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    The Changing Practice of Anesthesia The Changing Practice of Anesthesia Document Transcript

    • Department of Anesthesia and Perioperative Care University of California, San Francisco University of California San FranciscoTHE CHANGING PRACTICE OFAnesthesia H OT E L N I K KO • S A N F R A N C I S C O, C A L I F O R N I A September 21-23, 2012FRIDAY - S UNDAY Pre-Conference Workshops: September 20, 2012 • Anesthesia Simulator Workshop • Hands-On Difficult Airway Management Workshop • Ultrasound for Regional Anesthesia Workshop • Hands-on Ultrasound for the Anesthesia Provider: Vascular Access and Intravascular Volume Assessment www.cme.ucsf.edu
    • THE CHANGING PRACTICE OFAnesthesia H OT E L N I K KO • S A N F R A N C I S C O, C A L I F O R N I A September 21-23, 2012 ACCREDITATION Physicians: The University of California,The Changing Practice of Anesthesia is designed to update San Francisco School of Medicine UCSF) isthe clinician on some of the most significant advances in the accredited by thefield of anesthesia. These changes include new developments Accreditation Councilin general and specialized areas of perioperative medicine, for Continuing Medical Education to provideanesthesia, and critical care. We have also included case- continuing medicalbased discussions, and four optional, interactive workshops to education for physicians. UCSF designates this livebe conducted on September 20, 2012: activity for a maximum of • Anesthesia Simulator Training 18 AMA PRA Category 1 CreditsTM, the Anesthesia • Hands-On Difficult Airway Training Workshop Simulator Workshops (MAN1301A/B) for a • Ultrasound for Regional Anesthesia Workshop, and maximum of 2 AMA PRA Category 1 CreditsTM, the • Hands-On Ultrasound for the Anesthesia Provider: Hands-On Difficult Vascular Access and Intravascular Volume Assessment. Airway Management Workshop (MAN1201C), for a maximum of 8 AMA Upon completion of the educational activity participants shouldE D U C AT I O N A L O B J E C T I V E S PRA Category 1 CreditsTM, be able to: the Ultrasound for • Review the guidelines for practice and performance measures Regional Anesthesia for anesthesia providers; Workshop (MAN1301D/E), • Understand the agents available for spinal anesthesia in the for a maximum of 4 AMA ambulatory patient; PRA Category 1 CreditsTM and the Ultrasound for • Review the deaths and their causes during ambulatory surgery Diagnosis and in the Los Angeles area; Intravascular Access • Discuss techniques to prolong local anesthetic blocks for (MAN1301F/G) for a ambulatory surgery patients; maximum of 4 AMA PRA • How to effectively intervene with disruptive behavior or Category 1 CreditsTM. aging issues in your practice; Physicians should only claim credit commensurate • Review positions and safe movements while delivering with the extent of their anesthesia care; participation in each of • Review the hazards and protections against radiation and these activities. trace gas exposure; This CME activity meets • Understand the alternatives to opioids that are available for the requirements under perioperative pain management; California Assembly Bill 1195, continuing education • Discuss the problems associated with pain control in the and cultural and linguistic opioid tolerant patient and treatment options; competency. • Understand the mechanisms of how acute pain becomes For the purpose of chronic and how to prevent it; recertification, the American • Discuss the many challenges of anesthesia for labor and Nurses Credentialing delivery in the cardiac patient; Center accepts AMA PRA • Discuss problems with bleeding in obstetrics; Category 1 CreditTM issued by organizations accredited • Review the different options for labor analgesia; by the ACCME. • Discuss the emerging structure of ACOs; • Discuss Health Care Reform and the effect on anesthesia providers; • Discuss the costs of anesthesia care in the United States; • Review the emerging use of smart intravenous pumps for delivery of anesthetic medications; • Discuss the pharmacokinetics of intravenous propofol; • Review strategies for ventilation without endotracheal intubation; • Discuss the options for assisted ventilation by new ventilators; • Review the use of monitoring to accurately guide fluid therapy during surgery and in the ICU; • Discuss the incidence and prevention of peri-operative stroke; • Review the incidence and causes of cognitive decline after anesthesia and surgery; • Review new options for pediatric pain control; • Review new and old devices for the pediatric patient; • Review the choice of drugs and anesthetic techniques for spine surgery with neuromonitoring; • Discussion of recent studies on blindness after surgery with emphasis on spine surgery; • Review the new anticoagulants as they relate to the practice of anesthesia.
