2007 to 2012
Transcription
2007 to 2012
Department of Anesthesiology Report 2007 to 2012 Photo by Mélanie Provencher Dr. David Ewing Dr. Philipp Mossdorf TOH Anesthesia CHEO Anesthesia Chief Civic Campus Site Chief Dr. Jean-Yves Dupuis Dr. Robert MacNeil University of Ottawa TOH Anesthesia Heart Institute Cardiac Riverside Campus Site Chief Anesthesia Chief Dr. Homer Yang University of Ottawa Department of Anesthesia Chair, TOH Department of Anesthesia Chief Dr. Donald Miller TOH Anesthesia General Campus Site Chief Table of Contents ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAIR & CHIEF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 The Ottawa Hospital –Civic Campus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Malignant Hyperthermia Investigation Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 The Ottawa Hospital – General Campus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Hyperbaric Medicine Unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 TOH Pain Clinic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 The Ottawa Hospital- Riverside Campus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 University of Ottawa Heart Institute – Division of Cardiac Anesthesiology and Critical Care Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Children’s Hospital of Eastern Ontario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Department of Anesthesia Research Summary Contributors: Drs. Wilkes, Bould and Murto.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 TOH Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 CHEO Anesthesia Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..32 Annual Gary Johnson Anesthesiology Research Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Education Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Undergraduate Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Anesthesia Simulation Postgraduate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Medical education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 The ottawa hospital Fellowships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 CHEO Fellowships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Cardiac Anesthesiology Fellowship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Faculty Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Journal Club . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Annual Anesthesia Winterlude Symposium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Global Anesthesia Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Publications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Book Chapters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Awards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Historical Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 STAFF LISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Front cover photo: Dr. Caroline Tallmadge an•es•the•sia : (an”es-the´zhah) 1. New Latin anaesthēsia, from Greek anaisthēsiā, insensibility : an-, without; see a-1 + aisthēsis, feeling (from aisthanesthai, aisthē-, to feel; see au- in Indo-European roots). DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 ACKNOWLEDGEMENTS As in any large department, it takes a number of people to make such a report possible. We acknowledge the assistance of France Greenwood at the General Campus office and Elaine Stinson at the Civic Campus office for providing details incorporated in these reports. Ms Julie Ghatalia provided the statistics on undergraduate teaching. Jennifer Borup provided information on the activities at CHEO for which we are grateful. Denise Wozny and Alison Conley, at the Department of Anesthesia research office, provided tremendous help on research funding details. We also thank Angie Ross at the Heart Institute for her support. Holly Videto provided information on the residency and Family Practice Anesthesia. Tara Fuller, Assistant to the Chair, has provided tremendous support in facilitating and coordinating all the documents to be available in time for editing and proofreading. Lynne McHardy, Department Manager, provided copious detail, both historical and current, on all aspects of the Department of Anesthesiology. She also provided timely management and review on every aspect of this project. This has allowed us to present a very complete picture of who and where we are. The work of Jane Armstrong in editing the text for flow and consistency of style has been essential indeed. The artistic flair of Jayne Robertson has made the report both visually appealing and easy to read. We are also grateful for the photographic talents of Mélanie Provencher, Dr. Lucie Filteau, Dr. Caroline Tallmadge and Diane Sheppard. The images they have provided do justice to our dynamic and multi-faceted department. 1 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 CHAIR AND CHIEF Welcome to the Department of Anesthesiology 2012 Report, a summary of 2 our activities from June 2007 to May 2012. This is one of the largest departments of anesthesiology in Canada, with over 100 faculty members, more than 50 residents, about 20 fellows, and a number of valuable support staff, including research and anesthesia assistants. The department spans the CHEO, The Ottawa Hospital (General Campus, Civic Campus and Riverside Campus), and the Division of Cardiac Anesthesia at the University of Ottawa Heart Institute (UOHI). Incorporating the Montfort Hospital as the main francophone campus for the University of Ottawa School of Medicine is also under consideration. As this report demonstrates, there is a strong sense of coherence and collaboration among all pillars of our department. A key element of a successful department is its ability to play an important role as a citizen in a larger community. I believe our department has participated fully as a citizen both in the university and in the hospitals. I would also like to take this opportunity to express our appreciation to the Faculty of Medicine, The Ottawa Hospital, CHEO, the Heart Institute, the CHEO Research Institute, Dr. Homer Yang, University of Ottawa Anesthesia Chair and TOH Anesthesia Chief and the UOHI for their help and collaboration – without which it would not have been possible to achieve our objectives. This includes the support from our nursing colleagues, administrative decision-makers, and other colleagues in research and in education outside of our department. In the last five years, our department has achieved significant advances in clinical care, education, clinical research, quality and patient safety. In clinical care, there have been tremendous developments in acute (Dr. Penning) and chronic pain management (Drs. DiRenna and Smyth), the establishment of the hub-and-spoke model to create an integrated care model, and in complex palliative pain management. Our program of echocardiography for noncardiac surgery (Dr. Fayad), the only one of its kind in the country, also plays a leadership role in offering a fellowship program. The unique skillsets in perioperative hemodynamic monitoring and in diagnosing unanticipated cardiovascular abnormalities build on our already excellent DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The University of Ottawa Surgical Skills and Simulation Center (uOSSC) is an excellent example of collaboration between the University of Ottawa and The Ottawa Hospital. It is the largest in Canada and third largest in North America. With the collaboration of the Academy of Innovation in Medical Education (AIME), our departmental research in education has blossomed. Our simulation and education research places us among the top departments, if not at the top, in innovation and productivity. The credit, of course, must go to Drs. Naik, Bould, Boet and Hamstra for this very successful endeavour. A significant development in clinical care is recognizing the importance of quality and patient safety, directly evolving from the “To Err is Human” report by the Institute of Medicine. The Ottawa Hospital — through its enterprise electronic medical records (vOACIS), Patient Safety Learning System (PSLS), Surgical Information System (SIMS), National Surgical Quality Improvement Program (NSQIP), and more recently, computerized order and entry system (CPOE) – has provided the pillars of quality improvement and patient safety. Our department has established the Anesthesia Quality and Patient Safety Committee (Dr. Alan Baxter), a multi-disciplinary coordinating committee to provide oversight on the available data from these systems affecting perioperative care. “ One cannot improve what one cannot measure”; now we are actually able to measure processes and outcomes. This is a significant advance in care. We have a strong Post Graduate Medical Education (PGME) Program and the core activity is strongly supported by all of our faculty. We are proud to say we have passed the Royal College Accreditation with flying colors. We have an excellent working relationship with family medicine in the GP Anesthesia Program. I am proud of our department and of its components, for they are truly global villages within a bigger entity. Our accomplishments would not have come about without the collaboration of those both inside and outside the department, focusing on the welfare of our patients, and caring for them as “our loved ones.” intraoperative cardiac echocardiography program (Drs. Hynes, Lambert, Sohmer and Dickie) and add to the multitude of indications in non-cardiac surgery. The department’s contributions to pharmacotherapeutics (Dr. Chaput) and pain management (Drs. Penning and Smyth) in the Undergraduate Medical Education (UGME) have been acknowledged by the Faculty of Medicine, as evidenced by the awards and student feedback received. We are also consistent contributors to the case-based learning tutorials at the medical school. 3 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 4 Royal Connection: Dr. Yang’s office at the Civic Campus of The Ottawa Hospital has a special connection to the Dutch royal family. In 1940, after the occupation of the Netherlands by Nazi Germany, Princess Juliana moved to Ottawa with her two young daughters. On January 19, 1943, she gave birth to a third child, Princess Margriet, at the Ottawa Civic Hospital. The maternity ward was temporarily declared to be “extraterritorial” by the Canadian government and therefore was Photo: Mélanie Provencher considered to be technically international territory. This ensured that the newborn Princess would derive her citizenship from her mother only, thus making her solely Dutch. The delivery room was on the third floor and the mother of Princess Margriet convalesced in what is now Dr. Yang’s office, where a wall plaque serves as a reminder of the room’s historical significance. The Dutch royal family remembers Canada with a yearly gift of tulips for Ottawa. Princess Margariet Photo Credit : Source unknown. Photo: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 CLINICAL DEPARTMENTS The Ottawa Hospital Civic Campus Dr. David Ewing, TOH Anesthesia Civic Campus Site Chief Any large Canadian teaching hospital will undergo many changes over a five-year period, and the Civic Campus has been no exception, with new surgical programs, transfers of programs between campuses, the implementation in 2011 of SIMS computerized perioperative record keeping, as well as staffing changes. I became the Anesthesia Civic Campus Site Chief in May 2010, following Dr. Michael Curran, who spent a productive four and a half years in the position. Staffing Since 2008, there have been several new additions to the Civic Campus staff. In 2009, we were joined by Dr. Naveen Eipe, whose interests include Acute Pain Management; Dr. Jordan Hudson, whose interests include Perioperative Echocardiography and Vascular and Thoracic Anesthesia; Dr. Viren Naik, whose interests are in Simulation and Medical Education; and Dr. Sanjiv Gupta, whose interest is in Pharmacology. Dr. George Evans, whose interest is in Chronic Pain, and Dr. Leo Jeyaraj, whose interest is in Obstetrical Anesthesia, joined the group in 2010. Dr. Greg Krolczyk, with an interest in Neuroanesthesia, joined in 2011. In the summer of 2012, Sukhjeewan (Cindy) Basran joined our department. Dr. Basran has interests in Vascular, Thoracic and Echo. In the fall of 2012 we expect to be joined by Dr. Jelka Lujic, whose interests include Neuroanesthesia. New Programs Another new program is echocardiography in non-cardiac surgery. In the deployment of vascular stents, echo studies of the great vessels now play an integral role in supporting stent deployment, not infrequently providing more information than angiography. In addition, intraoperative and postoperative echo studies have now started playing a key role in managing complex cardiovascular problems. Many case reports have been published from these management challenges. The Bariatric Surgical Program, which started in September 2009 with the use of two operating rooms per week and four cases, has grown to four operating rooms per week with 10 cases in order to fulfill the Ministry of Health funding requirement of 450 cases a year. 5 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The addition to The Ottawa Hospital in 2011 of a new neurosurgeon, Dr. Amin Kassam, with expertise in skull-based surgery, has challenged the operating room team with a whole new set of surgical and neuromonitoring equipment and expertise. TOH is assisting Dr. Kassam in attracting international patients and will be reconstructing one of the operating rooms for his use in 2012-13. Program Transfers There has been a greater realignment of surgical volumes and services within TOH. Thoracic surgery moved to the General Campus prior to 2008. In 2010, major head and neck surgery was transferred to the General, and major dental maxillofacial surgery and major urological cancer surgery were transferred to the General in 2011. We may see more consolidation of total joints in 2012 and a move by breast cancer surgery to the General in 2013. 6 Photo: TOH DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Renovations Renovations of the operating rooms at the Civic Campus are scheduled for the latter half of 2012 and into 2013.The plans call for four new suites to be built in the old operating roo Two rooms will be used for minimally invasive general surgery and vascular surgery. Three rooms will be transformed into one neurosurgical suite to allow for intraoperative CT scanning. Non-Clinical Time Thanks to the Alternate Funding Plan and the expansion of our Fellowship Program, the need for non-clinical time for education (postgraduate and undergraduate), research and administration has increased in recent years. We now routinely have six to eight Fellows per year at the Civic Campus, giving us the flexibility to juggle our non-clinical commitments throughout the TOH and the University of Ottawa. Out-of-Hospital Clinics Since 2007, the Civic group has continued to work at out-of-hospital clinics. As of mid-2012, the Civic group is providing anesthesia at five private clinics, compared to two in 2007. We are also actively involved in the new Out-of Hospital Inspection Program, which was created by the College of Physicians and Surgeons of Ontario in 2010 to improve the quality of these clinics. Challenges Ahead Going forward, our challenge will be to continue providing excellent clinical and non-clinical activities at a time of shrinking health care funding. We have added more on-call coverage for the weekends to handle last-minute neurointervention and other procedures and to keep the busy operating rooms running. The hospital hired efficiency experts from Harvard University in 2011 to improve our backlogged operating room emergency lists and improve our hospital bed shortage – while not reducing service. Over time we will see if this strategy improves working conditions and patient-care efficiency at TOH. GENERAL 7 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Malignant 8 Hyperthermia Investigation Unit Dr. Kevin Nolan, TOH Anesthesia Malignant Hyperthermia Unit Director The Malignant Hyperthermia (MH) Investigation Unit at the Civic Campus of The Ottawa Hospital was established in 1978 through the pioneering efforts of Dr. Vivian Morton, an anesthetist at what was then the Ottawa Civic Hospital. Following a clinical experience with an MH crisis, she decided to visit Dr. Beverly Britt’s MH unit in Toronto. There, Dr. Morton acquired the skills to counsel and investigate individuals thought to be susceptible to MH. Various individual anesthetists have followed in her footsteps as directors of this unit: Drs. Wayne Lambert, Charles Cattran, Greg Allen, Gord Reid and Kevin Nolan. Throughout, Mary Lou Crossan, our dedicated lab technician/coordinator, helped keep us on a steady course. Over the years we have regularly answered phone and written requests from individual patients and the health care practitioners who care for them. Although many of our contacts live in Ontario, the unit serves patients from all over Canada and receives email correspondence from a variety of other countries. We have developed a substantial family tree database of MH-susceptible families, along with copies of related medical records. The MH Unit is an active member and contributor to the North American Malignant Hyperthermia Registry, an extensive database of MH-susceptible individuals. We regularly attend meetings sponsored by the MH Association of the United States. We correspond regularly with members of this group, Canadian anesthesiologists interested in MH and MH investigators in Europe and New Zealand. The MH Unit in Ottawa has assisted in the development of publications in peer-reviewed journals and poster presentations at international meetings. Under the leadership of Dr. Victor Neira, an anesthesiologist at the Children’s Hospital of Eastern Ontario (CHEO), we have taken part in educational events involving the management of simulated MH crises. The MH unit hosted an educational conference in June 2011 in Ottawa for health care workers, patients and families interested in malignant hyperthermia. This event was sponsored by the MH Association of the United States. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Dr Nolan has been invited to give MH-related presentations at: TOH General OR nurses Wednesday morning educational conference, April 2009. Annual meeting of the Ontario PeriAnesthesia Nurses Association, October 2009. CHEO Anesthesia Grand Rounds, March 2010. Winterlude Anesthesia Conference, Ottawa, February 2011. TOH Civic OR nurses Wednesday morning educational conference, February 2011. MH educational conference, Ottawa, June 2011. TOH Cardiac Anesthesia Grand Rounds, June 2011. Currently, we are one of the two remaining MH investigation units in Canada (the other being in Toronto), the centres in Winnipeg and Calgary having closed. The MH unit continues to advise individuals who request assistance and investigate patients for MH susceptibility. We are now involved in selecting individuals for genetic assessment in collaboration with genetic counsellors at CHEO, and in developing computer-based access to our large database of MH individuals. Since November 2011, due to funding issues, we have not performed muscle biopsy or caffeine halothane contracture testing. 9 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The Ottawa Hospital 10 General Campus Clinical Activities – Operating Room Clinical activities have grown steadily over the last five years, and all 17 surgical suites of the General Campus are used extensively. During the last fiscal year (April 1, 2011, to March 31, 2012), there were 20,690 elective hours of surgery, representing 7,327 cases, and 6,584 hours of non-elective surgery, representing 2,664 cases. In all, the General Campus accounted for 27,274 hours of the 64,609 hours of surgery time at TOH that year. The surgical case mix at the General Campus continues to evolve. Major orthopedics, excluding spine surgery, and the bulk of surgical oncology programs have now been consolidated to the General Campus. During 2011-12, the breakdown by services by hours used was: orthopedics 28.7%; general surgery 19%; urology 15.7%; thoracic surgery 9.1%; otolaryngology 7.3%; gynecologic oncology 5.1%; ophthalmology 4.4%; and plastics 2.6%. A smaller number of OR hours are used by dental surgery after the dental services program was consolidated to the General Campus in 2011. Dr. Donald Miller, TOH Anesthesia General Campus Site Chief Drs. Calvin Thompson and Larry Byford co- lead the thoracic anesthesia program, which also recognizes Drs. Stéphane Moffett and Sylvain Gagné as subspecialists in thoracic anesthesia. The regional anesthesia program is led by Dr. Alan Lane. The “regional group” of subspecialists consists of Drs. Evans, McKenna and Costache. Other sub-specialized programs at the General Campus include the living-related transplant program, which has a very high success rate for living –related kidney transplantation. In addition, the robotics-assisted surgery program was launched in 2011. Current surgeries being performed with the Da Vinci® robot include radical prostatectomy and radical hysterectomy. In over 120 roboticsassisted procedures performed at TOH, there has been very low associated morbidity and no related mortality, while hospital stays are reduced to overnight only. Dr. Calvin Thompson has served as the anesthesia lead during the implementation of this multidisciplinary program. Anesthesia services to the specialties and subspecialties are provided by 31 full-time and part-time faculty from the General Campus, as well as faculty from the Civic Campus, on a rotating basis. