVT/PE Prophylaxis in the Surgical Patient II: The AAOS Guidelines and the Orthopedist’s Perspective

Krystin A. Hidden, M.D.

• What concerns do orthopedists have about DVT prophylaxis?
• What are the AAOS Guideline recommendations for DVT prophylaxis in orthopedic surgical patients?
• When is extended DVT prophylaxis indicated and which agent is best?

9:30 a.m.            Perioperative Management of Direct Oral Anticoagulants

Geno J. Merli, M.D.

• How long should I hold dabigatran, rivaroxaban or apixaban before surgery?
• Now that some reversal agents are available, should we routinely be using these to expedite DOAC reversal preoperatively in patients who need urgent surgery?
• When should target specific oral anticoagulants be restarted postoperatively?
• Do patients on target specific oral anticoagulants need to be bridged?
• How do I manage prolonged DVT prophylaxis in patients who are also taking dabigatran, rivaroxaban, edoxaban or apixaban?
• How should we reverse these agents if major bleeding occurs?

10:00 a.m.          Question and Answer Session

Geno J. Merli, M.D. and Krystin A. Hidden, M.D.

10:15 a.m.          Refreshment Break

10:30 a.m.         Cases from the Vascular Clinic

Matthew Bartlett, M.D.

• Which patients with atrial fibrillation need bridging anticoagulation perioperatively?
• Which patients with mechanical heart valves need bridging anticoagulation perioperatively?
• Can you recommend an approach to anticoagulation dosing and the timing of bridging?
• How and when should anticoagulation be restarted after surgery?

11:00 a.m.          Perioperative Management of the Patient with Kidney Disease

Virginia A. Dines, M.D.

• What perioperative issues do I need to consider for a patient with kidney disease?
• How do I manage patients with advanced kidney disease, at risk for requiring perioperative hemodialysis?
• What is the optimal timing of preoperative dialysis in ESRD patients?
• What are the key considerations for patients on peritoneal dialysis?
• How do I prevent acute kidney injury in the perioperative period?
• Which electrolyte abnormalities should delay surgery?
• Are there some key perioperative recommendations for patients who are on the kidney transplant list?

11:30 a.m.         Question and Answer Session

Matthew Bartlett, M.D. and Virginia A. Dines, M.D.

11:45 p.m.         Challenge the Experts Case #3

Moderator: Howard H. Weitz, M.D.

Geno J. Merli, M.D., Matthew Bartlett, M.D., and Virginia A. Dines, M.D.

12:00 p.m.         Adjourn

 FRIDAY, OCTOBER 31, 2025                                                                                                                                    

6:30 a.m.            Breakfast with the Professor featuring Friday’s Course Faculty

                                              Perioperative Endocrine and Hematology Topics                                

7:00 a.m.            Managing the Diabetic Patient in the Perioperative Period

Vinaya Simha, M.B.B.S., M.D.

• Should I be screening for diabetes preoperatively in patients who are at risk?
• When would I recommend postponing an elective surgical procedure because of poor diabetic control?
• How should I manage patients on insulin therapy in the perioperative period?
• How should I manage patients on oral hypoglycemics non-insulin injectables in the perioperative period?
• How should I manage patients on insulin pumps/continuous glucose monitors in the perioperative period?
• What is the optimal glycemic control in the postop setting?

7:45 a.m.            Common Hematology Issues in the Perioperative Period

Rajiv K. Pruthi, M.B.B.S.

• Which transfusion strategy is best in the perioperative period—conservative or liberal?

• What should trigger transfusion in the postop period?
• When are factor concentrates and/or FFP indicated preoperatively?
• What is the role of platelet transfusion in patients taking antiplatelet agents who need emergent or urgent surgery?
• How do I diagnose and treat heparin induced thrombocytopenia in the perioperative period?
• How do I manage non-HIT thrombocytopenia?
• How do I manage patients with sickle cell disease perioperatively?

8:30 a.m.            Perioperative Management of Endocrine Issues: Stress Dose Steroids, Adrenal Insufficiency, Thyroid Disease

Vinaya Simha, M.B.B.S., M.D.

• What issues do I need to consider in patients with hypothyroidism or hyperthyroidism in the perioperative period?
• Which patients should have thyroid function testing preoperatively?
• Who is at risk for adrenal insufficiency perioperatively?
• How do I determine the need for and the dose of stress dose steroids in the surgical patient?
• Do patients who receive dexamethasone for prevention of nausea and vomiting also need stress dose hydrocortisone as well?

9:00 a.m.            Question and Answer Session

Vinaya Simha, M.B.B.S., M.D. and Rajiv K. Pruthi, M.B.B.S.

9:15 a.m.            Refreshment Break

                                                         Gastrointestinal and Nutrition Topics                                                        

9:30 a.m.            Perioperative Management of the Patient with Liver Disease

William Sanchez, M.D.

• How do I approach preoperative risk assessment in a patient with liver disease?
• What is the VOCAL-PENN Score?
• Which patients with liver disease may not be good candidates for elective surgery due to a significant increase in perioperative morbidity and mortality?
• What are the common postoperative issues for patients with advanced liver disease and clinical pearls for managing them?
• What do I need to know about managing the transplant patient undergoing non- cardiac surgery?

10:15 a.m.          Management of Postoperative Gastrointestinal Complications

Arya B. Mohabbat, M.D.

• How do I prevent and manage postoperative nausea and vomiting?
• How should I evaluate a patient with postoperative diarrhea?
• What agents are recommended to prevent stress related mucosal disease in the surgical patient?
• How do I manage postoperative constipation and postoperative ileus?

10:45 a.m.          Perioperative Nutrition Considerations

Ryan T. Hurt, M.D., Ph.D.

• from a preoperative nutrition consultation?
• What preoperative testing is useful to assess nutritional status?
• Does optimizing nutrition preoperatively improve outcomes?
• When should patients receive TPN in the perioperative setting?