    • PROGRAM CHAIRS UCSF COURSE FACULTY UCSF COURSE FACULTY (CONT’D)Merlin D. Larson, MD (Department of Anesthesia and Perioperative Care unless otherwise Rondall K. Lane, MDProfessor Emeritus, Department of noted) Assistant ProfessorAnesthesia and Perioperative Care J. Matthew Aldrich, MD Mark L. Latronica, MDJohn M. Taylor, MD Assistant Professor Assistant ProfessorAssociate ProfessorMedical Director, Department of Pedram Aleshi, MD Jacqueline M. Leung, MD, MPHAnesthesia and Perioperative Care, Assistant Professor ProfessorMoffitt-Long Post Anesthesia Care Matthias Behrends, MD Jeremy A. Lieberman, MDUnit and Perioperative Support Assistant Professor ProfessorServices Philip E. Bickler, MD, PhD Linda L. Liu, MDSusan S. Yoo, MD Professor ProfessorAssistant Professor, Department ofAnesthesia and Perioperative Care Matthias R. Braehler, MD Jennifer M. Lucero, MDC. Spencer Yost, MD Assistant Professor Clinical InstructorProfessor, Department of Daniel H. Burkhardt, MD Margaret C. Martin, JDAnesthesia and Perioperative Care Associate Professor Executive Director, Managed CareDirector, ICU at Mount Zion and Strategic Planning Lundy Campbell, MDHospital UCSF Medical Group Associate Professor Ramana K. Naidu, MD Lydia Cassorla, MD, MBADEPARTMENT CHAIR Assistant Professor ProfessorMervyn Maze, MB, ChB Dorre Nicholau, MD, PhDWilliam K. Hamilton Distinguished Christopher C. Choukalas, MD ProfessorProfessor in Anesthesia Assistant Professor Victor Ng, MDChair, Department of Anesthesia Adam B. Collins, MD Assistant Professorand Perioperative Care Associate Professor David Robinowitz, MD, MHD, MS Scott Dingeman, MDVISITING FACULTY Assistant Professor Assistant ProfessorSelma Calmes, MD Mark D. Rollins, MD, PhD Kenneth Drasner, MDConsultant in Anesthesiology Associate Professor Professorfor the Los Angeles County Patrica A. Roth, MDCoroner-Medical Examiner Clinical, Marla B. Ferschl, MD ProfessorLos Angeles, CA Assistant Professor Mark Schumacher, MD, PhDLee A. Fleisher, MD Pamela D. Flood, MD Associate ProfessorRobert D. Dripps Professor Professorand Chair, Department of Mohammed Shaikh, MD, PhD Pedro L. Gambus, MD, PhDAnesthesiology and Critical Care Assistant Professor Visiting Associate ProfessorProfessor of Medicine Laura Siedman, MDPerelman School of Medicine Adrian Gelb, MBChB ProfessorUniversity of Pennsylvania Health ProfessorSystem; Philadelphia, Pennsylvania Kristina Sullivan, MD Jay Harris, BA Associate ProfessorSean Mackey, MD, PhD Associate DirectorChief, Division of Pain UCSF Medical Center Donald M. Taylor, MD, PhDManagement; Associate Professor, Administration Assistant ProfessorDepartment of Anesthesia Andrew J. Infosino, MD J. Matthew Taylor, MD, PhDNeurosciences and (by courtesy) Professor Assistant ProfessorNeurology, Stanford UniversitySchool of Medicine, Palo Alto, CA Ravi V. Joshi, MD Kevin C. Thornton, MDSteven L. Shafer, MD Assistant Professor Assistant ProfessorProfessor of Anesthesia, Jeffrey Katz, MD Frank van der Heusen, MDStanford University; Adjunct Emeritus Professor Assistant ProfessorProfessor of Bioengineering and Sakura Kinjo, MD Maurice Zwass, MDTherapeutic Sciences, University Associate Professor Professorof California at San FranciscoEditor-in-Chief, Anesthesia &Analgesia
    • THE CHANGING PRACTICE OF AnesthesiaTHURSDAY, SEPTEMBER 20, 2012 Anesthesia Simulator Workshop MAN1301A/B Department of Anesthesia Center for Health Care Simulation at San Francisco General Hospital (SFGH) Session A 8:00 – 10:00 am / Session B 10:30 am – 12:30 pm Workshop Sessions are limited to 4 participants per session Registration Fee: $250 MD/CRNA Registration is ONLY available online at https://www.cme.ucsf.edu Directors: Manuel C. Pardo Jr., MD • Adam B. Collins, MD COURSE DESCRIPTION This program is designed to provide the practitioner with an opportunity to apply baseline knowledge and skills in the management of perioperative medical crises in an immersive learning environment. The participants then undergo guided reflection to improve future practice performance. Details of medical