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 General Campus Anesthesia Services – Birthing Unit The General Campus division provides exemplary elective anesthesia services on weekdays for elective cesarean deliveries and related surgical procedures, a full consultation service and 24/7 services for labour analgesia and emergency procedures for 3,300 to 3,500 deliveries a year. Dr. Catherine Gallant is the lead of obstetrical anesthesia services. The subspecialty group consists of 12 dedicated individuals with an interest in obstetrical anesthesia who rotate through the birthing unit on a regular basis. The anesthesia department is involved in the care of close to 90% of parturients in this hospital. Over the past three years, our cesarean delivery rate has ranged from 28% to 30%. Our epidural rate is 55%. Friday afternoons are now dedicated to an obstetrical anesthesia clinic where we see high-risk patients with a variety of complex co-morbidities. We work closely with the advanced practice nurse, Debra Kaye, and the maternal fetal medicine group, along with other specialties, to devise multidisciplinary plans for these mothers. 11 GENERAL Photo: TOH DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 All members of the birthing unit team have worked hard to improve patient safety by implementing all three portions of the surgical safety checklist, with close to 100% compliance. The patient safety learning system has been enthusiastically embraced and anesthesia is part of an active quality assurance program that meets to review cases on a monthly basis. 12 This year the anesthesia department was delighted to start a series of academic lectures to the maternal fetal medicine fellows and we look forward to continuing this on an annual basis. We continue to contribute to undergraduate education by providing a lecture on epidural analgesia to the second year medical students as part of their reproductive learning block. For resident education, in 2011 we purchased a dedicated ultrasound machine for placement of labour epidurals. We are actively teaching the residents to become experts in its use. We purchased a low fidelity simulation mannequin for our newest residents to practise placement of both epidurals and spinals. We have upgraded our difficult airway cart by recently purchasing one that is identical to that available in the main operating room, including a new bronchoscope. In 2011, Janet Sample became the clinical manager of the birthing unit. We have worked together to improve communication between nursing, obstetrics and anesthesia and look forward to continuing this in the future. Clinical Activities – Preoperative Assessment Unit (PAU) There was a wonderful celebration in 2012 related to the opening of the new Preoperative Assessment Unit on Level 2 of the South Tower of the General Campus. The new, modern physical space offers unparalleled work flow through a large waiting area, spacious consultation rooms, offices and conference room adapted to patient evaluation and documentation with the SIMS electric medical record. As the number of elective cases increases, so do the number of patients in the PAU. The General Campus PAU assessed 12,132 patients in the 2011-2012 fiscal year. Of those, there were 6,008 anesthesia assessments, 1,974 nursing assessments and 4,150 family physician visits. The total number exceeds the elective OR volumes due to the number of chart reviews and re-assessments. Major changes coming to the PAU process include the implementation of a patient-completed, pre-screening tool to help determine visit type, 11 surgical pre-printed pre-op order sets for surgeons, and a surgeoncompleted PAU checklist to improve communicationand completion of required documentation, and to ensure all pre-op orders are completed. The PAU model will also be standardized across all three campuses, with the following visit types available, based on surgical procedure and medical history: telephone nursing assessment, in-person nursing assessment and anesthesia consult with nursing assessment. In March 2012, the patient health history pre-screening tool was used in a pilot by the PAU, Surgery and Nunavut teams, which successfully helped to triage 12 successful joint patients to Ottawa for their knee surgery. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Barbara Crawford-Newton has played a major role in this project and will continue to do so as the process becomes fully implemented . it was announced that the ECT services at TOH would be consolidated to the General Campus, with full implementation in late 2012. Other initiatives include updating our fasting guidelines to promote oral intake of fluids containing carbohydrates pre-op, establishing a smoking cessation program with the help of Dr. Chris Pysyk, initiating standardized bowel and skin prep protocols for patients prior to the day of surgery with the assistance of the surgical division chiefs, and the revision of the patient education booklets for the Preoperative Assessment Unit, Surgical Day Care Unit, Same Day Admit Overnight Unit and Same Day Admit Unit. Anesthesia for Endoscopy: Anesthesia services for deep conscious sedation and general anesthesia for endoscopy are provided on Tuesday mornings. Lastly, research to determine the usability and validity of the new tools and processes is currently underway with the Ottawa Hospital Research Institute and will continue into the next year. This will allow the clinical, organizational and patient-specific outcomes of the PAU standardization at TOH to be evaluated. General Campus - Satellite Anesthesia Services Program In addition to their many other supportive roles in the perioperative setting, duly qualified anesthesia assistants have been instrumental in the provision and expansion of satellite anesthesia services in the following domains: Electroconvulsive Therapy: Within the Mental Health Program, electroconvulsive therapy (ECT) services are offered in the Post Anesthesia Care Unit Monday, Wednesday and Friday mornings. In 2011, Anesthesia for Brachytherapy: Brachytherapy services were consolidated to a new unit built on the main floor of the General Campus in 2010. Services for general anesthesia for complex brachytherapy afterloading catheter insertions are provide on Mondays and Wednesday. Anesthesia for Radiofrequency Ablations, MRIs and Cardioversions: Anesthesia services for these procedures are provided on an as-needed basis. CARD The Cardiac Arrest Roles Defined (CARD) study, which aims to improve multidisciplinary operating room team crisis management, is currently in its second phase. The study, run by Dr. Tania Di Renna, Dr. Simone Crooks and Dr. Sylvain Boet, received TOHAMO funding this year and has successfully trained over 140 multidisciplinary health care professionals at the Civic and General Campuses on teamwork and crisis management using simulation. The goal of this initiative is to evaluate a novel cardiac arrest protocol, which has been designed to eliminate the problems of role definition and overcrowding during intraoperative cardiac arrests. The project 13 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 has also expanded to the OB and neonatal department with OB CARD currently being developed. It is hoped that this collaborative effort between neonatology, obstetrics and anesthesia will improve outcomes in perinatal crisis management. 14 Other Departmental Activities Since 2005, TOH General Campus Department of Anesthesiology has been proud to serve as the home of the editorial office of the Canadian Journal of Anesthesia, whose editor-in-chief is Dr. Donald R. Miller. Among the benefits of hosting an editorial office “in-house” are ready access for faculty members to pre-submission inquiries, educational opportunities (within the CanMEDS Framework) in editorial peer review, and the ability to offer editorial electives for senior residents in anesthesia. The journal is owned by the Canadian Anesthesiologists’ Society and published by Springer Science + Business Media LLC New York. Journal content is driven by the mission statement: “Excellence in research and knowledge translation related to the clinical practice of anesthesia, pain management, perioperative medicine and critical care.” Articles are received in either English or French, and those accepted for publication appear in the language of submission. All articles are peer reviewed and published articles appear both in print and online. The publishing model is subscription-based, although authors are able to pay a fee to retain copyright of individual articles for a fee, under the Creative Commons Licence and the publisher’s Open Choice program. The journal’s international exposure and reach continue to grow. In 2011, 749 articles were submitted by authors from 52 different countries. The journal published 203 articles in 12 monthly issues (Can J Anesth 2011; Volume 58) representing 1,326 editorial pages. These articles included invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, reviews, systematic reviews, continuing professional development (CPD) modules and letters to the editor. In keeping with the mission statement, the content spanned the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the journal published the Canadian Anesthesiologists’ Society Guidelines to the Practice of Anesthesia 2011 Edition. The February 2012 issue was devoted to medical education, with substantial input from Drs. S. Boet and V. Naik , experts in medical education at TOH Department of Anesthesia. The one-year journal Impact Factor, which is an independent measure of mean journal citation frequency, remains stable. In 2009, it was 2.306, while in 2010 it was 2.18. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Hyperbaric Medicine Unit The Ottawa Hospital’s Hyperbaric Medicine Unit (HMU) is the only hospital-based hyperbaric unit in Eastern Ontario. The Ottawa Hospital’s Hyperbaric Medicine Unit (HMU) is the only hospital-based hyperbaric unit in Eastern Ontario. The Hyperbaric Medicine Unit opened its doors in 1995 at TOH’s General Campus. In 2007, the HMU expanded to two chambers to meet the growing demands for treatment and moved to a new space within the hospital. The HMU employs a Perry Sigma II dual place system with a locking chamber, as well as a Perry Sigma II/III dual place chamber. Hyperbaric oxygen therapy provided in TOH’s HMU is covered under the Ontario Health Insurance Plan for the following Undersea and Hyperbaric Medical Society approved conditions: • Air or gas embolism Dr. Peter Duffy, TOH Hyperbaric Unit Director • Carbon monoxide poisoning and smoke inhalation; carbon monoxide complicated by cyanide poisoning • Clostridial myositis and myonecrosis (gas gangrene) • Crush injury, compartment syndrome, and other acute traumatic ischemias • Decompression sickness • Enhancement of healing in selected problem wounds • Exceptional blood loss (anemia) • Necrotizing soft tissue infections • Refractory osteomyelitis • Delayed radiation injury (soft tissue and bony necrosis) • Compromised skin grafts and flaps • Thermal burns Most commonly seen are problem wounds related to diabetes and peripheral vascular disease and radiation injury. We see a combination of in-patients and out-patients and accept outside referrals. Patients are seen for consultation, transcutaneous oximetry studies, HBO2 treatments, and follow-ups, or some combination of these. 15 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The team consists of a medical director, safety director, charge respiratory therapist, seven rotating hyperbaric physicians (with backgrounds in anesthesia and otolaryngology), 28 rotating hyperbaric controllers and/or attendants (all of which are registered respiratory therapists), and one secretary. The Hyperbaric Medicine Unit’s Best Practice Committee includes the entire team and is dedicated to advancing patient care, promoting patient and employee safety, and enhancing communication. Among other continuous quality improvement projects, regular learning activities, safety drills and other emergency procedures are conducted to ensure and maintain staff proficiency. 16 Photos: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 TOH Pain Clinic Dr. Tania DiRenna, TOH Pain Clinic Director The Ottawa Hospital Pain Clinic consolidated to a single site within the Critical Care Wing (Level I), near the General Campus Department of Anesthesia administrative offices, in 2009. The Pain Clinic is an impressive, modern facility comprising a large waiting area and reception, 10 examination areas and a lead-lined fluoroscopy suite with access to fluorosccopy service three days/ week. There are also physician’s offices, a conference area and a small library. The Pain Clinic is collaborating with an expanding number of clinical services to create interdisciplinary clinics, including a Pelvic Pain Clinic with gynecologist Dr. Sony Singh. We will also be collaborating with the Department of Psychiatry to create a joint clinic. In April 2012, the Pain Clinic acquired the services of psychologist and researcher Dr. Patricia Poulin. Dr. Poulin is extensively published and is currently involved in many pain-related research projects in the clinic. The Pain Clinic continues to evolve under the medical leadership of Dr. Tania DiRenna, who assumed this role from Dr. Cathy Smyth in 2011. Dr. Smyth was awarded a grant from The Ottawa Hospital Academic Medical Organization (TOHAMO) for the hub-and-spoke Pain Preceptorship Project, which involves assessing and managing complex pain patients with their family doctors in the community setting. This project has many benefits, including providing support for family practitioners and building a network of family doctor resources. The neuromodulation program is running well, with support from the hospital for the implantation of spinal cord stimulators and baclofen pumps. The pain physicians are collaborating closely with the Neurosurgery Division to help in the recruitment of a neurosurgeon with subspecialty training in pain. Chronic Pain Education Initiatives Dr. Cathy Smyth collaborated with Dr. John Penning to establish the University of Ottawa Medical Undergraduate Pain Week curriculum that is offered during the integration block. Chronic Pain physicians are responsible for giving yearly lectures and running case-based learning sessions. 17 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Dr. Smyth is also a representative on the Royal College of Physicians and Surgeons of Canada specialty committee responsible for creating the Pain Medicine Residency Program, which is expected to be rolled out in 2014. In addition, she serves as the vice-chair of the Academic Pain Directors Committee (Canada). Pain physicians are responsible for organizing and teaching at the Family Medicine “Essentials of Chronic Pain” Continuing Medical Education day. The Pain Fellowship Program will be welcoming two new fellows for the 2012-2013 year. Dr. George Evans is the pain fellowship director and in this role has developed a weekly education curriculum with didactic teaching and interactive multidisciplinary rounds. Pain Clinic Administration The pain team is collaborating closely with The Ottawa Hospital quality plan to improve pain control throughout the hospital. Initiatives 18 Photo: Mélanie Provencher Photo: Dr. Caroline Tallmadge DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 include the creation of the Pain Education Series, which is a collection of 10 modules created by Dr. Tania Di Renna and Susan Madden that will be posted on TOH Infonet. Completion of the first three modules will become mandatory for all nurses and residents. The pain team is collaborating with the Department of Internal Medicine to give priority to inpatient chronic pain consults. Dr. Di Renna and Pain Clinic Manager Sean Gehring are creating a novel approach to pain services triaging, which involves a web-based triaging system for all TOH pain services. 19 Photos: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Special patients/special procedures Andrea Blakeley was a special patient of TOH Complex Cancer Pain Clinic. Andrea has kindly allowed us to tell her story. We met her in November 2011 when Gyne-Oncology asked for our assistance in managing her pain from cervical cancer. Over the next two months, we trialed several pharmaceutical approaches, but Andrea’s pain grew worse as her cancer escalated. Andrea was finally admitted to hospital to have an intraspinal catheter implanted. Although her pain subsided, it still presented a challenge. 20 Ultimately, her pain was controlled during the last months of her life through the use of a continuous intraspinal catheter (port-a-cath) infusing lidocaine and morphine. Andrea was comfortable and able to spend time with friends and family, watching hockey games and going out for walks, until she peacefully passed away on April 25, 2012. Andrea was accomplished in sports and in her career. At age 11, she was the first girl to play on the Nepean Raiders minor hockey team. She attended St. Lawrence University on a hockey scholarship and was a Hall of Fame star. She had a thriving career as a lawyer and Crown attorney. Andrea excelled at everything she took on, including her battle with cancer. She has left cherished memories with her partner, Janice Mulcock, her parents Michael (OHI ECHO lab) and Christine Blakeley, and her brothers, Mark and Andrew. The Pain Clinic staff and especially our fellow, Dr. Mairi Chadwick, made a special friend caring for this exceptional young person. —Dr. Catherine Smyth Photo of Andrea provided by: Dr. Cathy Smyth DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The Ottawa Hospital Riverside Campus Infrastructure Over the last five years, the Riverside Campus has continued to fulfil its role as an outpatient facility. It operates five main operating rooms, which processed 5,685 cases last year, and one fluoroscopy-equipped cystoscopy room, able to provide anesthesia on the main floor, which handled a further 3,335 cases. There is also a lithotripsy unit on the main floor, which operates 10 days a month (eight spots/day). On the second floor remains the Eye Care Centre, which has four operating room Two of these rooms are exclusively allocated for cataract surgeries, with one of the other two rooms hosting mostly retinal cases. They operate under an Anesthesia Care Team (ACT) model of one anaesthesiologist with five anesthesia assistants. There were 9,300 cataract surgeries and 1,329 other ophthalmological Dr. Robert MacNeil, TOH Riverside Anesthesia Site Chief cases performed here last year. Preoperative assessments and postoperative care are also carried out in this unit. Cardioversions on an elective basis continue to be held on the occasional Tuesday morning. There have been 18 cardioversions in the past year. Staff There are three anesthesia staff who work 1.6 FTEs total exclusively for this campus. The remainder of the anesthesia staff are assigned from the Civic Campus anesthesia group, with the exception of one daily assignment from the General Campus anesthesia group. Information on their individual and collective research and educational activities can be found in the reports from those sites. 21 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Highlights Highlights over the past five years include: • Integration of the computer record keeping – SIMS project; • Walking Wounded Program, which is successfully coordinated by Kerry Cook, Clinical Manager of the Operating Room, Pre-Admission Unit (PAU), Surgical Day Care Unit (SDCU) and the Post-Anesthetic Care Unit (PACU); 22 • Regional Block Program, providing local anesthesia infusions for day care patients after discharge, with the support of anesthesia assistants; • Teleconferencing of the Wednesday morning educational departmental rounds. Dr. Robert McBurney had served as the most recent Anesthesia Site Chief since the last report in June 2007 up until May 31st, 2010 when he was succeeded by Dr. Robert MacNeil. RIVERSIDE Photo: TOH DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 UOHI Division of Cardiac Anesthesiology and Critical Care Medicine Dr. Jean-Yves Dupuis, University of Ottawa Heart Institute Cardiac Anesthesia Chief Infrastructure The University of Ottawa Heart Institute (UOHI) has undergone many changes in infrastructure over the last five years that have affected the activities of the Division of Cardiac Anesthesiology and Critical Care Medicine. Two new operating rooms (ORs) were added in late 2007 and the UOHI now runs four operating rooms daily and on occasion, a fifth OR for emergency cases. Other additions have been a second electrophysiology (EP) laboratory and a fourth cardiac catheterization laboratory in 2009. These facilities have allowed the development of new cardiology and surgical programs, such as transcatheter aortic valve implantation (TAVI), minimally invasive coronary artery surgery and complex electrohypsiological ablations (e.g. ventricular tachycardia and atrial fibrillation). As a result of those changes and new programs, anesthesia service requirements have increased by 15% in the Cardiac Surgical Intensive Care Unit (CSICU), 50% in the EP/catheterization laboratories and 20% in the pre-admission unit. To meet the increased demand for anesthesia and critical care services, the division increased its manpower from 11 to 13 consultants during the last five years and a fourteenth consultant will soon be added. In August 2011, the UOHI received approval from the provincial government to proceed with the planning and construction of a new facility and the renovation of existing facilities to house the life support services. Planning is underway and it is hoped that construction will start over the next five years and will be completed within 10 years. At that point, the UOHI will have six cardiac surgical operating rooms, six cardiology catheterization laboratories, three electrophysiology laboratories and 27 CSICU beds. Clinical Performance While the number of cardiac surgical cases has not increased much, patient comorbidity, surgical complexity and duration are significantly greater than a decade ago. For example, the number of octogenarians undergoing cardiac surgery has increased from 5.1% to 10.6% over the last 10 years. Interestingly, the mortality in those patients has decreased from 8.9% to 6.7%. In fact, the overall cardiac surgical mortality decreased from 3.4% to 3% during the same time period. These results are undoubtedly the result of better surgical technique in association with better anesthesia and postoperative care. The quality of cardiac surgical care at the UOHI was highlighted in a 2009 Fraser Institute report comparing the results of coronary artery surgery between Ontario and American hospitals (Walker M, Hazel M, Esmail N. A comparative analysis of mortality rates associated with coronary artery bypass graft (CABG) surgery in Ontario and select US States. Studies in Health Policy. Fraser Institute. February 2009). The surgical 23 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 results at the UOHI were the best in Ontario and the only ones in the province that matched the best American centres. The Division of Cardiac Anesthesiology and Critical Care Medicine takes great pride in its role in this excellent clinical performance. 24 Other Highlights In November 2011, Dr. James Robblee stepped down after 15 years as Division Chief and was replaced by Dr. Jean-Yves Dupuis. In the history of the UOHI, only Dr. Wilbert Keon (Division of Cardiac Surgery) and Dr. Donald Beanlands (Division of Cardiology) served longer in a Division Chief function. Dr. Robblee significantly contributed to the development of the Division of Cardiac Anesthesiology and Critical Care Medicine. He also took part in preparing many projects at the UOHI, ensuring the Division was involved in every major development. New Programs and Initiatives • Perioperative TEE • Three-dimension (3D) echocardiography in all cardiac operating rooms • Continuous medical education: local, national and international • Quality assurance: periodic review by Dr. Hynes of randomly selected TEE exams performed by Division members and fellows • Research on 3D TEE for evaluation of valve repair DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 CSICU • Ultrasound for invasive procedures: central line and chest tube insertion • Local and Multicentre Critical Care Research • Monitoring and reporting of patient physiological score Clinical Programs • Transcatheter aortic valve implantation (femoral and transapical) • Surgical aortic valve repair • Percutaneous mitral valve repair (MitraClip) Areas of Clinical Activity • Cardiac Surgical Suite (4 regular operating rooms and 1 emergency operating room) • Electrophysiology (EP) laboratories (2 EP rooms and 1 general procedure room) • Cardiology Catheterism Laboratory (3 laboratories) • Cardiac Surgical Intensive Care Unit Activity (19 beds) • Pre-admission Unit • Percutaneous ablation of ventricular tachycardia • Implantation of Impella ventricular assist device 25 Weighted Case Volume Table 1. Cardiac Surgical Case Load by Type by Year. CASE TYPE 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 CABG (or OPCAB) 783 728 715 593 660 CABG & Valves or Complex 173 171 161 175 173 Valves Only 189 208 208 251 216 Other Open Heart 211 224 250 365 349 Heart Transplant 9 13 12 19 24 Artificial Hearts and VADs 3 8 6 8 11 Total 1367 1351 1352 1411 1433 Table 2. Critical Care Activity in Cardiac Surgical Intensive Care Unit (CSICU). Year 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Total Patient Days 4607 5180 5456 5525 5374 Beds 19 19 19 19 19 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Table 3. Case load in the Electrophysphyiology and Catheterization Laboratories. 26 Year 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Defibrillators 267 342 384 390 452 All ablations 287 338 449 523 505 Complex ablations N/A N/A N/A 147 190 Percuatneous PFO/ASD closure 23 23 37 27 36 Table 4. Consultations in the Pre-Admission Unit Year 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Cardiac Surgery 651 567 544 581 490 Cardiology: EP/other 20 150 210 270 345 Total 671 717 754 851 835 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Children’s Hospital of Eastern Ontario Clinical Activities The Anesthesiology Department at the Children’s Hospital of Ontario (CHEO) performs about 8,500 surgical procedures and 9,500 anesthetic procedures a year. Consisting of 17 anesthesiologists, the team has grown by almost one-third over the past five years to match increased clinical demands and to enhance academic activities. CHEO has a pediatric cardiac surgery program and provides surgical service in almost every specialty except for transplant and very complex cardiac surgery. CHEO anesthesia has also developed an acute and chronic pain service and several other clinical initiatives over the past five years. CHEO’s anesthesiologists are sub-specialized in pediatric anesthesia and are required to have completed either a fellowship program or an equivalent of training. Among our recruits in recent years are two pediatric anesthesiologists with substantial training in pediatric cardiac anesthesia Dr. Philipp Mossdorf, CHEO Anesthesia Chief who have joined the cardiac program. One of the recruited anesthesiologists has a keen interest in pediatric pain management. Currently, we provide three fellowship positions funded by the Department of Anesthesia. Fellows participate in all clinical activities. While the number of anesthesia assistants in the department has increased, we are hoping to add one additional full-time equivalent to establish full anesthesia assistant coverage. Initiatives A number of initiatives and processes have been introduced in the last five years to improve efficiency, quality and patient care: Since the introduction of a new flexible block schedule in September 2004, operating room capacity has increased by 4% without budget or resource adjustments. The increase in capacity is used primarily to address wait time commitments. 27 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 28 A Team in Charge (TIC) has been in operation since September 2011. Consisting of representatives from anesthesia, surgery and OR nursing, the TIC is tasked with facilitating smooth clinical operations during the day and has proven to be instrumental to the effective and efficient operation of the OR. With the introduction in 2009 of a standardized procedural sedation outside the operating room environment, anesthesia assistants now provide sedation to all children requiring it, with anesthesia staff backup. This provides consistent quality and expertise in pediatric sedation, improving patient safety. A full-time nurse practitioner specializing in pain was recruited and a proposal for an addition RN has been submitted. Blood transfusions in children pose particular challenges. Guidelines for the management of massive transfusion in children have recently been developed recently, led by anesthesia. Photo: Mélanie Provencher CHEO Photo: CHEO DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The assistance of anesthesia assistants (AA) is extremely important in the safe conduct of pediatric anesthesia. The effort to provide sufficient coverage by AAs is ongoing. A team of nurses and physicians is collecting data as a basis to improve the time needed between cases. As well, as of September 2011, start times in the OR have been measured and services held accountable for delays. To ensure data-driven decision-making, a new governance system has been established in the past two years. The Perioperative Leadership Team (PLT), with representation from anesthesia, surgery, nursing and administrative staff as well as the Family Forum, ensures follow-up on various projects, oversees quality assurance parameters, and keeps staff informed. Anesthesia is also involved in numerous corporate CHEO patient safety initiatives. Since the Institute of Medicine Report “To Err is Human” in 1999, there has been a notable change in focus on risk and risk management in pediatric anesthesia: What once was considered an acceptable risk may be completely unacceptable today. Anesthesia is engaged in developing tools such as clinical guidelines, pathways and pre-printed orders to improve the flow of operations and enhance safety and the quality of care to our patients. Since 2007, one parent has been allowed to stay with the child during the induction of anesthesia. This project was awarded the CHEO Gold Ribbon Award. Most importantly, the child and parent during a stressful period are able to be together, a circumstance which is of benefit to both. 29 0 2007 2008 2009 2010 2011 2012 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Publications Department of Anesthesia Research Summary 1600000 25 1400000 20 Number 1000000 15 Bould and Murto. Contributors: Drs. Wilkes, Anesthesia Research 30 Year 25 20 1600000 40 1400000 35 1200000 30 1000000 15 800000 10 5 2007 2008 2009 2010 2011 2012 Year Number Number “Nothing has such power to broaden the mind as the ability to investigate systematically and truly all that comes under thy observation in life.” – Marcus Aurelius Dollars TOH 800000 10 A renewed commitment to research across the University of Ottawa Department of Anesthesiology has 0 resulted in unparalleled engagement of both2011 staff and trainees alike. Increases in both the value of grants 2007 2008 2009 2010 2012 5 procured (Figure 1) and the number of publications in peer-reviewed journals (Figure 2) attest to the renewal of research in the department. Only four months intoPublications 2012, we have met the number and dollar value of 2007 2008 2009 2010 2011 2012 grants awarded in 2011. 25 20 600000 15 400000 10 200000 5 0 0 2007 2008 2009 2010 2011 Year The Department of Anesthesiology has long held excellence in education at the core of its mission; it should come as no surprise that learning has figured prominently in the revitalization our research. 40 35 Number The addition of Drs. Viren Naik, Dylan Bould and Sylvain Boet to the University of Ottawa faculty has 30 accelerated research within our simulation in anesthesia group. The University of Ottawa Skills and 25 Simulation Centre (uOSSC) and the Fellowship in Simulation and Medical Education are a focal point for 20 collaboration among our faculty. The uOSSC provides a platform for multidisciplinary projects that expand 15 traditional anesthesia strengths in crisis resource management and high-fidelity simulation to colleagues 10 in medicine, surgery and obstetrics. Results of this collaboration can be seen in the wide variety of topics 5 represented in grants and publications from the education/simulation group. Dr. Gregory Bryson, TOH Anesthesia Research Director 0 2007 2008 2009 Year 2010 2011 2012 2012 600000 400000 200000 0 Dollars 1200000 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Both faculty and trainees have expressed a desire to advance their skills and are seeking postgraduate degrees to advance their research interests. Faculty members Drs. Amy Fraser and Ben Sohmer are completing MEd degrees at the University Illinois – Chicago and University of Cincinnati (respectively), Drs. Jordan Hudson and Chris Hudson are completing Masters of Public Health degrees at Harvard University, and Dr. Diem Tran is completing a MSc in Epidemiology at the University of Ottawa. Dr. Sylvain Boet is completing a PhD in Education at Université de Strasbourg. Dr. Ashraf Fayad is completing a Masters of Clinical Research at University of Liverpool, U.K. Our residents are also seeking additional training with Drs. Dan McIsaac and Louise Sun joining the Hudsons in the Harvard MPH program. This unprecedented degree of research commitment and preparation bodes well for research in the department in the years ahead. Several large, externally funded clinical trials evaluating cardiovascular outcomes following surgery and the influence of perioperative pain management on cognition and persistent postoperative pain energized the department’s research team in 2009-10. As these trials move to publication, researchers exploring perioperative care will have new resources to draw upon. The University of Ottawa Heart Institute has long had both automated records and a departmental database. This resource led to the development of the renowned CARE (cardiac anesthesia risk evaluation) score in 2001 and a host of subsequent publications. In 2010, The Ottawa Hospital launched its electronic health record (PICIS) and will soon roll out the ACUPAM database for the acute pain service. These digital resources will spark research and patient safety initiatives that will drive the clinical research agenda over the next five years. Turning research questions into publications requires energy, time and support. All participating hospitals have motivated their faculty to pursue their research interests and funded the time required to do so. All departments have invested in the research infrastructure suited to their programs: Research assistants, database coordinators, and collaborations with methodologists at local research institutes have provided the platform for innovative research. Investigators have capitalized on the support of their colleagues and have aggressively sought and received “innovation” funds from their academic maintenance. Education researchers have further capitalized on grants offered by University of Ottawa. These local grants have been leveraged to seek larger funding opportunities at the provincial and national level. Under the direction of Vice Chair of Research Dr. Howard Nathan, the Chairman’s Research Fund has provided both the financial and logistical support to obtain external funding and deliver quality results to publication. The results of this collaborative process were recognized with awards and prizes given to University of Ottawa investigators at provincial and national meetings. Research at the University of Ottawa is a team effort and we would like to take this opportunity to thank our colleagues and staff. You provide both the support and stimulus to explore anesthesia practice. Our researchers systematically investigate the observations of our clinicians and teachers. With the knowledge gained, together we will change practice. 31 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 CHEO Anesthesia Research 32 The introduction of a hospital-wide alternate funding plan (AFP) in April 2004 has been instrumental in creating a favourable research environment. In 2007, at a retreat held to define clinical, academic, administrative and educational roles, the following research objectives were developed: 1. Ensure protected time, 2. Expect one first author publication per average weekly number of assigned academic days per year, 3. Hire a clinical research assistant or coordinator, 4. Attract an individual with a Master’s degree in epidemiology or education, 5. Strive for accumulative research funding over $500,000. To this end, the amount of protected nonclinical time for all staff members has averaged 20% over the last few years. We have hired two clinical research coordinators. Dr. Dylan Bould has a Master’s in Education and Dr. Victor Neira is working towards an MEd. Our overall publication rate is improving. Dr. Kimmo Murto, CHEO Research Director Our medical education research arm has been flourishing. Dr. Bould is a senior associate of the University of Ottawa Academy for Innovation in Education (AIME). In addition, both he and Dr. Neira are affiliated with the highly acclaimed University of Ottawa Skills and Simulation Centre. Dr. Bould has been working to bring the U.K. simulationbased course “Managing Emergencies in Pediatric Anesthesia” to Canada. He has established a network for curricular and research collaboration in seven Canadian universities and has been asked to be the research lead for this collaborative effort. Dr. Neira is a collaborator and will advance his own agenda to assess, measure and teach CanMEDs qualities to physicians. He is also involved in establishing a clinical database to assess patients undergoing scoliosis surgery. Dr. Murto is the principal investigator for two ongoing randomized controlled trials investigating postoperative pain relief using oral celecoxib and locally administered clonidine for post-tonsillectomy and hernia surgery respectively. Recruitment for a large cohort of patients (382) in our hospital sleep lab has been completed for a study to determine a clinical prediction rule to diagnose obstructive sleep apnea in children. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Significant progress has been made to improve our research infrastructure. The department provides partial funding for one of our clinical research coordinators. Both have demonstrated excellent administrative abilities and proven to be effective at patient/family recruitment. Much of their success can be attributed to the resources and training provided by the CHEO Research Institute clinical research unit. We have formed links with laboratories to assess analgesic pharmacogenetics and measure drug levels using high performance liquid chromatography and mass spectroscopy. A formal research committee has been struck and we hope to establish a formal clinical/ research-based pediatric anesthesia fellowship.We are also being contacted by pharmaceutical companies to run various clinical drug trials, funding from which will be used to support our various research initiatives. 33 Photo: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Annual Gary Johnson Anesthesiology The Annual Gary Johnson Anesthesiology Research Day is held to recognize the research activity of our residents and fellows. While the format of the day continues to evolve, a nationally or internationally recognized researcher is always invited to speak and to adjudicate the presentations. Visiting professors since 2007 have been: Dr. Kimmo Murto, Gary Johnson Research Day Coordinator 2008: Dr. Viren Naik 2009: Dr. Vincent Chan 2010: Dr. Jerrold Lerman 2011: Dr. David McKnight We are beginning to see activity in areas related to bench and medical education research. Research Day 34 Examples include: 2008: Dr. Shawn Hicks, first prize for “Intralipid does not Improve Survival in a Swine Model of Bupivacaine.” 2010: Dr. Manoj Lalu, first prize for “Safety of Cell Therapy with Mesenchymal Stromal Cells (MSCs): A Systematic Review.“ 2011: Dr. Devin Sydor, second prize for “The Effects of Team Dynamics on Trainees’ Ability to Challenge Authority: Measuring Health Advocacy with Patient Simulation.” At the closing dinner, prizes are awarded to the top three research competition participants and our graduating residents and fellows receive diplomas. The very successful 2011 dinner, held at the National Arts Centre, provided a chance to honour Dr. Gary Johnson on the occasion of his retirement. A former chair of the department, Dr. Johnson initiated this annual celebration of research. Photos: Mélanie Provencher Undergraduate MD Programme DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Fellowship Education Education Summary Vision The Department of Anesthesia will be an international leader in anesthesia education by providing learning excellence with best education practices that are guided by education scholarship. Dr. Viren Naik, Vice Chair of Education Faculty Development Postgraduate Residency Program Vision The Department of Anesthesia will be an international leader in anesthesia education by providing learning excellence with best education practices that are guided by education scholarship Simulation Based Education Research in Education Six pillars support this vision: 1. Undergraduate Education 2.Postgraduate Education 3.Fellowship Education 4.Faculty Education 5.Simulation-based Education 6.Research in Education 1.Anesthesia has a strong presence in the undergraduate MD programs. Our faculty teach in both the clerkship and pre-clerkship. Our commitment is recognized, with faculty selected to the University of Ottawa’s prestigious Distinguished Teacher Program, designed to train future leaders in undergraduate education. 2.Our residency program is our “crown jewel.” We have the best mentors and the best residents in the country. We continue to be one of the strongest and most popular postgraduate programs. We continue to proactively adapt our curriculum for the best education experience. 3.Our fellowship program invites applicants from across the nation and around the world. We offer post-residency training in almost every anesthesia subspecialty. We balance clinical service and education with the opportunity to engage in scholarly projects for a well-rounded experience. 4. We believe that the best teachers never stop learning. With that in mind, we have a strong commitment to faculty development through rounds, workshops, a high quality visiting professor program, and an annual faculty development day dedicated to continuing professional development. 5. We continue to demonstrate our international leadership in simulation-based education at the University of Ottawa. Simulation-based education is integrated into our undergraduate, postgraduate and continuing education activities. The University of Ottawa Skills and Simulation Centre (uOSSC) is the largest simulation centre in Canada focused on high fidelity mannequin and procedural skills simulation. 6.Our department has actively recruited faculty to make education research one of our research foci. Our grants, publications and awards are a proven metric of our success. New and established researchers are engaged in both quantitative and qualitative research in best education practices in collaboration with the Academy for Innovation in Medical Education (AIME). 