management will be discussed, as well as proper crisis management behaviors. The course includes a brief introduction, followed by several realistic OR-based patient simulations. Scenarios will be recorded and reviewed immediately afterwards in a debriefing conference. For educational objectives and course schedule please see https://www.cme.ucsf.edu Hands-On Difficult Airway Management Workshop MAN1301C Hotel Nikko, San Francisco Session C is limited to 40 participants. Faculty to registrant ratio = 1:4 Registration Fee $395 • Time 8:00 am – 5:00 pm Registration is ONLY available online at https://www.cme.ucsf.edu Directors: Patricia A. Roth, MD • Robin Stackhouse, MD This workshop is designed to update practitioners on the latest airway data, equipment, and techniques. It will begin with a series of talks and demonstrations that detail various situations in which an airway cannot be established through conventional means, including a discussion of appropriate methods and tools that can be used in difficult airway management. This will be immediately followed by a hands-on training workshop where participants will practice these techniques using many types of airway management equipment on mannequins to further sharpen and freshen their skills. For educational objectives and course schedule please see https://www.cme.ucsf.edu Ultrasound for Regional Anesthesia Workshop MAN1301D/E Hotel Nikko, San Francisco Workshop Sessions are limited to 24 participants • Registration Fee: $325 Session D 8:00 am – 12:00 pm / Session E 1:00 pm – 5:00 pm Registration is ONLY available online at https://www.cme.ucsf.edu Director: Andrew T. Gray, MD, PhD Special Guest Instructor: Jens Kessler, MD The purpose of this activity is to provide the practitioner with the necessary skills to successfully use ultrasound guidance to administer regional blocks. Instruction includes both didactic and hands-on sessions and covers basic and advanced uses of ultrasound imaging. Each student will use ultrasound equipment to scan live and phantom models. For educational objectives and course schedule please see https://www.cme.ucsf.edu Hands-on Ultrasound for the Anesthesia Provider: MAN1301F/G Vascular Access and Intravascular Volume Assessment Hotel Nikko, San Francisco Workshop Sessions are limited to 16 participants per session • Registration Fee: $200 Session F 8:00 am-12:00 pm / Session G 1:00 pm – 5:00 pm Registration is ONLY available online at https://www.cme.ucsf.edu Director: John M. Taylor, MD The purpose of this activity is to provide the practitioner with the necessary skills to successfully use ultrasound guidance for vascular access and as an aid to evaluate intravascular volume status and for the presence of pneumothorax. Instruction includes both didactic and hands-on sessions and covers basic and advanced uses for ultrasound imaging. Each student will use ultrasound equipment for scanning using live and phantom models. For educational objectives and course schedule please see https://www.cme.ucsf.edu
    • September 21-23, 2012FRIDAY, SEPTEMBER 21, 20127:00 am Registration and Continental Breakfast8:00 - 8:10 Welcome Announcements and Introduction of Mervyn Maze, MB, ChB Guest Speaker8:10 - 8:55 Guidelines and Performance Measures: Lee A. Fleisher, MD How Do You Apply the Evidence8:55 - 9:10 DiscussionAMBULATORY SURGERY • Moderator: Andrew Infosino, MD9:10 - 9:35 Spinal Anesthesia for Outpatient Surgery Kenneth Drasner, MD9:35 - 10:00 Ambulatory Surgery Disasters Selma Calmes, MD10:00 - 10:20 Prolonging Peripheral Nerve Blocks for Matthias Behrends, MD Ambulatory Surgery10:20 - 10:35 Discussion10:35 - 10:50 BreakPROVIDER SAFETY • Moderator: Spencer Yost, MD10:50 - 11:15 “Over-the-Top” or “Over-the-Hill” Practitioners: Dorre Nicholau, MD, PhD Legal and Practical Issues11:15 - 11:35 Body Mechanics in the OR Donald M. Taylor, MD, PhD11:35 - 11:55 Minimizing Risks from Radiation and Trace Gases Kristina Sullivan, MD11:55 - 12:10 pm Discussion12:10 - 1:30 Lunch (on your own)ACUTE PAIN • Moderator: Mark