35 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Undergraduate Medical Education 36 MEDICAL EDUCATION Having taken on a leadership role in the delivery of pharmacology, physiology and pain management at the pre-clerkship level, and offering a popular clerkship rotation, Anesthesia has increased its profile in Undergraduate Medicine over the past five years. of Anesthesia has assumed a leadership role in the delivery of pharmacology and pain management teaching. Dr. Alan Chaput, who is the content expert for pharmacology and therapeutics, has been selected for the faculty’s distinguished professor program, committing 120 hours a year for two years to dedicated undergraduate teaching. The University of Ottawa School of Medicine underwent a cycle of curriculum review and renewal in 2008 and accreditation in 2009- 2010 under the guidance of Dr. Lucie Filteau, the previous Undergraduate Anesthesia Director. The process was a positive experience for both the medical school and the department. The Council for Accreditation of Canadian Medical Schools expressed strong approval of the solid education delivered in the English, French, and Aboriginal streams and awarded the faculty with its highest standard – accreditation for eight years. Dr. John Penning directs the pain curriculum, which is part of the integration block and is presented to students prior to starting their clinical clerkship. The course consists of a weeklong intensive workshop that brings together basic and clinical sciences through lectures and small group teaching and involves over 25 faculty fellows and residents. Curriculum renewal has solidified anesthesia’s contribution to undergraduate education at the pre-clerkship and clerkship level. The Department Dr. Nikhil Rastogi, University of Ottawa Department of Anesthesia Undergraduate Program Director Over the past five years the medical school has transitioned to case-based learning (CBL) from problem-based learning and many faculty members have taken the training course for CBL. Faculty also lecture at the undergraduate level in physiology, pharmacology and reproductive medicine. In total, 47 staff delivered 512 hours of dedicated teaching at the pre-clerkship level in the last academic year. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The Anesthesia Clerkship rotation is a two-week compulsory block in third year and is combined with Emergency Medicine to make up the Acute Care Block. A total of 156 students rotate through our ORs in both the English and French streams at three different sites. As part of the rotation, there is an airway management workshop and a simulation session for crisis management. Highly rated by students, this block highlights our role as experts and teachers of airway management, fluid management and resuscitation pharmacology. A teaching guide has been developed and is distributed annually to all staff, residents and fellows to aid in the delivery of the clerkship curriculum. The Ottawa Anesthesia Primer, a handbook for medical students written by staff and residents under the guidance of Dr. Pat Sullivan, is expected to be available in electronic and print format in the fall of 2012. This is a follow-up to Anesthesia for Medical Students, which has been a favorite in anesthesia programs across the country. Departmental Teaching Activity Overall Teaching Activity (Departmental Members Only) (Including Fellows and Residents) 1% 4% 2% 1% 3% 1% 5% 4% 5% 21% 12% 2% 1% 1% 2% 4% 22% 16% Anaesthesia Otolaryngology BMI Paediatrics CMM Pathology ECM Psychiatry Emergency Radiology Family Medicine Surgery Medicine Overall 1% 16% 5% 2% 4% 5% 10% 14% 22% 1% Obs-Gyn 1% 3% Ophthalmology Ophthalmology 10% 37 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Anesthesia Simulation 38 Much has changed over the last five years in simulation within our department. Dr. Michelle Chiu, Anesthesia Simulation Co-Director One of the most significant developments was the establishment of the University of Ottawa Skills and Simulation Center (uOSSC) at the Civic Campus of The Ottawa Hospital in 2010. Dr. Viren Naik is the Medical Director of the uOSSC. At 25,000 sq ft, it is the largest simulation center in Canada and our department comprises one its largest user groups. We would like to thank Drs. Robert Elliott, Patti Murphy and Earl Wynands for their guidance and significant contributions as the founders of our simulation centre and curricula. We would not be where we are today without their vision! There are currently seven simulation faculty in our department: Drs. Michelle Chiu (Simulation Director), Sylvain Boet, Dylan Bould, Simone Crooks, George Dumitrascu, Amy Fraser and Victor Neira. With a successful track record in research and many international presentations, our faculty is widely recognized for their expertise in simulation and medical education. Our faculty members are the foundation underlying the successes of our simulation program. Undergraduate Medical Education We continue to be active in the undergraduate curriculum with 112 third-year students rotating through the uOSSC annually during their anesthesia clerkship rotation. Postgraduate Medical Education Our Anesthesia residents have multiple opportunities during their residency to participate in simulation sessions at the uOSSC. Our Postgraduate Year-1 (PGY-1) residents attend the Acute Critical Events Simulation (ACES) Course, where they receive simulation-based training on the principles of resuscitation, and the Transition into Independent Call (TIC) Course, where they receive teaching and experiential practice with the responsibilities of being on-call in anesthesia. All PGY-2 to PGY-5 residents participate twice a year as the “hotseat” in charge of a clinical situation and four times a year as “helpers” or “confederates” in the scenario. Residents receive regular pediatric simulation training when rotating through the Children’s Hospital of Eastern Ontario (CHEO). We continue to work closely with our simulation colleagues in the departments of Obstetrics/Gynecology, Emergency Medicine and Surgery to provide our residents with opportunities to acquire medical knowledge from and develop DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 communication strategies between different specialties. For over 10 years, we have collaborated in inter-disciplinary Anesthesia/OB simulation sessions to address the unique challenges in jointly managing the care of critically ill obstetrics patients. At CHEO, anesthesia residents regularly participate alongside anesthesia assistants and nurses in inter-professional simulation. In 2011, we introduced multi-disciplinary simulation sessions, where PGY-3 Anesthesia, Emergency, Surgery and OB residents learn to manage multiple critically ill patients in the emergency room. In 2012 we teamed up with the Department of Surgery to develop tissue models that allow surgery residents to “operate” on a mannequin. This breakthrough facilitated the introduction of joint Anesthesia/Surgery perioperative team training simulation sessions – an educational experience that residents from both departments have enthusiastically embraced. 39 EDUCATION Photos: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 40 Fellowship We have four graduates of our internationally subscribed Anesthesia Fellowship in Simulation and Medical Education. Our graduates have initiated new (Dr. Jay Ross, Winnipeg) and joined in established (Dr. Devin Sydor, Kingston) simulation training programs across Canada and around the world (Dr. Abeer Arab, Saudi Arabia). Dr. Dan Power will take a leading role as a member of the Canadian Forces Steering Committee on Simulation Training. He will be their first formally trained simulation instructor. In total, our Fellows have accrued $83,178 in funding as primary investigators in their research projects. Please see the Fellowship Director’s section for further details on their accomplishments. In 2009, we partnered our fellowship program with the University of Ottawa Academy for Innovation in Medical Education (AIME) and uOSSC. With other AIME/uOSSC Fellows and clinician educators, our Fellows attend the AIME Health Care Education Scholar’s Program (HESP), which “seeks to develop a community of medical educators and inspire innovation and scholarship in healthcare education.” Our Fellows also attend the AIME Foundational Elements of Applied Simulation Theory (FEAST) Curriculum, which provides them with a solid grounding in simulation theory and practice via interactive teaching covering simulation in education, research in simulation and effective simulation instruction and design. Continuing Medical Education and Patient Safety The use of simulation has risen exponentially in departmental continuing medical education (CME) events. This reflects the growing belief in the important role of simulation-based training in the improvement of patient safety. We hear from our residents how their simulation experiences have improved their ability to manage critical incidents in clinical practice. Our annual Winterlude Conference Perioperative Crisis Resource Management (CRM) workshops have been well received. Dr. Ben Sohmer has conducted workshops for novice physicians (residents and staff) on the basics of transesophageal echocardiography. Simulation-based education will be featured prominently at our inaugural departmental Faculty Development Day in November 2012 at the uOSSC. Also occurring in Ottawa this November is the Royal College Simulation Summit. Dr. Viren Naik is co-chair of this conference and our simulation faculty are on the planning committee. Our simulation faculty and anesthesia residents regularly volunteer to demonstrate to the public the benefits of practicing perioperative crisis management; our TOH Foundation demonstrations are legendary and we are approached regularly to participate. Inter-professional, intra-operative, in-situ simulation has debuted at TOH for the Cardiac Arrest Roles Defined (CARD) study. The goal of CARD, led by Dr. Tania DiRenna, is to improve the management of intraoperative cardiac arrest by using a cognitive aid based on role clarification to enhance team crisis management skills. Every aspect of simulation-based training is covered. This includes developing the technical skills of bronchoscope manipulation in the bronchoscopic simulator to the mastery of the non-technical skills of team leadership and effective communication strategies in high-fidelity crisis resource management scenarios. It is all geared towards the overall goal of maximizing patient safety. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Postgraduate The Ottawa Anesthesia Residency Program continues with its strong heritage of teaching, education and research. With expanding numbers of medical students, the program has grown to record Medical education numbers of resident applicants. We have yet to have a vacant position in anesthesia in Ottawa and have always matched on the first round of the Canadian Residency Matching System (CaRMS). 41 Program numbers have increased from 48 in 2007 to 54 in 2012. CaRMS Applicants: uOttawa Anesthesia 200 60 IMG 180 160 CMG 140 50 40 120 100 30 80 20 60 40 10 20 0 2007 match 2008 match 2009 match 2010 match 2011 match CMG (Canadian Medical Graduates) IMG (International Medical Graduates) Dr. Desiree Persaud, University of Ottawa Department of Anesthesia Residency Program Director 2012 match 0 2007 2008 2009 2010 Residents per academic year 2011 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 42 Between 2007 and 2012 we will have had a projected total of 49 graduates. These include one foreign medical graduate, 11 international medical graduates, three military anesthesia residents and seven family practice-anesthesia residents. We also graduated 10 residents from the joint Ottawa/Northern Ontario School of Medicine (NOSM) program. This joint program matched the last two residents in 2011, as NOSM will soon have its own anesthesia program. Our success in the Royal College examinations is illustrated by the 100% pass rate of our Canadian medical graduates from the classes of 2007 to 2011. The scope of practice of graduating residents has varied from year to year. On average, 63% of graduating residents over the last five years have pursued clinical fellowships, and 45% of those remained in Ottawa for their fellowship year. 12 Fellowships 10 Graduates 8 6 4 2 0 2007/08 2008/09 2009/10 2010/11 2011/12 One of the more remarkable years in the postgraduate training program was 2010, when the University of Ottawa underwent its regular, sixyear accreditation review. Our residency program again obtained full accreditation. The first edition of the national anesthesia curriculum, co-edited by Dr. Patti Murphy (Ottawa Anesthesia Education Director 2006-11), was fully endorsed and integrated into every Canadian anesthesia program. In July 2010, Dr. Desiree Persaud became the Ottawa Anesthesia Residency Program’s eighth director. As a former graduate of the program who has garnered local, provincial and national teaching awards, Dr. Persaud brings broad experience combined with a fresh, new approach to the residency program. The Ottawa Skills and Simulation Centre opened its doors in the fall of 2010, giving rise to new momentum in innovation in education and research, with anesthesia at the forefront. The program has benefited immensely from the leadership of Dr. Viren Naik, who not only serves as the medical director of the skills and simulation centre but also has a major role in simulation education at the Royal College. With Dr. Dylan Bould at the helm, education research is flourishing. Traditional methods of teaching and evaluation are being challenged, the debate over competency-based training versus time spent in an educational setting is evolving, and restrictions in duty hours for residents have been introduced. All these factors will influence our training program in the coming years. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 With Dr. Simone Crooks as the director of postgraduate anesthesia training in simulation, every anesthesia resident has two formal simulation training encounters a year. There are also multidisciplinary team-based training sessions in development, covering themes such as cardiac arrest, general surgery and trauma. Additionally, a new program, Transition to Independent Call, was developed in 2011 to address the needs of PGY-1 anesthesia residents as they take on call responsibilities. Research has flourished in the residency program. Dr. Alan Chaput has successfully integrated basic principles of critical appraisal in the resident journal clubs. Dr. Gregory Bryson has organized a comprehensive series of research core lectures. New in 2012 will be the integration of both journal club research principles and core lecture program themes, led by Dr. Jordan Hudson. A few residents have also taken advantage of elective time with Dr. Don Miller, editor of the Canadian Journal of Anesthesia. RESIDENCY 43 Photo: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 There has been a great deal of scholarly activity in the residency program. An Ottawa anesthesia resident has contributed to every chapter in the forthcoming Ottawa Anesthesia Primer edited by Dr. Patrick Sullivan. This book is an extension of the popular Anesthesia for Medical Students textbook. Our residents have taken a leadership role in teaching Respiratory Therapy students as part of the Anesthesia Assistant training at Algonquin College, leading a variety of problembased learning (PBL) courses for medical students and a number of core lectures to junior anesthesia residents. 44 In 2010, Dr. Louise Sun (PGY-4 anesthesia resident) and Dr. Dan McIsaac (PGY-3 anesthesia resident) were also enrolled in the Masters of Public Health Program at Harvard University. Dr. Manoj Lalu also successfully incorporated a major scientific research component within residency. Since 2007, our residents have had more than 25 publications in peerreviewed journals and 20 poster presentations at various meetings, including the Canadian Anesthesiologists’ Society annual meeting. Involvement in hospital administration and committees is fully supported in the program. A few residents have completed electives in hospital administration. Anesthesia residents have also been on a number of hospital and university committees, such as the physician engagement committee, patient quality and safety committee, appeals committee, professionalism committee and the postgraduate medical education committee, as well as various specialty program accreditation reviews. Our residents also serve as representatives at the Professional Association of Internes and Residents of Ontario (PAIRO), the Ontario Anesthesia Society and the Canadian Anesthesia Society. Photos: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 the ottawa hospital Fellowships Dr. Amy Fraser, TOH Corporate Fellowship Director The Ottawa Hospital continues to expand and improve its fellowship training program Our long-established programs in Chronic Pain and Regional Anesthesia have been expanded to include a number of other fellowship program At present, fellowship programs are offered in the subspecialties of Acute Pain (Fellowship Director: Dr. Naveen Eipe), Chronic Pain (Dr. George Evans), Neuroanesthesia (Dr. Kevin Nolan and Dr. Tom Polis), Obstetric Anesthesia (Dr. Catherine Gallant and Dr. Susan Goheen), Perioperative Echocardiography (Dr. Ashraf Fayad), Regional Anesthesia (Dr. Anne Lui), Simulation (Dr. Sylvain Boet and Dr. Michelle Chiu), Thoracic Anesthesia (Dr. Larry Byford and Dr. Calvin Thompson), and Vascular Anesthesia (Dr. Ashraf Fayad). Two programs, Airway Management and Perioperative Medicine, are inactive at this time. The position of Corporate Fellowship Director was established in late 2009 to better manage the increasing size and complexity of the fellowship workload at TOH. Dr. George Dumitrascu held the position from its inception in 2009 to December 2011. Dr. Amy Fraser was appointed to the position in January 2012. Administrative support for the Corporate Fellowship Director is primarily provided by Lynne McHardy and Elaine Stinson. Some fundamental changes were introduced to fellowship contracts in 2010 to make our programs more competitive and better aligned with other Canadian programs Fellows’ salaries were increased, and Fellows also began to provide coverage of late rooms and Saturday morning Acute Pain Service rounds. At present, the Corporate Fellowship Director is actively pursuing initiatives that are intended to improve the fellowship programs in three fundamental ways: • Recruitment of high-quality candidates who are practising at the Royal College of Physicians and Surgeons of Canada Anesthesia Fellow level; • Provision of first-class education and training; and • Achievement of research and academic excellence from our fellows. 45 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 46 Our fellowship programs have remained popular with Canadian-trained and international anesthesia graduates. In the last application cycle, we received over 120 applications for 12 positions. Our graduating fellows have gone on to found and/or direct subspecialty programs across Canada (Dr. Jennifer Szerb, Regional Anesthesia) and around the world (Dr. Abeer Arab, Simulation). Recent fellows have also established new perioperative patient care programs (Dr. Jonathan Antrobus, Regional), developed educational measurement tools (Dr. Cathy Delbridge, Regional), presented at international conferences (Dr. Wes Edwards and Dr. Ali Faris, Obstetric), and won peer-reviewed research grants (Dr. Dan Power and Dr. Devin Sydor, Simulation). In some cases, Fellows from outside Canada have gone on to enter Canadian anesthesia residency training programs. Fellowship Photos: Dr. Caroline Tallmadge DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 CHEO Fellowships CHEO has for many years offered a one-year clinical fellowship or a combined clinical/research fellowship for those considering a subspecialty career or wishing to pursue an academic career. With three positions currently funded by the Department of Anesthesia, this fellowship attracts candidates from around the world seeking advanced and broader clinical exposure in Pediatric Anesthesia prior to entering into a mixed adult/pediatric anesthesia practice. Fellows are actively involved in supervised clinical practice and are offered protected research time to develop their academic interests. 47 Dr. Leslie Hall, CHEO Fellowship Director Photos: Diane Sheppard DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Cardiac Anesthesiology FellowshipS Between 2007 and 2012, we successfully trained nine highly competent, consultant cardiac anesthesiologists. While some have chosen to remain in Ottawa, others have joined academic practices both nationally and internationally. The education of our fellows has significantly evolved over the last five years. This process was initiated by the former fellowship director, Dr. Ben Sohmer, and continues under the guidance of Dr. Sean Dickie, who became the fellowship director in September 2010. What originally began as informal bedside teaching has evolved into multiple teaching opportunities within the entire perioperative environment, including both formal teaching sessions and less formal coffee rounds. 48 Dr. Sean Dickie, UOHI Fellowhsip Director In an attempt to formalize our fellowship teaching, we have recently developed an internet-based Wiki page, complete with articles, lectures and our formal UOHI perioperative transesophageal echocardiography teaching curriculum. The page allows fellows to electronically document their progress with assigned readings and TEE studies and gives the fellowship director the opportunity to provide any necessary direction We have enjoyed great success in teaching perioperative TEE to our fellows. To date, our fellows have a 100% success rate for the National Board of Echocardiography (NBE) advanced perioperative TEE exam. Our fellows consistently finish in the top tenth percentile of all applicants in any given year and in two consecutive years we have had a fellow finish in the top five of all candidates in North America. This is evidence that our TEE teaching curriculum is effective in educating the next generation of advanced perioperative echocardiographers. With the development of a formalized advanced TEE certification from the NBE, cardiac anesthesia fellows have devoted their non-clinical time and energy towards achieving this certification. However, we have made recent progress on the research front with the peer-reviewed publication of Dr. Diem Tran’s fellow research project and the submission for publication of Dr. Juliet Atherstone’s research project. We are anticipating that fellow research will improve both qualitatively and quantitatively in the near future. With the recent addition of several new 3D echo machines within the cardiac ORs, we have the distinction of being only the second training centre in Canada with full 3D echo capabilities in all of our cardiac operating rooms. This will allow us to define ourselves as a centre of excellence in 3D echo training and research. This will also benefit our fellows, who will help define the future of 3D echocardiography. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Faculty Development In 2012, the position of Department of Anesthesia Director of Faculty Development was created to coordinate, facilitate and expand local Continuing Medical Education (CME) opportunities within the Department of Anesthesia. The role of the Director is to collaborate with all the members of the Department on issues related to faculty development. A primary goal of the position is to facilitate continuing education through planning and implementation of medical education programs and to attain Royal College of Physicians and Surgeons of Canada CME accreditation for these programs. To achieve this primary goal, the first annual Department of Anesthesia Faculty Development Day is in development and scheduled to take place Dr. Benjamin Sohmer, Director of Faculty Development in November 2012. With the use of the University of Ottawa Skills and Simulation Centre, this half-day workshop will draw upon high fidelity simulation and place an emphasis on self-assessment. Many excellent educators and educational initiatives exist at each of the University of Ottawa campuses. An additional role of the Director is to function as an educational liaison between campuses. Ideally, all members of the department should have the opportunity to learn and develop with assistance and guidance from their internal, high quality educational resources and colleagues. Dr. Benjamin Sohmer, a member of the Division of Cardiac Anesthesia, has been appointed Director for a term of three years. 49 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Journal Club the Department of Anesthesiology held five or six Journal Clubs each year from 2008 to 2012. These consist of traditional Journal Clubs, in which salient journal articles are presented, critically evaluated and discussed, and Research Journal Clubs, in which new research projects in the Department are presented and feedback given. These rounds are attended by residents, as well as staff from The Ottawa Hospital General, Civic and Riverside Campuses, the Children’s Hospital of Eastern Ontario and the Ottawa Heart Institute. They are typically held at one of the hospitals. 50 Dr. Jordan Hudson, Anesthesia Journal Club Co-ordinator In September 2007, Dr. Alan Chaput took charge of Journal Club with a mandate to improve the residents’ ability to appraise research methodology. With his background in research and epidemiology, Dr. Chaput incorporated a greater emphasis on rigorous analysis and critical appraisal. This change was well received by the Department. In September 2012, Dr. Jordan Hudson will take over the responsibilities of Journal Club coordinator and will endeavor to uphold the tradition of academic discussion and education. Each Journal Club consists of three or four articles related to a specific theme, often selected to compare and contrast methodologies or to offer varying perspectives on a common clinical topic. An overview, including educational objectives and links to the articles, is e-mailed to Ottawa area residents and anesthesiologists beforehand. Additional material, which may include other relevant articles, editorials and critical appraisal tools, is frequently included as background information. This allows participants to arrive at Journal Club prepared to discuss the articles at hand. During Research Journal Clubs, two or three researchers from the Department are invited to present ongoing research projects. Presenters may be residents, fellows, or staff anesthesiologists. The research presented may be clinical, educational, basic science, or of mixed methodology. Department members are encouraged to present projects at the design phase as well as later on, in order to share insight into the process of trial conceptualization and design. Presenters may also share information on methodology, present results, and obtain feedback and advice from audience members. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The format consists of formal presentations, typically given by a resident or fellow pre-assigned to each journal article, which summarize the methods and provide critical appraisal. The audience is then engaged in further discussion and debate, both of the article itself and its impact vis-à-vis the theme of the Journal Club. Implications for clinical practice are also discussed. Each University of Ottawa anesthesiology resident is required to present and analyze an article for Journal Club at least once during residency. Summary of Journal Club activities, September 2007-present Date Theme Presenters Objectives 2007/09/17 Statins and perioperative cardiovascular risk Dr. Jen Chow 1) Review the results from recent studies that have demonstrated a reduction in adverse cardiovascular outcomes in patients treated with statins perioperatively Dr. Lukasz Bartosik Dr. Firas Al-Qadhi 2007/10/22 Pregabalin and gabapentin for perioperative pain Dr. Dan Power Dr. Ali Namazie Dr. Greg Krolzyk 2007/11/19 Research Dr. Sanjiv Gupta Dr. Leilani Doyle Dr. Rebecca Chauvin 2) Compare and contrast different research methodologies including case-control and cohort studies, and RCTs 1) Review the results from recent studies that have demonstrated improved pain outcomes in patients treated with pregabalin and gabapentin perioperatively 2) Compare and contrast different research methodologies including RCT and meta-analysis 1)Review basic aspects of research including asking a research question, reviewing current evidence, deciding on a study design, calculating a sample size and other practical issues in an interactive format 2) Discuss the available evidence behind opioid-induced hyperalgesia and tolerance 3) Discuss how to design a study to determine if low-dose intrathecal fentanyl administered with intrathecal morphine shortens the duration of postoperative analgesia provided by intrathecal morphine 2008/01/14 NSAIDs and cardiovascular risk Dr. Matt Quon Dr. Ashley Meister Dr. Carla Lipan 1)Review the results from recent studies that have demonstrated adverse cardiovascular outcomes associated with treatment with NSAIDs and discuss perioperative implications 2)Review case-control methodology 3) Compare and contrast meta-analyses of both randomized and observational studies 2008/02/18 Economic analysis in anesthesia Dr. Karolinah Lukitto 1)Review and critique the methodology and results of three economic analyses Dr. Sinan Demir 2)Review various methods of economic analysis (cost analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis) and how to critique these studies Dr. Robert Sikorski 51 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 2008/09/17 Patient safety Dr. Jeremy Stewart Dr. Chris Pysyk Dr. Ahmed El-Alfy 1) Review and critique methods of qualitative research and how these methods differ from quantitative research 2) Explore the methodological advantages of closed claims analysis 3) Discuss how closed claims analyses have altered our practice 4)Review the pros and cons of case-control methodology 5) Discuss whether residual neuromuscular blockade leads to clinically significant adverse postop outcomes 2009/02/23 Delirium Dr. Melissa Forbes 1)Explore the pros and cons of large database research Dr. Alan Chaput 2)Gain an appreciation for the burden of illness of postoperative delirium 3)Review the pathophysiology of postop delirium 4) Review the process of getting a study off the ground from concept to patient randomization 52 5)Review the pros and cons of RCTs Photos: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 2009/04/20 Perioperative glycemic control Dr. Joel Berube Dr. Rebecca Moga Dr. Eric Tsai 1)Review the evidence for tight glycemic control in the perioperative period, with particular emphasis on intraoperative glucose control and clinical outcomes 2) Compare and contrast advantages and disadvantages of various research methods including database analysis, RCTs and meta-analysis 3)Focus on causality, and discuss which types of studies allow you to draw a cause-effect relationship 4) Discuss intention-to-treat (ITT) analysis 5)Review the statistics of meta-analysis 2009/09/09 Research Dr. Greg Bryson 1)Review studies highlighting functional disability following ambulatory surgery Dr. Ben Sohmer 2)Review studies highlighting impact of surgery and hospitalization on caregivers 3) Describe characteristics of measurement tools for disability and caregiver burden 4)Explore optional study designs 2009/10/26 Postoperative cognitive dysfunction Dr. David Goulet Dr. Travis Nairn Dr. Ramez Hendy 1)Review the evidence linking anesthetic technique and surgery to postoperative cognitive dysfunction 2) Compare and contrast advantages and disadvantages of various research methods including database analysis, RCTs and meta-analysis 3)Focus on causality, and discuss which types of studies allow you to draw a cause-effect relationship 2010/01/18 Magnesium Dr. Steve Masselink Dr. Tim O’Connor Dr. Hilary Meggison 1)Examine the various therapeutic effects and uses of magnesium sulfate in the perioperative period 2) Discuss choice of outcomes in pain studies 3 Review methods of randomization in RCTs 4)Review basic statistical tests for continuous and categorical data frequently cited in RCTs 2010/02/22 Anesthetics and the developing brain Dr. Marie-Jo Plamondon 1)Recognise differences between animal and human research methodology Dr. Jen Mihill 2)Appreciate how animal research can be applied to everyday clinical practice Dr. Alim Punja 3)Review evidence for and against anesthetic effects on learning disabilities and cognitive performance 4) Understand the importance of twin studies and when they should be used 2010/04/19 Simulation Dr. Natalie Clavel 1)Gain exposure to educational/simulation research Dr. Susan Fossey 2) Discuss concepts of validity and reliability Dr. Vance Beck 3)Observe the relationship between education and patient safety 53 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 2010/09/27 Research Dr. Don Miller 1)List and review the criteria used to assess the quality of a biomedical journal 2)Rank the top 10 anesthesia journals using these criteria 3)List the criteria by which to judge the quality of an RCT 4)List the types of editorial peer review 5) Discuss the strengths and limitations of editorial peer review and the impact on the reporting quality of published clinical trials 2010/10/25 Anesthetic technique and cancer Dr. Ahmed Soliman 1)Review the evidence linking anesthetic technique to cancer-related outcomes Dr. Richard Waldolf 2)Review the strengths and weaknesses of observational research Dr. Louise Sun 3) Use the STROBE checklist to critically appraise observational studies 4)Review the importance of multivariate analysis in observational studies 54 5)Review Cox proportional hazards regression 2011/01/17 2011/02/28 TEE for noncardiac surgery Dr. Jordan Zacny 1)Review evidence for safety of TEE Dr. Melanie Toman 2)Review evidence for benefit of TEE in non-cardiac surgery Dr. Rya Boscariol 3)Review optimal study designs for safety outcomes Transfusion strategies in pediatric Dr. Yvonne Kaethler patients Dr. Richard Waldolf 1) Compare and contrast studies of transfusion triggers in critically ill pediatric and adult patients Dr. Janie DesRosiers 2)Review evidence linking length of storage of transfused RBCs and MODS in pediatric ICU patients 3)Review issues around the need for non-inferiority trials and their design 4)Review the benefits of conducting a cohort analysis of patients enrolled in an RCT 2011/09/12 Remifentanil for labor analgesia Dr. Marc Dore 1)Review evidence supporting efficacy of remifentanil for labour analgesia Dr. Diana Noseworthy 2)Review evidence supporting safety of remifentanil for labour analgesia Dr. Andy Roberts 3)Review key features of dose-finding studies 4) Discuss general issues of studies that examine safety outcomes DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 2011/09/12 Tool development and validation Dr. Maria Hudecova 1)Review methods of tool development Dr. Sandra Bromley 2)Review methods of validating tools and explore the importance of validation Dr. Dan McIsaac 3)Learn why snoring, tiredness, observed apnea and hypertension are important in predicting OSA 4)Appreciate important factors that correlate with recovery in a variety of surgical patients 5)Evaluate the importance of intraoperative blood loss, heart rate and MAP and how these can predict major complications or mortality at 30 days 2011/10/24 Perioperative dexamethasone – pros and cons Dr. Teresa Furtak 1)Review recent evidence of the effects of dexamethasone on postoperative pain Dr. Doris Leung 2)Review the safety profile of dexamethasone in the periop period with a focus on postop infections Dr. Chris Kirby 3) Discuss optimal study designs for evaluating safety outcomes 2011/01/16 Fast track pediatric surgery Dr. Brock Wilson Dr. Raylene Sauve Dr. Reva Ramlogan 1)Review methodology for studying the impact of a ‘program of care’ (vs. a single intervention) 2) Discuss challenges in studying perioperative programs 3)Review evidence of safety and efficacy of fast-track surgery programs in pediatrics 2011/02/27 Articles hot off the press Dr. Janet Young 1)Review evidence for management of dural puncture in labour Dr. Joey Tremblay 2)Examine the association of preop management of DM2 and outcomes Dr. Matthew Silvaggio 3)Review evidence of the perioperative use of ketorolac in terms of both safety and efficacy 55 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Annual Anesthesia 56 Winterlude Symposium For the last 18 years, the University of Ottawa’s Department of Anesthesiology has held an annual symposium to coincide with the city’s famed Winterlude festival. Winterlude, which offers skating on the canal, ice sculptures and a festive atmosphere, adds a great deal to the experience of the guest faculty and visiting delegates drawn from across Canada. The Annual Anesthesia Winterlude Symposium brings together practising anesthesiologists and other experts to foster knowledge and skills by providing a forum for discussion and dialogue on emerging concepts. In recent years, this meeting has grown from a regional Continuing Medical Education event to a nationally known symposium, attracting delegates from across Canada and eminent speakers from Europe and North America. Dr. Naveen Eipe, Chair of the Winterlude Committee The symposium is hosted by the Department of Anesthesiology of the University of Ottawa with a mandate to focus on current perioperative challenges and controversies encountered by anesthesiologists. We promote the introduction of cutting-edge research, review standards of practice and facilitate delegates’ learning needs. The 18th symposium was held Feb. 4-5, 2012, at the Westin Hotel in Ottawa, attracting more than 200 delegates. The theme for 2012 was The Science and Practice of Perioperative Medicine. Plenary sessions were dedicated to Ambulatory Surgery, Patient Safety and Outcomes, and Transfusion and Thrombosis. The Winterlude Debate focused on the role of anesthesiologists in out-of-OR sedation and was well received. Winterlude each year also offers the Earl Wynands Lecture, which is sponsored by the Royal College of Physicians and Surgeons of Canada The 2012 lecture was on Workplace Stress and Burnout. In response to feedback from previous years, in 2012 we dedicated the entire first day to the lectures and talks and the second morning to workshops and case-based learning. The workshops were held in the new University of Ottawa Skills and Simulation Centre (uOSSC). Simultaneously, we offered case-based learning sessions with visiting faculty at the adjacent Ottawa Heart Institute (OHI). Feedback from delegates was encouraging – most found the program stimulating and rewarding. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The continued success of this meeting is the result of the hard work of the planning committee, contributions of our own faculty and support from industry. Lynne McHardy, Administrator of the Department of Anesthesiology, has managed this meeting since its inception and has ably led the ‘behind the scenes’ team. We continue to be supported by industry sponsors, whose unrestricted educational grants allow us to provide this high quality program at an affordable cost. Delegate feedback, input from the planning committee and the emergence of topical issues and trends will continue to shape the content of the symposium. Our goal is for it to remain an important event on the national scene and a symbol of excellence for the University of Ottawa’s Department of Anesthesiology. Website: www.anesthesia.org/Winterlude Email: anescme@toh.on.ca 57 2012 Winterlude DEMOGRAPHICS 2006-2012 2012 Winterlude Delegates distance from Ottawa 250 >2000km 1001- 2000km AA, RT, RT, Others 200 501- 1000km 150 201- 500km 100 50-200km Residents, Fellows Anesthesiologists Total 50 Area 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Global Anesthesia Activities 58 Dr. Patti Murphy, Chair of the World Anesthesia Interest Group Dr. Hooper has been on many missions over the past eight years, including trips to Bolivia, Peru, Bangladesh, China, Ethiopia, Mali and Ghana. Most have these have been with Interplast, now called ReSurge International, which provides cleft lip and palate repair and burn repair surgery, mostly in children. As part of these missions, he has also taught local surgeons and anesthesia providers. clinical teaching of the local “anesthetic officers.” These are nurses with a year of extra training who are the mainstay of anesthetic service provision in Uganda. Being part of a small, independent group posed a challenge in terms of infrastructure and resources. Basic necessities such as electricity, oxygen, suction, drugs and sterile supplies were frequently unavailable. Dr. Patti Murphy With CANHEAR Uganda, Dr. Patti Murphy visited Uganda for two weeks in 2009 to provide clinical anesthetic services in support of a small team that included three ear, nose and throat (ENT) surgeons, two audiologists, two biomedical technicians and a nurse. The purpose of the mission was to support Canadian ENT surgeons in teaching the local ENT surgeons to refine their technique in performing tympanoplasty/mastoidectomy, surgery for head and neck cancer, and thyroid surgery. Dr. Nik Rastogi In November 2011, Dr. Nik Rastogi, of TOH General Campus went on a two-week mission with Medical Ministry International to Cotacachi, Ecuador, where he worked in two hospitals, one of them a teaching hospital. Dr. Rastogi also spent a few days working in the mobile medical and dental clinic, which offered treatment in a different village each day, making a great impact on patients despite a shortage of personnel and the language barrier. Dr. Rastogi participated in about 20 procedures, among them a laparoscopic cholecystectomy under spinal anesthesia and two pediatric cases, including one in the CT scanner. Dr. Murphy first worked in Mulago Hospital in Kampala, then in a small community hospital in Mbale. In addition to providing support to surgical teaching, Dr. Murphy also participated in daily DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Dr. Linda Wynne In February 2011, Dr. Linda Wynne visited the Kilema District Hospital in Tanzani to assess resources and needs to aid in planning for missions and educational module development with the Canadian African Community Health Alliance (CACHA), as well as the Canadian Network for International Surgery (CNIS). Dr. Wynne also participated in the “Medicos en action” trip in January 2012 to the Hermano Pedro public hospital in Antigua, Guatemala, which is run by a Franciscan order. Every week of the year, except Holy Week and Christmas, a different surgical mission arrives from around the world, mainly the U.S., Canada, Germany and Spain. Two of the groups are Canadian: Operation Walk, for orthopedic surgery, and Medicos en action, for general surgery, gynecology and ENT. Team members pay their own expenses as well as help pay for supplies. Dr. Dylan Bould Dr. Dylan Bould (CHEO) is a faculty member of the University of Zambia Master of Medicine Anesthesia Residency Program, which accepted its first eight residents in 201l. This is a partnership between the University of Zambia and the Tropical Health and Education Trust, currently funded by the U.K. Department for International Development. Dr. Bould visited Lusaka to teach in November 2011, and will visit again each year. Beginning in 2012, University of Ottawa anesthesia residents will accompany him for a global health and anesthesia elective. In addition to providing service, the program is also meant to create capacity in anesthesiology, which is a new profession in Zambia. Prior to this new program, no physician anesthesiologists had been trained in Zambia since independence in 1964, and there are fewer than 10 physician anesthesiologists in a country of more than 12 million people. The program is focused on developing a body of professionals who, in time, will be able to advocate for patient safety, investigate research questions appropriate to their environment and, ultimately, become self-sustaining, rendering visiting faculty redundant. World Anesthesia Interest Group Dr. Patti Murphy initiated the World Anesthesia Interest Group, which had its inaugural meetings in early 2012. Comprised of both staff and residents, its members include: Staff: Drs. Tammy Barrows, Dylan Bould, Holly Evans, Jordan Hudson, Chris Hudson, Donald Miller, Stéphane Moffett, Nikhil Rastogi, Dennis Reid, Cathy Smyth, William Splinter, Linda Wynne, Caroline Tallmadge and Patti Murphy. Residents: Drs. Natalie Clavel, Rya Boscariol, Amir Bouzari, Doris Leung, Raylene Sauve, Reva Ramlogan, Mathew Silvaggio, Tinu Birdi, Lillia Fung, Louise Sun and Susan Fossey. 