Latronica, MD1:30 - 1:55 Strategies to Decrease Perioperative Ramana K. Naidu, MD Opioid Complications1:55 - 2:25 Perioperative Management of the Opioid Mark Schumacher, MD, PhD Tolerant Patient2:25 - 2:55 When Acute Pain Becomes Chronic: Sean Mackey, MD, PhD What Do We Know and How Can We Prevent It?2:55 - 3:10 Discussion3:10 - 3:25 BreakOBSTETRICAL ANESTHESIA • Moderator: Jennifer Lucero, MD3:25 - 3:55 Parturient with Cardiac Disease Pamela D. Flood, MD3:55 - 4:20 Management of Coagulopathy in Obstetrics Mark D. Rollins, MD, PhD4:20 - 4: 45 Labor Epidurals: Local Anesthetics and Beyond Pedram Aleshi, MD4:45 - 5:00 Discussion5:00 Adjourn5:00 pm Wine Tasting ReceptionSATURDAY, SEPTEMBER 22, 20127:00 am Continental Breakfast8:00 - 8:05 AnnouncementsHEALTH CARE REFORM • Moderator: Mervyn Maze, MB, ChB8:05 - 8:30 Accountable Care Organizations Jay Harris, BA8:30 - 8:55 Legislative Reform: Effects on Payers Margaret Martin, JD8:55 - 9:20 Value from Anesthesia Care: Lee A. Fleisher, MD Where Do We Influence the Outcome/ Cost Equation in Medicine?9:20 - 9:35 DiscussionPERI-OPERATIVE PHARMACOLOGY • Moderator: Mohammed Shaikh, MD, PhD9:35 - 9:50 New Anticoagulants Linda L. Liu, MD9:50 - 10:10 TIVA and Smart Pumps Pedro L. Gambus, MD, PhD10:10 - 10: 40 Pharmacokinetics in the Steven L. Shafer, MD Trial of Conrad Murray, MD10:40 - 10:55 Discussion10:55 - 11:10 Break
    • Hotel Nikko • San Francisco, CaliforniaSATURDAY, SEPTEMBER 22, 2012 (CONT’D)CRITICAL CARE • Moderator: John Taylor, MD11:10 - 11:35 Peri-operative Use of Non-invasive Ventilation J. Matthew Aldrich, MD11:35 - 11:50 Review of Ventilators with Emphasis on Kevin C. Thornton, MD New Modes11:50 - 12:15 pm Goal Directed Fluid Therapy Christopher C. Choukalas, MD12:15 - 12:30 Discussion12:30 - 2:00 LunchPROTECTION OF THE BRAIN • Moderator: Jacqueline Leung, MD2:00 - 2:25 Perioperative Stroke Adrian Gelb, MBChB2:25 - 2:50 Cognitive Decline after Surgery Mervyn Maze, MB, ChB2:50 - 3:05 DiscussionPEDIATRICS • Moderator: Maurice Zwass, MD3:0 - 3:30 New Modalities for Treating Perioperative Scott Dingeman, MD Pediatric Pain3:30 - 3:55 Airway Devices for Pediatrics Laura Siedman, MD3:55 - 4:10 Discussion4:10 - 4:25 BreakANESTHESIA FOR ORTHOPEDIC SURGERY • Moderator: Sakura Kinjo, MD4:25 - 4:50 Anesthesia for Spine Surgery, Neuromonitoring Jeremy A. Lieberman, MD4:50 - 5:15 Optic Neuropathy and Blindness after Surgery Rondall K. Lane, MD5:15 - 5:30 Discussion5:30 pm AdjournSUNDAY, SEPTEMBER 23, 20127:00 am Continental Breakfast8:00 - 9:45 Participants may attend one workshop: Difficult Cases in Regional Anesthesia Philip E. Bickler, MD, PhD Adam B. Collins, MD Matthias R. Braehler, MD Difficult Airway Cases and Equipment Patricia A. Roth, MD Perioperative Issues for the Cardiac Patient Ravi V. Joshi, MD Undergoing Non-cardiac Surgery Frank van der Heusen, MD Victor Ng, MD Lundy Campbell, MD Thoracic Epidural – Acute Pain, Teaching Merlin D. Larson, MD Models, Anatomy, Case Discussions Mark L. Latronica, MD Daniel H. Burkhardt, MD Unusually Difficult Pediatric Cases Maurice Zwass, MD Marla B. Ferschl, MD David Robinowitz, MD, MHD, MS9:45 - 10:15 Break10:15 - 12:00 pm Participants may attend one workshop: Difficult Cases in Regional Anesthesia Phillip E. Bickler, MD, PhD Adam B. Collins, MD Matthias Braehler, MD Difficult Airway Cases and Equipment Patricia A. Roth, MD Anesthesia for Thoracic Surgery: Challenges, Lundy Campbell, MD Techniques for Lung Isolation, and Difficult Lydia Cassorla, MD, MBA Cases Jeffrey Katz, MD Thoracic Epidural - Acute Pain, Teaching Models, Merlin D. Larson, MD Anatomy, Case Discussions Mark L. Latronica, MD Daniel H. Burkhardt, MD Unusually Difficult Pediatric Cases Maurice Zwass, MD Marla B. Ferschl, MD David Robinowitz, MD, MHD, MS12:00 pm Evaluations and Adjourn