59 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 The purpose of the group is to: • Identify staff and residents with an interest in global health • Provide a mechanism for interested residents to link with staff for future missions • Provide a venue for members returning from trips to provide debriefs, allowing others to benefit from lessons learned • Provide inspiration to foster future involvement in projects • Provide support and encouragement to those interested but perhaps a bit hesitant to take on this sometimes daunting work The group plans to meet two or three times a year. In addtion, it will work with Dr. Hassan Shenassa, who is developing educational modules for anesthesia provideirs who support him on his missions with CACHA to Tanzania. Below, the inaugural meeting of the World Anesthesia Group, February 29, 2012. 60 Members from left to right: Louise Sun, Nikhil Rastogi, Hassan Shenassa, Linda Wynne, Patti Murphy, Caroline Tallmadge, Jordan Hudson, Takpal Birdi, Chris Hudson, Lillia Fung Photo provided by Dr. Patti Murphy DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 University of Ottawa Department of Anesthesiology Grants 2007-2012 Grants 2007 1. Chiu M, Chadwick C, Segal R, Cross, Lui A, Bryson GL, Taljaard M, Evans H. Efficacy of Thoracic Paravertebral Block in Reducing Chronic Pain and Disability after Breast Cancer Surgery with Axillary Lymph Node Dissection. Canadian Anesthesiologists’ Society $10,000 2. Chiu M, Chadwick C, Segal R, Cross P, Lui A, Bryson GL, Taljaard M, Evans H. Efficacy of Thoracic Paravertebral Block in Reducing Chronic Pain and Disability after Breast Cancer Surgery with Axillary Lymph Node Dissection. Ottawa Regional Cancer Clinic Foundation $49,500 (over 2 years) 3. Doherty D, Messier. Piceatannol: A pharamcological approach to ischemic conditioning. University of Ottawa Department of Anesthesiology. $8,000 4. Doherty D, Kumar, Kryworuchko. The anti-inflammatory effects of anti-CD18 therapy after ischemic brain injury in the mouse. Canadian Anesthesiologists’ Society/ Abbott Career Investigator Award. $120,000 (over 2 years) 5.Fayad A. Perioperative Mycardial Ischemia in Isolated Systolic Hypertension (PROMISE). Age 45+ with Elevated Systolic Blood Pressure Special Competition, Heart and Stroke Foundation of Ontario, $179,000, 6.McNally D, Doherty, D. Vitamin D-parathyroid axis abnormalities in children with congenital heart defects: prevalence and association with post operative hypocalcemia, cardiovascular dysfunction and inflammation. A pilot study CHEORI Resident Grant. $2,500 7.Neilipovitz DN, Bryson GL, Nagpal S, Nathan H. Short Term Atorvastatin Regime for Vascular Surgery (STAR VaS) Study. Canadian Anesthesiologists’ Society. $20,000 8.Robblee J. Blood conservation using antifibrinolytics in a randomized trial (BART) study of high-risk cardiac surgical patients. CIHR. $11,736 9.Shinkaruk K, Nolan K. Preparation of Datex Ohmeda Aestiva 5 Anesthetic workstation for Malignant Hyperthermia (MH) Susceptible Patients. The Ottawa Hospital Patient Safety Grant. $3,000 10.Splinter W, Vaillencourt, Doherty D. The use of off-label medications in children during the perioperative period. A cohort study into the usage of orphan drugs in anesthesia and critical care over a 1 month period in a tertiary care pediatric hospital. Ontario MedBuy. $10,000 Grants 2008 1. Chaput A, Madden S. Implementation of a computerized Acute Pain Service database to monitor and prevent adverse events related to treatment of acute pain at The Ottawa Hospital. University of Ottawa Department of Anesthesiology. $30,000 2. Dhanni S, Murto K. Inter-observer reliability of USCOM non-invasive Doppler ultrasound cardiac monitor in children. University of Ottawa Department of Anesthesiology. $4,750 3. Jay O, Daboval T, Murto, K. Improving the non-invasive monitoring of core temperature in infants. FHS/CHEO. $20,450 4.Fayad A. Perioperative Mycardial Ischemia in Isolated Systolic Hypertension (PROMISE). Age 45+ with Elevated Systolic Blood Pressure Special Competition, Heart and Stroke Foundation of Ontario, $183,000, 5.Murto K. Pilot study: Validation of the American Society of Anesthesiologists’ (ASA) guidelines to identify children with obstructive sleep apnea. University of Ottawa Department of Anesthesiology. $4,750 6.Neilipovitz DN, Bryson GL, Nagpal S, Nathan H.Short Term Atorvastatin Regime for Vascular Surgery. Heart & Stroke Foundation Ontario. $99,799 (over 2 years) 7.Robblee J. Plan-Do-Study-Act for continuous quality improvement with perioperative patients. University of Ottawa Heart Institute AMO. $25,000 8.Yang H, Jetty P, Gofton W, Watters J, Ruddy T, Wells G, Fayad A. Perioperative Ischemia Reduction Study. Heart & Stroke Foundation Ontario. $49,994 61 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Grants 2009 1.Arab AA, Cherry R, Tarshis J, O’Leary S, Lee AC, Naik VN. Simulation assisted oral examination for anesthesia certification in Canada. University of Ottawa Academy for Innovation in Medical Education. $20,500. 2. Bould MD, 2009–2010. Self-assessment debriefing versus personalized instructor debriefing: A prospective randomized study. The Network of Excellence in Simulation for Clinical Teaching and Learning. $27,414. 3. Bould MD, 2009 – 2010. Patient simulator-based education for teaching anesthesia residents cognitive and interpersonal non-technical skills for the management of life-threatening airway crisis: impact of technical skills of cricothyrotomy, The Network of Excellence in Simulation for Clinical Teaching and Learning. $21,942. 4. Chaput A, Yang H, Bryson GL, Evans H, Power B, Jetty P, Beaule P. A randomized, double-blind, placebo-controlled trial to determine if the use of pregabalin preoperatively and for 3 days post-operatively in high risk orthopedic and vascular surgery patients reduces acute post-operative pain and delirium. Physicians’ Services Incorporated. $159,000 (over 2 years). 5. Chiu M, Chadwick C, Segal R, Cross P, Lui A, Bryson GL, Taljaard M, Evans H. Efficacy of Thoracic Paravertebral Block in Reducing Chronic Pain and Disability after Breast Cancer Surgery with Lymph Node Dissection (TPVB study). Women’s Breast Health Centre Research. $13,506. 62 GRANTS Photos: Diane Sheppard DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 6. Chiu M,Chadwick C, Segal R, Cross P, Lui A, Bryson GL, Taljaard M, Evans H. Efficacy of Thoracic Paravertebral Block in Reducing Chronic Pain and Disability after Breast Cancer Surgery with Lymph Node Dissection. Canadian Breast Cancer Foundation Ontario. $258,829 (over 2 years). 7. Crooks S, Chiu M, Dumitrascu G Elliott R. High Fidelity Simulation as an Assessment Tool: A comparison with traditional methods of evaluating resident performance. University of Ottawa Educational Initiatives in Residency Education. $3,000. 8. Doherty D, Chakraborty, Menon, McNally. The Prevalence of Vitamin D deficiency in Pediatric Critical Illness. CHEO RI. $26,737. 9. Doherty D, Messier. Piceatannol: A pharmacological approach to ischemic preconditioning. University of Ottawa Department of Anesthesiology. $8,000. 10. Doherty D, McNally, Ward, Chakraboorty. Vitamin D-parathyroid axis abnormalities in children with congenital heart defects: Prevalence and association with post operative hypocalcemia, cardiovascular dysfunction, and inflammation; a pilot study. University of Ottawa Department of Anesthesiology. $10,500. 11. Dupuis JY Bourke M, McDonald B. A Multi-Centre, Randomised, Double-Blind, Placebo Controlled Trial on Efficacy and Safety of FXIII Replenishment with two different Doses of Recombinant Factor XIII following Cardiopulmonary Bypass Surgery. Novo-Nordisk. $72,353. 12. Dupuis JY Registry for Off-Label Use of Recombinant Factor VIIa- A Canadian Multi-Centre, Web-Based Registry. Novo-Nordisk. $17,300. 13. Dupuis JY The effect of acadesine on clinically significant adverse cardiovascular events in high-risk subjects undergoing coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass. Sponsor: Shering-Plough. Amount: $28,149. 14.MacDonald B. Esophageal Doppler hemodynamic monitoring to optimize fluid therapy in CSICU patients. University of Ottawa Heart Institute AMO. $25,000. 15.Moulin D, Smyth C, Wynne L. Development of a National Neuropathic Pain Database. Pfizer $104,450 16.Murto K, MacCormick, Lamontagne C, Rosen D, Vaillencourt. Celecoxib for pediatric adenotonsillectomy: a randomized controlled double blinded study. University of Ottawa Department of Anesthesiology. $8,000. 17.Murto K, El-Alfy A, Ramphal, Halton, Vaillancourt R, Chaput A. The impact of genotype on plasma and CSF PK of celecoxib in children. CHEO RI.$30,000. 18.Murto K, El-Alfy A, Ramphal, Halton, Vaillancourt R, Chaput A. The impact of genotype on plasma and CSF PK of celecoxib in children. CHEO RI University of Ottawa Department of Anesthesiology. $8,000. 19.Neira V, Mossdorf P, Doherty D, Nakajima A, Jabbour, Allain, Writer H. Evaluation of High Fidelity Simulation Based Training in Crisis Resource Management for Anesthesia, Emergency Medicine and Pediatrics Residents in Critical Pediatric Respiratory Events. University of Ottawa Department of Anesthesiology. $6,000. 20.Posner G, Nakajima A, Varpio L, Naik VN. Assessing residents disclosure of Adverse Events: Simulated Scenario vs Standardized Patient. University of Ottawa Academy for Innovation in Medical Education. $15,500. 21.Robblee J. CSICU readmissions and long-term outcome. University of Ottawa Heart Institute AMO. $25,000. 22.Robblee J. Survey Standards for critical care - Identify risks for patients and staff. University of Ottawa Heart Institute AMO. $25,000. 23.Rubens F, Dupuis JY. The effect of acadesine on clinically significant adverse cardiovascular events in high-risk subjects undergoing coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass. Schering-Plough. $28,149. 24.Splinter W. Dexmedetomidine. $11,375. 25. Vaillancourt R, Splinter W, Doherty D. The use of off-label medications in children during the perioperative period. A cohort study into the usage of orphan drugs in anesthesia and critical care over a 1 month period in a tertiary care pediatric hospital. Ontario MedBuy. $9789.37. 26.Yang H, Jetty P, Gofton W, Watters J, Ruddy T, Wells G, Fayad A. Perioperative Ischemia Reduction Study III (PROSE III). The Ottawa Hospital Academic Medical Organization. $606,502 (over 2 years). 63 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Grants 2010 1.Anderson V, Hutchison J.S., Doherty D. Serum biomarkers and quality of life in children with traumatic brain injury (TBI), Ontario Neurotrauma Foundation (ONF) and The Victorian Neurotrauma Initiative (Australia), $50,527. 2.Arab AA, Friedman Z, Naik VN. Addressing challenging gap in the curriculum: Teaching professionalism using simulation. University of Ottawa Educational Initiatives in Residency Education. $9,200. 3. Bryson GL, Power B, Taljaard M, Nathan H. Functional recovery and caregiver burden following surgery in the elderly. Canadian Anesthesiologists’ Society. $40,000. 4. Chaput A, Jetty P, Neilipovitz DN, Power B, Skinner C. A pilot study to evaluate the polysomnographic effects of pregabalin in postoperative patients. Canadian Anesthesiologists’ Society. $10,000. 5. Chaput A, Madden S, Charapov I, Penning J, Szeto M. Implementation of a computerized Acute Pain Service database to monitor and prevent adverse events related to treatment of acute pain at The Ottawa Hospital. University of Ottawa Department of Anesthesiology. $8,107. 6. Chaput A, Jetty P, Neilipovitz DN, Power B, Skinner C. A pilot study to evaluate the polysomnographic effects of pregabalin in postoperative patients. Pfizer. $30,000. 7. Doherty D, 2010-2012 The Prevalence of Vitamin D Deficiency in Pediatric Critical Illness, Seed Grant, Children’s Hospital of Eastern Ontario. CHEO Research Institute. $26,737. 64 8. Doherty D. Messier C. Piceatannol: A pharmacological approach to ischemic preconditioning. JP Bickell Foundation. $76,749. 9.Fraser A, Chiu M, Crooks S, Naik VN. Simulated based education vs didactic teaching sessions for sterile technique training for Anesthesia Practitioners. The Ottawa Hospital Academic Medical Organization. $13,300. 10.Hudson C. Compare CT-angiography with transesophageal echocardiography to detect and quantify atheromatous disease of the thoracic aorta. University of Ottawa Heart Institute AMO. $25,000. 11.Macdonald J. ABC’s of dialogue: Establishing a therapeutic relationship in acute care medicine. University of Ottawa Heart Institute AMO. $25,000. 12.Murto K, 2010-2011 Celecoxib for pediatric Adenotonsillectomy: A randomized controlled-double-blinded study. Department of Anesthesiology Chairman Fund Competition. $20,000. 13.Naik VN, Sydor D, Thompson C, Woo, Pugh, Worthington J, Patel R. Online learning and simulation training for residents in ultrasound-guided central venous catheter insertion for a standardized approach at the Ottawa Hospital. University of Ottawa Educational Initiatives in Residency Education. $8,500. 14.Neilipovitz DN, Bormanis J, Bryson GL, Chaput A, Giulivi A, Jetty P, Pagliarello G, Taljaard M. Study using plasma for patients requiring emergency surgery. PALM. $7,054. 15.Sohmer B, Hudson C, Hudson J, Naik VN. Psychomotor readiness optimized for beginner echocardiographers. University of Ottawa Educational Initiatives in Residency Education. $3,000. 16. Wilson K, Harris C, Jarvis V, Kowal J, Nathan H, Smyth C. Coping with Chronic Neuropathic Among Cancer Survivors: A Multidisciplinary Approach. CIHR. $82,397. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Grants 2011 1. Bould MD, Everett T, Neira V, Naik VN. Simulation-based assessment for pediatric anesthesiology: a prospective, multicenter study. University of Ottawa Academy for Innovation in Medical Education. $24,900. 2. Bould MD, Everett T, Ng, Letal, Cowie, Fleming, Kulkarni, Buu. Simulation-based assessment for pediatric anesthesiology: a prospective, multicenter study. Royal College of Physicians and Surgeons of Canada. $45,278. 3. Bould MD, Everett T, Letal, Kulkarni, Cowie. Simulation-based assessment for pediatric anesthesiology: a prospective, multicenter study. Canadian Anesthesiologists’ Society. $28,079. 4. Bould MD, Everett T, Letal, Kulkarni, Cowie. Simulation-based assessment for pediatric anesthesiology: a prospective, multicenter study. University of Ottawa Department of Anesthesiology. $20,000. 5. Bryson GL, Power B, Taljaard M, Nathan H. Functional recovery and caregiver burden following surgery in the elderly. University of Ottawa Department of Anesthesiology. $20,000. 6. Chaput A, Neilipovitz DN, Skinner C, Jetty P, Power B. Identification of risk factors for sleep deficits in postoperative abdominal aortic aneurysm repair patients using polysomnography: an Observational Study. University of Ottawa Department of Anesthesiology. $20,000. 7. Doja A, Naik VN, Sharma M, DeMeulemeester C, Lindsay, Bould MD. The development of a feasible, valid and reliable tool for assessment of performance during 65 ‘Stroke Codes.” University of Ottawa Educational Initiatives in Residency Education. $9,000. Photo: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 8.Naik VN, Sydor D, Thompson C, Woo, Pugh, Worthington J, Patel R. Online learning and simulation training for residents in ultrasound-guided central venous catheter insertion for a standardized approach at TOH. University of Ottawa Educational Initiatives in Residency Education. $8,500. 9.Naik VN, Punja A, Sydor D, Chiu M, Lee. Investigating the reliability and feasibility of a summative oral examination administered remotely over the internet. University of Ottawa Educational Initiatives in Residency Education. $3,500. 10.Malas T, Price J, Lam K, Hendry P, Brandys T, Boodhwani M, Naik VN. The Use of Visualization in Surgical Simulation Training to Evaluate Performance of Vascular Anastamosis on a High-Fidelity In-Vivo Model. University of Ottawa Department of Surgery. 11.Murto K, 2011-2012 The addition of clonidine to a 0.2% ropivacaine for wound instillation after lower abdominal surgery in children. Department of Surgery Research Fund. $10,000. 12.Murto K, 2011-2012 The addition of clonidine to a 0.2% ropivacaine for wound instillation after lower abdominal surgery in children. Department of Anesthesiology Chairman Fund. $7,500. 13.Murto K. Celecoxib for pediatric adenotonsillectomy: a randomized controlled double-blinded study. CHEO Department of Surgery Research Fund. $7,500. 14.Murto K, MacCormick A, Lamontagne C, Rosen D, Vaillancourt R. Celecoxib for pediatric adenotonsillectomy: a randomized controlled double blinded study. CHEO RI University of Ottawa Department of Anesthesiology. $20,000. 15.Murto K. Celecoxib Plasma and Cerebral Spinal Fluid Pharmacokinetics in Children. November 2011 application to C17 (Children’s Cancer and Blood Disorders) 66 for $138,465. GRANTS Photos: Diane Sheppard DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 16.Neilipovitz DN, Bormanis J, Bryson GL, Chaput A, Giulivi A, Jetty P, Pagliarello G, Taljaard M. Study using plasma for patients requiring emergency surgery. University of Ottawa Department of Anesthesiology. $20,000. 17.Neilipovitz DN. The Ottawa Sleep Tool (TOAST) for ICU patients. The Ottawa Hospital–Intensive Care Unit. $10,000. 18.Sohmer B, Hudson C, Hudson J, Naik VN. Psychomotor Readiness Optimized for Beginner Echocardiographers (PROBE). University of Ottawa Educational Initiatives in Residency Education. $3,000. Grants 2012 1. Boet S, Power D, Bould MD, Everett T, Gale M. Does instruction on cognitive aid use improve performance and retention of skills? A simulation based randomized controlled trial. The Ottawa Hospital Academic Medical Organization. $28,628. 2. Boet S, Alam F, Piquette D, Leblanc VR. Using mental practice and modeling to enhance clinical learning experiences in medical education harnessing novel podcast technology. The University of Ottawa Educational Initiatives in Residency Education. $8,500. 3. Bould MD, Everett T, Cheng A, Eppich W, Moreau K, MacKinnon R. Characterizing The Debriefer: A Mixed Methods Study Of Debriefing in Simulation. University of Ottawa Academy for Innovation in Medical Education. $19,750. 4. Bould MD, Everett T, Cheng A, Eppich W, Moreau K, MacKinnon R. Characterizing the Debriefer: A Mixed Methods Study Of Debriefing in Simulation. Children’s Hospital of Eastern Ontario AMO. $36,857. 5. Bould MD, Moreau K, Clarkin C, McCarthy A, Ismailova F, Kinnear J. Global health partnerships in anaesthesia residency: the lived experience for postgraduate trainees. University of Ottawa Academy for Innovation in Medical Education. $11,300. 6. DiRenna T, Crooks S, Boet A, Fraser A, Naik VN, Power D. Cardiac Arrest Roles Defined (C.A.R.D.) protocol in perioperative cardiac arrests: a simulation-based multidisciplinary study. The Ottawa Hospital Academic Medical Organization. $47,835. 7. Doja A, Posner G, Sutherland S, Writer H, Bould MD. Formal, informal, or hidden curriculum: what type of interprofessional education is being delivered in the delivery room? University of Ottawa Academy for Innovation in Medical Education. $8,230. 8.Lai A, Boet S, Haligula A, Bould MD. Learning crisis resource management: Practicing versus observational role in simulation training. University of Ottawa Educational Initiatives in Residency Education $12,900. 9.Lalu M, Stewart D. In vivo assessment of a cellular clinical-grade immunotherapeutic for septic shock (CELLS2). Canadian Anesthesiologists’ Society/ LMA-Vitaid Residents’ Research Grant. $7,500. 10.Macdonald J, Hartwick M, Naik VN. Communication as a Medical Skill (ComMS) Check - Validation of a communication curriculum to enable medical professionals to develop rapport and therapeutic relationships in acute care environments. University of Ottawa Educational Initiatives in Residency Education. $ 6,500. 11.Murto K. Celecoxib Plasma and Cerebral Spinal Fluid Pharmacokinetics in Children. March 2012 application to CIHR (Children’s Cancer and Blood Disorders) for $147,000. (Results to be announced June 2012.) 12.Naik VN, Sydor D, Thompson C, Woo M, Pugh D, Patel R. Interactive online learning for staff physicians in US guided central venous catheter insertion for a standardized approach at TOH. The Ottawa Hospital Academic Medical Organization. $100,000. 13.Power D, Bould MD, Gale M, Everett T, Boet S. Does Instruction on Cognitive Aids Use improve Performance and Retention of Skills? A simulation-based randomized controlled trial. University of Ottawa Academy for Innovation in Medical Education. $16,350. 14.Robblee J. Real time adverse event reporting in the operating room – triggers. University of Ottawa AMO. $25,000. 15.Smyth C, Nathan H, DiRenna T, Wynne L, Lewis G, Poulin P, Jarvis H. Refinement of a chronic pain preceptorship program (Phase II) connecting family practitioners in the Champlain LHIN with the Academic Pain Clinic (TOHPC). The Ottawa Hospital Academic Medical Organization. $100,000. 67 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 University of Ottawa Department of Anesthesiology Publications 2007-2012 Publications 2007 1.Abu-Shahwan I, Mack D. Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy. Paediatr Anaesth 2007; 17(5):460-463. 2.Abu-Shahwan I, Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr Anaesth 2007; 17(9):846-850. 3.Abu-Shahwan I. Ambulatory anesthesia and the lack of consensus among Canadian pediatric anesthesiologists: a survey. Paediatr Anaesth 2007; 17(3):223-229. 4.Akbari A, Wilkes P, Lindheimer M, Lepage N, Filler G. Reference intervals for anion gap and strong ion difference in pregnancy: a pilot study. Hypertens Pregnancy 2007; 26(1):111-119. 5. Baxter AD, Kanji S. Protocol implementation in anesthesia: beta-blockade in non-cardiac surgery patients. Can J Anaesth 2007; 54(2):114-123. 6. Boodhwani M, Rubens F, Wozny D, Rodriguez R, Nathan HJ. Effects of sustained mild hypothermia on neurocognitive function after coronary artery bypass surgery: 68 a randomized, double-blind study. J Thorac Cardiovasc Surg 2007; 134(6):1443-1450. 7. Bryson GL, Macneil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anaesth 2007; 54(7):531-537. 8. Bryson GL, Thompson C, Gagne S, Byford L, Penning J, Kattan M. The addition of adrenaline to thoracic epidural meperidine does not improve analgesia following thoracotomy. Can J Anaesth 2007; 54(11):882-890. 9. Chan V, Kulik A, Bourke ME, Ressler L, Mesana TG, Ruel M. Clopidogrel is safe early after on- and off-pump coronary artery bypass surgery. J Card Surg 2007; 22(6): 493-497. 10. Chan V, Veinot JP, Hynes M, Lapierre H, Ruel M. Infected right ventricular myxoma and pulmonary valve endocarditis. J Thorac Cardiovasc Surg 2007;134:248-9. 11. Crosby ET. Considerations for airway management for cervical spine surgery in adults. Anesthesiol Clin 2007; 25(3):511-33, ix. 12.Ellis JA, Martelli B, Lamontagne C, Splinter W. Evaluation of a continuous epidural analgesia program for postoperative pain in children. Pain Manag Nurs 2007; 8(4):146-155. 13.Fayad A. Left ventricular outflow obstruction in a patient with undiagnosed hypertrophic obstructive cardiomyopathy. Can J Anaesth 2007; 54(12):1019-1020. 14.Fayad A. A misplaced guide wire in the false lumen during endovascular repair of a type B aortic dissection. Can J Anaesth 2007; 54(11):947-948. 15.Fayad A. Images in Anesthesia. Transesophageal echocardiographic diagnosis of a failed balloon catheter during endovascular stenting of a descending thoracic aneurysm. Can J Anaesth 2007; 54(10):848-849. 16. Kulik A, Rubens FD, Gunning D, Bourke ME, Mesana TG, Ruel M. Radial artery graft treatment with phenoxybenzamine is clinically safe and may reduce perioperative myocardial injury. Ann Thorac Surg 2007; 83(2):502-509. 17.Mesana TG, Ibrahim M, Kulik A, Ruel M, Dover K, Nicholson D et al. The “hybrid flip-over” technique for anterior leaflet prolapse repair. Ann Thorac Surg 2007; 83(1):322-323. 18.Miller DR, Wozny D. Research awards program of the Canadian Anesthesiologists’ Society/Canadian Anesthesia Research Foundation: survey of past recipients. Can J Anaesth 2007; 54(4):314-319. 19.Miller DR. Science journals and global outreach initiatives in developing countries. Can J Anaesth 2007; 54(11):868-871. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 20.Nathan HJ, Rodriguez R, Wozny D, Dupuis JY, Rubens FD, Bryson GL et al. Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: five-year follow-up of a randomized trial. J Thorac Cardiovasc Surg 2007; 133(5):1206-1211. 21.Neilipovitz DT, Crosby ET. No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anaesth 2007; 54(9):748-764. 22.Neilipovitz DT, Zunder I, Pagliarello G. Extension of a shortened endotracheal tube. Can J Anaesth 2007; 54(5):399-400. 23.Rodriguez RA, Rodriguez CD, Mesana T, Nathan HJ. Distinguishing air from solid emboli using ultrasound: in-vitro study of the effect of Doppler carrier frequency. J Neuroimaging 2007; 17(3):211-218. 24.Rubens FD, Boodhwani M, Mesana T, Wozny D, Wells G, Nathan HJ. The cardiotomy trial: a randomized, double-blind study to assess the effect of processing of shed blood during cardiopulmonary bypass on transfusion and neurocognitive function. Circulation 2007; 116(11 Suppl):I89-I97. 25.Rubens FD, Nathan H. Lessons learned on the path to a healthier brain: dispelling the myths and challenging the hypotheses. Perfusion 2007; 22(3):153-160. 26.Rubens FD, Nathan H. Lessons learned on the path to a healthier brain: dispelling the myths and challenging the hypotheses. Perfusion 2007; 22(3):153-160. 27.Rubens FD, Boodhwani M, Nathan H. Interpreting studies of cognitive function following cardiac surgery: a guide for surgical tea Perfusion 2007; 22(3):185-192. 28.Rubens FD, Nathan H. Lessons learned on the path to a healthier brain: dispelling the myths and challenging the hypotheses. Perfusion 2007; 22(3):153-160. 29. van Klei WA, Bryson GL, Yang H, Kalkman CJ, Wells GA, Beattie WS. The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery. Ann Surg 2007; 246(2):165-170. 30. van Klei WA, Bryson GL, Yang H, Kalkman CJ, Wells GA, Beattie WS. The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery. Ann Surg 2007; 246(2):165-170. 31. Wijeysundera DN, Karkouti K, Dupuis JY, Rao V, Chan CT, Granton JT et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA 2007; 297(16):1801-1809. Publications 2008 1.Abu-Shahwan I. Ketamine does not reduce postoperative morphine consumption after tonsillectomy in children. Clin J Pain 2008; 24(5):395-398. 2.Abu-Shahwan I. Is sevoflurane and remifentanil induction of anesthesia safe in children with severe dilated cardiomyopathy? J Cardiothorac Vasc Anesth 2008; 22(5):744-745. 3.Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth 2008; 18(1):55-59. 4.Allan R, Hynes M, Burwash IG, Veinot JP, Chan KL. Coronary artery complications in infective endocarditis. Ann Thorac Surg 2008; 86(4):1381. 5. Baxter AD, Cardinal P, Hooper J, Patel R. Rapid response systems--the real merit of MERIT? Crit Care Med 2008; 36(2):655-656. 6. Baxter AD, Cardinal P, Hooper J, Patel R. Medical emergency teams at The Ottawa Hospital: the first two years. Can J Anaesth 2008; 55(4):223-231. 7. Bhananker SM, Azavedo LF, Splinter WM. Addition of morphine to local anesthetic infiltration does not improve analgesia after pediatric dental extractions. Paediatr Anaesth 2008; 18(2):140-144. 8. Boodhwani M, Nathan HJ, Mesana TG, Rubens FD. Effects of shed mediastinal blood on cardiovascular and pulmonary function: a randomized, double-blind study. Ann Thorac Surg 2008; 86(4):1167-1173. 9. Bryson GL. Waiting for hip fracture repair - do outcomes and patients suffer? Can J Anaesth 2008; 55(3):135-139. 10. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008; 371(9627):1839-1847. 11. Dupuis JY. Predicting outcomes in cardiac surgery: risk stratification matters? Curr Opin Cardiol 2008; 23(6):560-567. 12.Eipe N, Doherty D. Flexible laryngeal mask airway for head and neck oncoplastic surgery? Eur J Anaesthesiol 2008; 25(11):947. 13.Eipe N, Kim J, Ramsey G, Mossdorf P. Anesthesia for laser treatment for retinopathy of prematurity--all clear now? Paediatr Anaesth 2008; 18(11):1103-1105. 69 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 14.Farion KJ, Splinter KL, Newhook K, Gaboury I, Splinter WM. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial. CMAJ 2008; 179(1):31-36. 15.Fayad A. Echocardiography images of endovascular mal-aligned stent grafts. Can J Anaesth 2008; 55(5):306-307. 16.Fayad A, Yang H. Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor? Curr Cardiol Rev 2008; 4(1):22-33. 17.Fayad A. Thoracic endovascular stent graft with a bird’s beak sign. Can J Anaesth 2008; 55(11):785-786. 18.Fergusson DA, Hebert PC, Mazer CD, Fremes S, Macadams C, Murkin JM et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008; 358(22):2319-2331. 19.Hutchison JS, Doherty DR, Orlowski JP, Kissoon N. Hypothermia therapy for cardiac arrest in pediatric patients. Pediatr Clin North Am 2008; 55(3):529-44, ix. 20.Irwin D, Vaillancourt R, Dalgleish D, Thomas M, Grenier S, Wong E et al. Standard concentrations of high-alert drug infusions across paediatric acute care. Paediatr Child Health 2008; 13(5):371-376. 21.Miller DR. Disclosure of conflicts of interest in biomedical publications. Can J Anaesth 2008; 55(5):265-269. 22.Murto K, Bryson GL, Abushahwan I, King J, Moher D, El-Emam K et al. Parents are reluctant to use technological means of communication in pediatric day care. Can J Anaesth 2008; 55(4):214-222. 70 23.Neema PK, Manikandan S, Ahuja A, Dharan BS, Gandhi S, Krishnamanohar SR et al. Case 4--2008: difficult weaning from cardiopulmonary bypass in the lateral position caused by lung collapse. J Cardiothorac Vasc Anesth 2008; 22(4):616-624. 24.Ozard J, Mossdorf P, Doja A, Writer H, Doherty DR. Acute hypomagnesaemia causing intra-operative lower limb movements in a paraplegic patient, despite full neuromuscular blockade. Acta Anaesthesiol Scand 2008; 52(7):1018-1020. 25.Rubens FD, Wells GA, Nathan HJ. Letter by Rubens et al regarding article, “Continuous-flow cell saver reduces cognitive decline in elderly patients after coronary bypass surgery”. Circulation 2008; 117(21):e348. Publications 2009 1. Boodhwani M, Rubens FD, Wozny D, Nathan HJ. Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann Thorac Surg 2009; 87(2):489-495. 2. Bould MD, Crabtree NA, Naik VN. Assessment of procedural skills in anaesthesia. Br J Anaesth 2009; 103(4):472-483. 3. Byrick RJ, Naik VN, Wynands JE. Simulation-based education in Canada: will anesthesia lead in the future? Can J Anaesth 2009; 56(4):273-278. 4. Choi PT, Beattie WS, Bryson GL, Paul JE, Yang H. Effects of neuraxial blockade may be difficult to study using large randomized controlled trials: the PeriOperative Epidural Trial (POET) Pilot Study. PLoS One 2009; 4(2):e4644. 5. Chong PC, Greco EF, Stothart D, Maziak DE, Sundaresan S, Shamji FM et al. Substantial variation of both opinions and practice regarding perioperative fluid resuscitation. Can J Surg 2009; 52(3):207-214. 6. Doherty DR. Towards a pharmacological neuro-protectant: can anesthesia deliver? Can J Anaesth 2009; 56(10):721-724. 7. Doherty DR, Parshuram CS, Gaboury I, Hoskote A, Lacroix J, Tucci M et al. Hypothermia therapy after pediatric cardiac arrest. Circulation 2009; 119(11):1492-1500. 8.Eipe N, Barrowman N, Writer H, Doherty D. A weight-based formula for tracheal tube size in children. Paediatr Anaesth 2009; 19(4):343-348. 9.Eipe N. Nasal intubation after tongue-flap surgery? Acta Anaesthesiol Scand 2009; 53(2):269-270. 10.Eipe N, Kim J. Unusually startling code blues! Paediatr Anaesth 2009; 19(1):68-69. 11.Eipe N, Lai L, Doherty DR. Severe pulmonary hypertension and adenotonsillectomy in a child with Trisomy-21 and obstructive sleep apnea. Paediatr Anaesth 2009; 19(5):548-549. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 12.Eipe N, Penning J. Bowel surgery and multimodal analgesia: same game, new team? Anesth Analg 2009; 109(5):1703-1704. 13.Eipe N. Left molar intubation for tongue flap division. Paediatr Anaesth 2009; 19(2):196. 14.Eipe N, Murto K. Adrenal insufficiency and thyroid replacement therapy. Paediatr Anaesth 2009; 19(4):422-423. 15. Kim J, Neilipovitz D, Cardinal P, Chiu M. A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as “CRM simulator study IB”). Simul Healthc 2009; 4(1):6-16. 16. Kim J, Thornton J, Eipe N. Spinal anesthesia for the premature infant: is this really the answer to avoiding postoperative apnea? Paediatr Anaesth 2009; 19(1):56-58. 17.Lane A, Crosby ET. Blood management for hip reconstruction surgery. Orthop Clin North Am 2009; 40(3):417-425. 18.Miller DR, Donati F, Drolet P. Special announcement: perioperative cardiovascular rounds and continuing professional development modules in the Journal. Can J Anaesth 2009; 56(6):402-407. 19.Miller DR. Special notice to readers and authors on scientific misconduct. Can J Anaesth 2009; 56(6):408-411. 20.Nathan HJ. Invited commentary. Ann Thorac Surg 2009; 87(1):288. 21.Pysyk CL, Murto K, Kuehn S, Doherty DR. Surgical diagnosis is an important variable to consider in postanesthesia exposure-associated learning disabilities. Anesthesiology 2009; 111(6):1382-1386. 22.Rodriguez RA, Nathan HJ, Ruel M, Rubens F, Dafoe D, Mesana T. A method to distinguish between gaseous and solid cerebral emboli in patients with prosthetic heart valves. Eur J Cardiothorac Surg 2009; 35(1):89-95. 23.Splinter WM, Eipe N. Anti-NMDA receptor antibodies encephalitis. Paediatr Anaesth 2009; 19(9):911-913. 24.Tang R, Evans H, Chaput A, Kim C. Multimodal analgesia for hip arthroplasty. Orthop Clin North Am 2009; 40(3):377-387. Publications 2010 1. Blew P, Muir JG, Naik VN. The evolving Royal College examination in anesthesiology. Can J Anaesth 2010; 57(9):804-810. 2. Boet S, Bould MD, Schaeffer R, Fischhof S, Stojeba N, Naik VN et al. Learning fibreoptic intubation with a virtual computer program transfers to ‘hands on’ improvement. Eur J Anaesthesiol 2010; 27(1):31-35. 3. Boodhwani M, Hamilton A, de VB, Mesana T, Williams K, Wells GA et al. A multicenter randomized controlled trial to assess the feasibility of testing modified ultrafiltration as a blood conservation technology in cardiac surgery. J Thorac Cardiovasc Surg 2010; 139(3):701-706. 4. Bould MD, Boet S, Riem N, Kasanda C, Sossou A, Bruppacher HR. National representation in the anaesthesia literature: a bibliometric analysis of highly cited anaesthesia journals. Anaesthesia 2010; 65(8):799-804. 5. Bruppacher HR, Alam SK, LeBlanc VR, Latter D, Naik VN, Savoldelli GL et al. Simulation-based training improves physicians’ performance in patient care in highstakes clinical setting of cardiac surgery. Anesthesiology 2010; 112(4):985-992. 6. Bryson GL, Charapov I, Krolczyk G, Taljaard M, Reid D. Intravenous lidocaine does not reduce length of hospital stay following abdominal hysterectomy. Can J Anaesth 2010; 57(8):759-766. 7. Bryson GL. Methods and madness: agitation, delirium, and postoperative cognitive dysfunction. Can J Anaesth 2010; 57(9):799-803. 8. Crosby ET. The role of simulator-based assessments in physician competency evaluations. Can J Anaesth 2010; 57:627-635. 9. Doherty DR, Pascuet E, Ni A, Stewart P, Splinter W, Vaillancourt R. Off-label drug use in pediatric anesthesia and intensive care according to official and pediatric reference formularies. Can J Anaesth 2010; 57(12):1078-1088. 10. Doherty DR, Hutchison JS. Study of hypothermia therapy after pediatric cardiac arrest. Pediatr Crit Care Med 2010; 11(2):315-316. 71 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 11.Eipe N, Penning J. Opioid conversions and patient-controlled analgesia parameters in opioid-dependent patients. Can J Anaesth 2010; 57(12):1129-1130. 12.Eipe N, Doherty DR. A review of pediatric capnography. J Clin Monit Comput 2010; 24(4):261-268. 13.Fayad A, Yang H, Terry Ruddy, James Watters, George Wells. Perioperative Myocardial Ischemia and Isolated systolic Hypertension (ISH) in Non-cardiac Surgery. Canadian Journal of Anesthesia. Aug 2010. In press. 14.Fayad A. Echocardiography images of inferior vena cava tumour thrombus in patient with renal cell carcinoma. Can J Anaesth. 2008. Aug; 55(8): 557-8. 15.Fayad A. Thoracic endovascular stent graft with a bird’s beak sign. Can J Anaesth. 2008 Nov; 55(11):785-6. 16.Geier C, Elgeti T, Ozcelik C, Fayad A. Hypertrophic cardiomyopathy - a matter of genes. Can J Anaesth. 2008 May; 55(5):309-11. 17.Fayad A. Echocardiography images of endovascular mal-aligned stent grafts. Can J Anaesth. 2008 May; 55(5):306-7. 18.Fayad A. Left ventricular outflow obstruction in a patient with undiagnosed hypertrophic obstructive cardiomyopathy. Can J Anaesth. 2007 Dec; 54(12):1019-20. 19.Fayad A. A misplaced guide wire in the false lumen during endovascular repair of a type B aortic dissection. Can J Anaesth. 2007 Nov; 54(11): 947-8. 20.Fayad A. Images in Anesthesia. Transesophageal echocardiographic diagnosis of a failed balloon catheter during endovascular stenting of a descending thoracic aneurysm. Can J Anaesth. 2007 Oct; 54(10):848-9. 72 21.Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R; BART Investigators. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008;358:2319-31. Epub 2008 May 14. Erratum in: N Engl J Med 2010;363:1290. 22.Grisoli D, Chan V, Tran A, Ressler L, Nicholson D, Hynes M et al. Frequency and surgical management of complex posterior leaflet prolapse of the mitral valve. J Heart Valve Dis 2010; 19(5):568-575. 23.Hall R, Beattie S, Cheng D, Choi P, Denault AY, Mazer D et al. Can we develop a Canadian Perioperative Anesthesiology Clinical Trials Group? Can J Anaesth 2010; 57(12):1051-1057. 24.Hayter MA, Friedman Z, Katznelson R, Hanlon JG, Borges B, Naik VN. Effect of sleep deprivation on labour epidural catheter placement. Br J Anaesth 2010; 104(5):619-627. 25.Hudson CC, Welsby IJ, Phillips-Bute B, Mathew JP, Lutz A, Chad HG et al. Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients. Can J Anaesth 2010; 57(6):565-572. 26. Kanji S, Jones E, Goddard R, Meggison HE, Neilipovitz D. Efficiency and safety of a standardized protocol for intravenous insulin therapy in ICU patients with neurovascular or head injury. Neurocrit Care 2010; 12(1):43-49. 27.Michaud A, Dupuis JY. Echocardiographic evaluation of TASER X26 in healthy volunteers. Am J Emerg Med 2010; 28(4):521-523. 28.Miller DR. 2010 Guidelines and international standards to the practice of anesthesia. Can J Anaesth 2010; 57(11):957-960. 29.Moga R, Nicholson D, Hudson JK, Hudson CC. A little-known valve. J Cardiothorac Vasc Anesth 2010. 30.Murto K. Diagnostic Challenge: Obstructive Sleep Apnea in Children Undergoing Anesthesia for Tonsil Surgery. Society for Ambulatory Anesthesia 2010; 25(3): 6. 31.Nairn TK, Giulivi A, Neurath D, Tokessy M, Sia YT, Ruel M et al. Urgent replacement of a mechanical mitral prosthesis in an anticoagulated patient with Bombay red blood cell phenotype. Can J Anaesth 2010; 57(6):583-587. 32.Parush A, Kramer C, Foster-Hunt T, Momtahan K, Hunter A, Sohmer B. Communication and team situation awareness in the OR: Implications for augmentative information display. J Biomed Inform 2011;44:477-85. Epub 2010 Apr 8. 33.Pascuet E, Cowin L, Vaillancourt R, Splinter W, Vadeboncoeur C, Dumond LG et al. A comparative cost-minimization analysis of providing paediatric palliative respite care before and after the opening of services at a paediatric hospice. Healthc Manage Forum 2010; 23(2):63-66. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 34.Pysyk CL, Persaud D, Bryson GL, Lui A. Ultrasound assessment of the vertebral level of the palpated intercristal (Tuffier’s) line. Can J Anaesth 2010; 57(1):46-49. 35.Rodriguez RA, Rubens FD, Wozny D, Nathan HJ. Cerebral emboli detected by transcranial Doppler during cardiopulmonary bypass are not correlated with postoperative cognitive deficits. Stroke 2010; 41(10):2229-2235. 36.Roy D, Neira V. Need for shortening of epidural catheter – not applicable for all types of catheters. J Anesth Clin Pharmacol 2010; 26 (3): 428. 37.Ruel M, Dickie S, Chow BJ, Labinaz M. Interventional valve surgery: building a team and working together. Semin Thorac Cardiovasc Surg 2010; 22(2):145-149. 38.Splinter WM, Thomson ME. Somatic paravertebral block decreases opioid requirements in children undergoing appendectomy. Can J Anaesth 2010; 57(3):206-210. 39.Swaminathan M, Hudson CC, Phillips-Bute BG, Patel UD, Mathew JP, Newman MF et al. Impact of early renal recovery on survival after cardiac surgery-associated acute kidney injury. Ann Thorac Surg 2010; 89(4):1098-1104. 40.Thomas M, Dhanani S, Irwin D, Writer H, Doherty D. Development, dissemination and implementation of a sedation and analgesic guideline in a pediatric intensive care unit...it takes creativity and collaboration. Dynamics 2010; 21(4):16-25. 41.Thompson C, Moga R, Crosby ET. Failed videolaryngoscope intubation in a patient with diffuse idiopathic skeletal hyperostosis and spinal cord injury. Can J Anaesth 2010; 57(7):679-682. 42. Vadeboncoeur CM, Splinter WM, Rattray M, Johnston DL, Coulombe L. A Pediatric Palliative Care Program in Development Trends in Referral and Location of Death. Arch Dis Child. 2010; 95: 686-689. 43. Vaillancourt R, Collins M, Vadeboncoeur C, Jacob P, Graham N, Foster D et al. Successful treatment of a seizure disorder with chronic high-dose chloral hydrate: a pediatric case report. J Palliat Care 2010; 26(4):311-313. 44. Wilkes P, Akbari A. Unappreciated aspects of fluid and electrolyte physiology and implications to patient recovery. Can J Anaesth 2010; 57(7):636-640. 45.Yang H. Further reflections on recent updates to perioperative beta-blocker guidelines. Can J Anaesth 2010; 57(7):712-713. Publications 2011 1.Antrobus JD, Bryson GL. Enhanced recovery for arthroplasty: good for the patient or good for the hospital? Can J Anaesth 2011; 58(10):891-896. 2. Bahaziq W, Crosby E. Physician professional behaviour affects outcomes: a framework for teaching professionalism during anesthesia residency. Can J Anaesth 2011; 58(11):1039-1050. 3. Belway D, Tee R, Nathan HJ, Rubens FD, Boodhwani M. Temperature management and monitoring practices during adult cardiac surgery under cardiopulmonary bypass: results of a Canadian national survey. Perfusion 2011; 26(5):395-400. 