    • also reach us by calling the Office register online visit our website atE Printed on Recycled Paper www.cme.ucsf.edu. You may of CME at (415) 476-4251 or email info@ocme.ucsf.edu. For more information or to University of California, Office of Continuing San Francisco, CA Medical Education UCSF Box 0742 San Francisco 94143-0742 0569 GENERAL INFORMATION CONFERENCE LOCATION Pre-registration is preferred. Enjoy San Francisco’s renowned attractions such HOW TO ENROLL as the historic cable cars, shopping in Union Square, Tuition: $525 Physician or visit San Francisco’s culinary hub at the Ferry Building. The Hotel Nikko is just steps from Union $450 CRNAs (include AANA#) Square and the Theatre District. $225 Residents, Interns, Student CRNAs A block of guestrooms has been reserved at the hotel Additional Workshop Fees – Registration is ONLY a special UCSF discounted conference rate of $259. available on-line AT http://www.cme.ucsf.edu The contracted cut off date is August 29, 2012, or Anesthesia Simulator: MAN1301A/B until the group room block is filled, whichever comes Each Workshop session is limited to 4 people first. After this date, rooms will be provided on a $250 Physician/CRNA space-available basis only. If you prefer to phone in Hands On Difficult Airway Management: your reservation, please identify yourself as a member MAN1301C Workshop session is limited to 40 people. of this conference, UCSF Anesthesia 2012 to receive the special rate. To make hotel reservations on-line, $395 Physician/CRNA go to www.hotelnikkosf.com use the booking Ultrasound for Regional Anesthesia Workshop: code: SSFFMM. If you prefer to telephone in your MAN1301D/E Registration is limited to 24 people. reservation, call 415-394-1111 to receive the special $325 Physician/CRNA rate. By staying at the host hotel, you help the Hands-on Ultrasound for the Anesthesia University of California meet its contractual obligations Provider: Vascular Access and Intravascular and keep future registration fees reasonable. Please Volume Assessment: MAN1301F/G Workshop take this into consideration when making your Session is limited to 16 people accommodation decisions. $200 Physician/CRNA **Hotel Policies: Reservations must be cancelled at least Payment may be made by Visa, MasterCard, 24 hours in advance or a one-night’s stay (and applicable AmEx or check. taxes) will be charged. A credit card number is required to confirm your reservation. Check-in is 3:00 pm; Check-out REGISTER VIA: is 12:00 noon. Reservation requests made after August Online: www.cme.ucsf.edu 29, 2012 will be honored at the conference room rates Mail: Complete course registration form on a space-available basis. Room rates are subject to and send with payment to: all state and local taxes (currently 15.565%, subject to UCSF Office of CME change without notice). P.O. Box 45368 RENTAL CAR San Francisco, CA Hertz is offering special rates for participants of 94145-0368 this conference; simply call (800) 654-2240 and Fax: Fax completed registration form to: refer to identification number 03BW0131, or call (415) 502-1795 (be sure to include your travel agent. You may also make reservations your credit card number) at www.Hertz.com. Advance reservations are recommended. Phone: To register by phone or to inquire about registration status, please call UCSF’s AIR TRANSPORTATION CME Registration Office at (415) 476-5808. UCSF has negotiated special fares with American Please check our website for up-to-date and United Airlines for our course attendees. You may information on the course: use the following tour codes to book on your own: www.cme.ucsf.edu American (800) 433-1790 code: 1310SS On-Site Registration: Generally we are able to United (800) 521-4041 code: 510CF accommodate on-site registration at our courses at our courses however pre-registration is preferred. GOT PAPER?... NOT REFUNDS We will no longer be distributing a printed syllabus Cancellations received in writing before the first for this course – printing one consumes nearly day of the course and each course workshop will be 400,000 pieces of paper! Registrants will have refunded, less a $75 administrative fee. No refunds access to all presentations on a conference website will be made on cancellations received after that date. pre- and post-conference.
    • www.cme.ucsf.edu The Changing Practice Of Anesthesia MAN13001 September 21-23, 2012 Hotel Nikko • San Francisco, California Mail to : UCSF Office of CME Online registration: www.cme.ucsf.edu P.O. Box 45368 Registration Information: (415) 476-5808 San Francisco, CA 94145-0368 Course Information: (415) 476-4251 Fax: (415) 502-1795 æ Dr. æ Mr. æ Mrs. æ Ms. _________________________________________________________________ Last Name First M.I. _________________________________________________________________ Degree Specialty _________________________________________________________________ Address _________________________________________________________________ City State Zip _________________________________________________________________ Daytime Phone Fax _________________________________________________________________ Email Address Label Code Letter (see address label: example, A, B, C, D, etc.)____________________ Would you like to be on our priority email list? £ Yes £ No Date of birth to be used as OCME registrant number: ___ ___ /___ ___ / X X Month Day Please indicate if you have any special needs: ____________________________________ SAN Registration Fees FRANCISCO £ $525 Physicians BAY AANA # __________________________________ £ $450 CRNAs £ $450 AHP, Nurses £ $225 Residents, Interns, Student CRNAs (include a letter from the Program Director) PIER Additional Workshop Fees – Registration is only online at39 www.cme.ucsf.edu St Jefferson UNDERWATER Make checks payable to UC Regents YOUTH FISHERMANS WHARF WORLD AQUARIUM Grant Av HOSTEL AQUATIC THE Beach St PARK MARITIME Please charge my credit card: £ Visa £ MasterCard £ AmEx for $ _________________________ CANNERY Kearny St FT. 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D MOSCONE CROOKE NORTH BEACH Greenwich RECREATION STREET PLAYGROUND CENTER LEVIS Lombard St PLAZA Course Registration Form Filbert Stestnut St Refund Policy: Cancellations St TELEGRAPH Union each course received inMICHELANGELO before the first day of the course and St writing Greenwich PLAYGROUND WASHINGTON HILL 101 workshop will be refunded, less a $75 administrative fee. No refunds will be made on ncancellations SQUARE NORTH Gree Stombard St Front St received after that date. Filbert St RUSSIAN BEACH Montgomery HILL BROADWAY Kearny St St St VallejoGreenwich PIER Grant Av St (Pedestrian) Powell St ion Please check our websiteUnfor up to date information on the course: www.cme.ucsf.edu.y Mason St COW Taylor St Filbert St Davis St Jones St HOLLOW Broadwa Stockton St St Leavenwo Green St Hyde St Larkin St Co Polk St Union St OCTAGON lum Pacific St Van Ness HOUSE WALTON Franklin St ON-SITE REGISTRATION Vallejo St bu PARK rth St Gough St sA Octavia St Drumm St v Jackson St Laguna St Green St Buchanan Landmarks Time: 7:00am - 8:00amBroadway Webster St Av Fillmore St St Vallejo St Neighborhoods TRANSAMERICA Washington WOR Date: September 21, 2012St CHINATOWN PYRAMID BLDG. TRAD St Pacific Points of Interest JUSTIN r Line Cable Ca PORTSMOUTH Clay St EMBARCADERO HERMAN F Broadway Parks B Place: Hotel Nikko Jackson St SQUARE SHOPPING CENTER PLAZA Th Cable Car Lines St Sacramento eE Pacific St 222 Mason Street Washington St NOB EMBARCADERO HILL STATION Jackson St San Francisco, CA 94102 FINANCIAL California St tS t DISTRICT Battery St RINCON Clay St rke Sansome St CENTER Ma Montgomery St BANK OF Washington Sp GRACE AMERICA BLDG. St ea LAFAYETTE St CATHEDRAL Sacramento rS PACIFIC PARK Pine St ion MASONIC ss Ma Clay St HEIGHTS AUDITORIUM Mi in St St St California Be Bush St St SAN FRANCISCO ale St rd Kearny St Sacramento TRANSBAY wa St Grant Av Ho Fr TERMINAL Stockton St em Pine St CROCKER Powell St on GOLDEN Mason St GALLERIA tS St California GATE UNIV. Taylor St 1s t Jones St t Leavenwo St Bush St Hyde St Post St MONTGOMERY ST. 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