4. Boet S, Borges BC, Naik VN, Siu LW, Riem N, Chandra D et al. Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session. Br J Anaesth 2011; 107(4):533-539. 5. Boet S, Bould MD, Diemunsch P. Evolving challenges and opportunities for difficult airway management guidelines. Can J Anaesth 2011; 58(8):703-708. 6. Boet S, Collange O, Bould MD. Teaching hemodynamics via horticulture. Can J Anaesth 2011; 58(6):588-589. 7. Boet S, Bould MD, Bruppacher HR, Desjardins F, Chandra DB, Naik VN. Looking in the mirror: self-debriefing versus instructor debriefing for simulated crises. Crit Care Med 2011; 39(6):1377-1381. 8. Boet S, Bould MD, Diemunsch PA. Combined rigid videolaryngoscopy-flexible bronchoscopy for intubation. Korean J Anesthesiol 2011; 60(5):381-382. 9. Bould MD, Sury MR. Defining awakening from anesthesia in neonates: a consensus study. Paediatr Anaesth 2011; 21(4):359-363. 10. Bould MD, Boet S, Sharma B, Shin E, Barrowman NJ, Grantcharov T. h-Indices in a university department of anaesthesia: an evaluation of their feasibility, reliability, and validity as an assessment of academic performance. Br J Anaesth 2011; 106(3):325-330. 73 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 11. Bryson GL, Wyand A, Wozny D, Rees L, Taljaard M, Nathan H. A prospective cohort study evaluating associations among delirium, postoperative cognitive dysfunction, and apolipoprotein E genotype following open aortic repair. Can J Anaesth 2011; 58(3):246-255. 12. Bryson GL, Wyand A, Wozny D, Rees L, Taljaard M, Nathan H. The clock drawing test is a poor screening tool for postoperative delirium and cognitive dysfunction after aortic repair. Can J Anaesth 2011; 58(3):267-274. 13. Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I et al. Characteristics and Short-Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery: A Cohort Study. Ann Intern Med 2011; 154(8):523-528. 14. Devereaux PJ, Guyatt G, Yang H, Yusuf S. Essay for the CIHR/CMAJ award: impact of the Perioperative Ischemic Evaluation (POISE) trial. CMAJ 2011; 183(6):E351-E353. 15. Dhanani S, Barrowman NJ, Ward RE, Murto KT. Intra- and inter-observer reliability using a noninvasive ultrasound cardiac output monitor in healthy anesthetized children. Paediatr Anaesth 2011; 21(8):858-864. 16. Dhanani S, Barrowman NJ, Ward RE, Murto KT. Intra- and inter-observer reliability using a noninvasive ultrasound cardiac output monitor in healthy anesthetized children. Paediatr Anaesth 2011; 21(8):858-864. 74 17. Donati F, Miller DR, Fiset P. Target-controlled infusion devices: are we missing much? Can J Anaesth 2011; 58(4):349-353. 18.Eipe N, Penning J. Postoperative respiratory depression with pregabalin: a case series and a preoperative decision algorithm. Pain Res Manag 2011; 16(5):353-356. 19.Ellis J, Martelli B, Lamontagne C, Pascuet E, Taillefer L, Gaboury I et al. Improved practices for safe administration of intravenous bolus morphine in a pediatric setting. Pain Manag Nurs 2011; 12(3):146-153. 20.Elmistekawy E, Lapierre H, Bourke M, Dennie C, Labinaz M, Ruel M. Repeat cardiac surgery in a Jehovah’s Witness patient with thrombocytopenia. Can J Cardiol 2011; 27(6):869-8. 21.Elmistekawy EM, Gawad N, Bourke M, Mesana T, Boodhwani M, Rubens FD. Is bilateral internal thoracic artery use safe in the elderly? J Card Surg 2012;27:1-5. Epub 2011 Nov 24. 22.Elmistekawy E, Chan V, Bourke ME, Dupuis JY, Rubens FD, Mesana TG, Ruel M. Off-pump coronary artery bypass grafting does not preserve renal function better than on-pump coronary artery bypass grafting: results of a case-matched study. J Thorac Cardiovasc Surg 2012;143:85-92. Epub 2011 Oct 27. 23.Fayad AA, Yang HY, Ruddy TD, Watters JM, Wells GA. Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery. Can J Anaesth 2011; 58(5):428-435. 24.Forero M, Neira VM, Heikkila AJ, Paul JE. Continuous lumbar transversus abdominis plane block may spread to supraumbilical dermatomes. Can J Anaesth 2011; 58(10):948-951. 25.Forster AJ, Worthington JR, Hawken S, Bourke M, Rubens F, Shojania K et al. Using prospective clinical surveillance to identify adverse events in hospital. BMJ Qual Saf 2011; 20(9):756-763. 26. Kraeva N, Riazi S, Loke J, Frodis W, Crossan ML, Nolan K et al. Ryanodine receptor type 1 gene mutations found in the Canadian malignant hyperthermia population. Can J Anaesth 2011; 58(6):504-513. 27.Labrosse MR, Boodhwani M, Sohmer B, Beller CJ. Modeling leaflet correction techniques in aortic valve repair: A finite element study. J Biomech 2011; 44(12):2292-2298. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 28.Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg 2011; 40(4):804-810. 29.Miller DR. Update to readers and authors on ethical and scientific misconduct: retraction of the “Boldt articles”. Can J Anaesth 2011; 58(9):777-781. 30.Miller DR, Roth SH. Special theme issue: mechanisms of anesthesia. Can J Anaesth 2011; 58(2):125-130. 31.Miller DR. Publication fraud: implications to the individual and to the specialty. Curr Opin Anaesthesiol 2011; 24(2):154-159. 32.Neira VM, Gardin L, Ryan G, Jarvis J, Roy D, Splinter W. A transesophageal echocardiography examination clarifies the cause of cardiovascular collapse during scoliosis surgery in a child. Can J Anaesth 2011; 58(5):451-455. 33.Parush A, Kramer C, Foster-Hunt T, Momtahan K, Hunter A, Sohmer B. Communication and team situation awareness in the OR: Implications for augmentative information display. J Biomed Inform 2011; 44(3):477-485. 34.Price J, Naik V, Boodhwani M, Brandys T, Hendry P, Lam BK. A randomized evaluation of simulation training on performance of vascular anastomosis on a highfidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg 2011; 142(3):496-503. 35.Riem N, Boet S, Tritsch L, Bould D. LMA with positive pressure ventilation is safe! Korean J Anesthesiol 2011; 61(1):88-89. 36.Robblee JA, Wilkes PR, Dickie SJ, Rubens FD, Bormanis J. Bleeding in a Jehovah’s Witness patient undergoing a redo aortic valve replacement controlled with cryoprecipitate and a prothrombin complex concentrate. Can J Anaesth. 2012;59:299-303. Epub 2011 Dec 10. 37.Rodriguez RA, Bussiere M, Bourke M, Mesana T, Nathan HJ. Predictors of duration of unconsciousness in patients with coma after cardiac surgery. J Cardiothorac Vasc Anesth 2011; 25(6):961-967. 38.Sine K, Vaillancourt R, Pascuet E, Martelli B, Lamontagne C, Ellis J et al. Review of prescribing practices for intermittent bolus administration of morphine. Can J Hosp Pharm 2011; 64(1):25-30. 39.Sury MR, Bould MD. Defining awakening from anesthesia in infants: a narrative review of published descriptions and scales of behavior. Paediatr Anaesth 2011; 21(4):364-372. 40.Tran DT, Dupuis JY, Mesana T, Ruel M, Nathan HJ. Comparison of the EuroSCORE and Cardiac Anesthesia Risk Evaluation (CARE) score for risk-adjusted mortality analysis in cardiac surgery. Eur J Cardiothorac Surg 2012; 41:307-13. Epub 2011 Dec 12. in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg 2011; 142(3):496-503. 33.Riem N, Boet S, Tritsch L, Bould D. LMA with positive pressure ventilation is safe! Korean J Anesthesiol 2011; 61(1):88-89. 34.Rodriguez RA, Bussiere M, Bourke M, Mesana T, Nathan HJ. Predictors of duration of unconsciousness in patients with coma after cardiac surgery. J Cardiothorac Vasc Anesth 2011; 25(6):961-967. 35.Sine K, Vaillancourt R, Pascuet E, Martelli B, Lamontagne C, Ellis J et al. Review of prescribing practices for intermittent bolus administration of morphine. Can J Hosp Pharm 2011; 64(1):25-30. 36.Sury MR, Bould MD. Defining awakening from anesthesia in infants: a narrative review of published descriptions and scales of behavior. Paediatr Anaesth 2011; 21(4):364-372. 75 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Publications 2012 (to April 30) 1. Bould MD, Naik VN, Hamstra SJ. Review article: new directions in medical education related to anesthesiology and perioperative medicine. Can J Anaesth 2012; 59(2):136-150. 2. Chan V, Ruel M, Chaudry S, Lambert S, Mesana TG. Clinical and echocardiographic outcomes after repair of mitral valve bileaflet prolapse due to myxomatous disease. J Thorac Cardiovasc Surg 2012; 143(4 Suppl):S8-11. 3. Chaput AJ, Bryson GL. Postoperative delirium: risk factors and management: Continuing Professional Development. Can J Anaesth 2012. 4. Charapov I, Eipe N. Cardiac arrest in the operating room requiring prolonged resuscitation. Can J Anaesth 2012. 5. Chiu M, Arab AA, Elliott R, Naik VN. An experiential teaching session on the anesthesia machine check improves resident performance. Can J Anaesth 2012; 59(3):280287. 6.Eipe N, McGuire T. Submental intubation: another anesthetic option for maxillofacial trauma. Paediatr Anaesth 2012; 22(5):494-496. 76 7.Elmistekawy E, Chan V, Bourke ME, Dupuis JY, Rubens FD, Mesana TG et al. Off-pump coronary artery bypass grafting does not preserve renal function better than onpump coronary artery bypass grafting: results of a case-matched study. J Thorac Cardiovasc Surg 2012; 143(1):85-92. 8.Elmistekawy EM, Gawad N, Bourke M, Mesana T, Boodhwani M, Rubens FD. Is bilateral internal thoracic artery use safe in the elderly? J Card Surg 2012; 27(1):1-5. 9.Giglioli S, Boet S, De Gaudio AR, Linden M, Schaeffer R, Bould MD et al. Self-directed deliberate practice with virtual fiberoptic intubation improves initial skills for anesthesia residents. Minerva Anestesiol 2012; 78(4):456-461. 10.Fayad A. “How long do we have to wait to accept a change in our practice”. Anaesthesia. Corrospondence 1098. 2012:67;4. 11.Miller DR. Special theme issue on advances in education in anesthesiology. Can J Anaesth 2012; 59(2):127-131. 12.Miller DR. Advances in medical education in anesthesia. Can J Anaesth 2012; 59(2):224-225. 13.Naik VN, Wong AK, Hamstra SJ. Review article: leading the future: guiding two predominant paradigm shifts in medical education through scholarship. Can J Anaesth 2012; 59(2):213-223. 14.Posner G, Naik V, Bidlake E, Nakajima A, Sohmer B, Arab A et al. Assessing residents’ disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality. J Obstet Gynaecol Can 2012; 34(4):367-373. 15.Power DJ, Boet S, Bould MD. Code reader: a novel concept that warrants more research. Simul Healthc 2012; 7(2):136-137. 16.Osman A, Fayad A, Bryson G, Fergusson D, Lalu M. “Practice guidelines for ultrasound guided subclavian vein catheterization: analyzing the evidence. Letter to the Editor. Anesthesia Analgesia. In press. 17.Osman A, Fayad A, Bryson G, Lalu M. Ultrasound-guided Subclavian Vein Catheterization: A Systematic Review and Meta-Analysis. Abstract CAS June 2012. Abstract 1341957. 18.Tran DT, Dupuis JY, Mesana T, Ruel M, Nathan HJ. Comparison of the EuroSCORE and Cardiac Anesthesia Risk Evaluation (CARE) score for risk-adjusted mortality analysis in cardiac surgery. Eur J Cardiothorac Surg 2012; 41(2):307-313. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 University of Ottawa Department of Anesthesiology Book Chapters 2007-2012 Book Chapters 2007 1. Doherty D, Hutchison J S. Hypoxic Ischemia Encephalopathy. Pediatric Critical Care: Basic Science and Clinical Evidence, Eors: Derek Wheeler, Hector Wong, Published by Springer-Verlag,. 3. Evans H, Nielsen KC, Steele SM. Regional Anesthesia for Ambulatory Surgery. In Handbook of Ambulatory Anesthesia. Twersky R and Philip B (eds), Springer; 2008: 195-233. 2. Dumitrascu, G. “Allergic Reactions”. In Decision Making in Anesthesiology 4th edition, under Bready LL. 2007. 4. Hutchison JS, Dermot D, Orlowski J, Kissoon N. Hypothermia Therapy for Cardiac Arrest in Pediatric Patients. Pediatric Clinics of North America Volume 55, Issue 3. Pages 529-544. 3. Dumitrascu, G. “Hyperparathyroidism”. In Decision Making in Anesthesiology 4th edition, under Bready LL. 2007. 4. Dumitrascu, G. “Chronic Obstructive Pulmonary Disease”. In Decision Making in Anesthesiology 4th edition, under Bready LL. 2007. 5. O’Brien ER, Nathan HJ. “Coronary Physiology and Atherosclerosis” in Kaplan J (ed): Essentials of Cardiac Anesthesia, First Edition. W.B. Saunders Company, 2008. 5. Evans H, Nielsen KC, Greengrass R, Steele SM. Equipment for Continuous Peripheral Nerve Blocks. In Textbook of Regional Anesthesia and Acute Pain Management. Hadzic A (ed), McGraw-Hill, 2007. 6. Saint-Pierre A, Buithieu J, Coutu S, Lambert AS. Mitral Valve. In Denault, Couture, Vegas, Buithieu, Tardif, Transesophageal Echocardiography, Informa Healthcare, New York, 2008 (in Press). 6. Evans H, Steele SM. Regional Anesthesia for Cosmetic Surgery. In Anesthesia for Cosmetic Surgery. Freidberg BL (ed), Cambridge; 2007 Apr. 1. DiRenna, T. Functional Pain Syndromes: Presentation and Pathophysiology: Book Review. Canadian Journal of Anesthesia / Journal canadien d’anesthésie. 56(11) November 2009 7. Schlosser R, Nielsen KC, Evans H et al. Peripheral Nerve Blocks for Outpatient Surgery. In Textbook of Regional Anesthesia and Acute Pain Management. Hadzic A (ed), McGraw-Hill, 2007. 2. Hudson JK, Shaw A. TEE in the critical care unit. In: Mathew J, Swaminathan M, Ayoub C (Eds.). Clinical manual & review of transesophageal echocardiography 2nd ed. 2010. Book Chapters 2008 3. Tang R, Evans H, Chaput AJ, Kim C. Multimodal analgesia for hip arthroplasty. Orthop Clin N Am 2009;40:377-87. 1. Lambert AS, Mitral Regurgitation. In: Perrino A, Reeves S. Practical Approach to Transesophageal Echocardiography (ed.), 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008: 171-188. 2. Evans H, Steele SM. Paravertebral Anesthesia. In Principles of Anesthesia. Longnecker D, Brown D, Newman M, Zapol W (eds), McGraw-Hill; 2008. Book Chapters 2009 4. Wilkes, PRH. Normal [SID]. In: JA Kellum, PWG Elbers (Eds.). Stewart’s Textbook of Acid-Base. AcidBase.org/Paul WG Elbers, Amsterdam, The Netherlands; 2009: 201-216. 5. Wilkes, PRH, Akbari, A. Pregnancy. In: JA Kellum, PWG Elbers (Eds.). Stewart’s Textbook of Acid-Base. AcidBase.org/Paul WG Elbers, Amsterdam, The Netherlands: 2009:293-304. 77 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Book Chapters 2010 78 1. Hudson JK, Shaw A. TEE in the critical care unit. In: Mathew J, Swaminathan M, Ayoub C (Eds.). Clinical manual & review of transesophageal echocardiography 2nd ed. 2010. 6. Feneck , Kneeshaw and Ranucci, Core Topics in. 2011 Invited book review, Core Topics in Transesophageal Echocardiography. published in the Canadian Journal of Anesthesiology (accepted for publication June 17, 2011). 2. Girard M, Fayad A, Vieillard-Baron A. In: Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC (Eds.).Transesophageal Echocardiography Multimedia Manual, Second Edition: A Perioperative Transdisciplinary Approach. Chapter 30 “TEE in The Intensive Care Unit and Nocardiac Surgery” 740-769, November 2010. 7. Hudson CCC, JKC Hudson, Mackensen GB. The assessment of a patient with endocarditis. In: Savage RM, Aronson S, Shernan SK (Ed). Comprehensive textbook of perioperative transesophageal echocardiography, 2nd ed. Philadelphia: Lippincott, Wilkins and Williams; 2011: 363-371. 3. Persaud D, Garneau S. Book and New media Reviews: An Introductory Curriculum for Ultrasound-Guided Regional Anesthesia – A Learner’s Guide. Canadian Journal of Anesthesia. Apr 2010. 8. Hudson CCC, JKC Hudson, Mackensen GB. Echocardiographic assessment of cardiomyopathies. In: Savage RM, Aronson S, Shernan SK (Ed). Comprehensive textbook of perioperative transesophageal echocardiography, 2nd ed. Philadelphia: Lippincott, Wilkins and Williams; 2011: 611-621. Book Chapters 2011 1. Amyot R, Lebeau R, Lambert AS. Imaging artifacts and pitfalls. In: Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC (Ed). Transesophageal echocardiography; Multimedia Manual, 2nd ed. New York: Informa Healthcare; 2011:145-165. 2. Chen RJB, Lambert S. Mitral valve repair with SAM. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:169-172. 9. Hudson JK, Hudson CC, Hill S. Routine postoperative care of the thoracic patient. In: Grichnik K, Shaw A, Barbeito A (Eds.).Thoracic anesthesia: ready to practice. 2011 10.Hudson CC, Hudson JK, Swaminathan M. Aortic insufficiency. In: Subramaniam B, Rengasamy SK, Subramaniam K (Eds.). Problembased approach to perioperative TEE. In Press. 11.Hudson J. TEE Pocket Manual. CJA (in press). 2011 3. Dickie SJ, Lambert AS. Cleft mitral valve. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:77-81. 12.Hynes MS, Lambert S. Percutaneous aortic valve. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011: 194-199. 4. Dickie SJ, Lambert AS. Tricuspid endocarditis. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:287-291. 13.Hynes MS, Lambert S. Unicuspid aortic valve. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011: 267-270. 5. Dickie SJ, Lambert AS. Left ventricular assist device. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:301-305. 14.Lambert AS. Mitral valve diseases. In: Oxorn. Intraoperative Echocardiography. (Practical Echocardiography Series. Series Editor: Catherine Otto). Philadelphia:Elsevier Saunders; 2011:19-45. DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 15.Lambert S. Acute mitral prosthetic dysfunction. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:1-4. 16.Lambert S. Endocarditis. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:158-161. 17.Lambert S. Prosthetic mitral stenosis. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:224-227. 18.Lambert S. Mitral paravalvular leaks. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:321-324. 19.Marcotte, F, Bouchard D, Hynes M. Pulmonic and tricuspid valve. In: Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC (Ed). Transesophageal echocardiography; Multimedia Manual, 2nd ed. New York: Informa Healthcare; 2011:460-491. 20.Nicholson D, Lambert S. Non-severe tricuspid valve regurgitation and mitral valve surgery. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:313-316. 21.Nicholson D, Lambert S. The ins and outs of mitral valve repair. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: 22.Lippincott, Wilkins and Williams; 2011:183-185. 23.Saint-Pierre A, Buithieu, Lambert AS. Imaging artifacts and pitfalls. In: Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC (Ed). Transesophageal echocardiography; Multimedia Manual, 2nd ed. New York: Informa Healthcare; 2011:398-428. 24.Sohmer B, Lambert S. Aortic intramural hematoma. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:111-114. 25.Sohmer B, Lambert S. Eccentric jet. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:154-157. 26.Sohmer B, Lambert S. Coronary air: diagnosis and management. In: Perrino AC, Reeves ST, Glas K (Ed.). The practice of perioperative transesophageal echocardiography: Essential cases. Philadelphia: Lippincott, Wilkins and Williams; 2011:97-100. 27.Sohmer B, Perrino A. Acute Ischemic MR. In A Perrino, S Reeves & K Glas (Eds), The Practice of Perioperative Transesophageal Echocardiography, Essential Cases. Philadelphia: Lippincott Williams and Wilkins. 2011: 354-359. Book Chapters 2012 1. Persaud D, Garneau S. Head and Neck: Scalp, Ophthalmic, and Cervical Blocks. In Essentials of Regional Anesthesia. New York: Springer. 2012: 463-483. 2. Fayad A, Woo M. Echocardiography in Anesthesia. In Trauma in Anesthesia. New York: Cambridge University Press. 2012:130-144. University of Ottawa Department of Anesthesiology 79 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Awards 2007-2012 Awards 2007 80 Dr.Wayne Barry University of Ottawa Lifetime Achievement Award Dr. Michelle Chiu Canadian Anesthesiologists’ Society David S. Sheridan Award Dr. John Cowan Canadian Anesthesiologists’ Society Gold Medal Award Dr. Dermot Doherty Canadian Anesthesiologists’ Society Abbott Career Scientist’s Award Dr. Chris PysykGary Johnson Research Day Award: Ultrasound measurement of Epidural and Neuraxial Structures. Dr. Anna WyandGary Johnson Research Day Award: Does the Clock Drawing Test Detect Delirium or Cognitive Dysfunction PPart – Peri-operative pressure in anesthesiologists and resident trainees? Awards 2008 Dr. Jean-Yves DupuisThe Ottawa Hospital Clinician Recognition Award Dr. Ilia CharapovGary Johnson Research Day Award: Effect of intravenous lidocaine on discharge, opioid use, and functional recovery following abdominal hysterectomy. Dr. Sylvain Gagne Dr. Lucie Filteau University of Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. Yvette GrabowskiGary Johnson Research Day Award: An Epidemiological Analysis of Preoperative Comorbidity, Surgical Priority and Outcome in Cardiac Surgery. Dr. Peter MacEwen Dave Roberts Memorial Award Dr. Robert MacNeil University of Ottawa, Department of Anesthesia Undergraduate Award University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Lawrie Garnett The Ottawa Hospital Clinician Physician Award Dr. Sanjiv GuptaGary Johnson Research Day Award: Awake laryngoscopic evaluation with remefentanil trial. Dr. Shawn Hicks Canadian Anesthesiologists’ Society Resident Research Competition, First Place Lynne McHardyThe Ottawa Hospital Compass Award Dr. Shawn HicksGary Johnson Research Day Award: Intralipid does not improve survival in a swine model of bupivacaine. Dr. Kimmo Murto Canadian Anesthesiologists’ Society Top 50 poster recognition Dr. Stephane Moffett University of Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. David Neilipovitz Canadian Anesthesiologists’ Society Organon Research Award Dr. Kimmo Murto CHEO Research Institute Excellence in Clinical Research Award Dr. Desiree Persaud Canadian Anesthesiologists’ Society Clinical Teacher Award Dr. Desiree Persaud Dave Roberts Memorial Award Dr. Michael Szeto University of Ottawa, Department of Anesthesia Undergraduate Award DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Awards 2009 Dr. Benjamin Sohmer Univesityof Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. Linda Wynne Dave Roberts Memorial Award Dr. Michael BourkeHeart of Gold Award, University of Ottawa Heart Institute Dr. Gregory Bryson Canadian Anesthesiologists’ Society Raymond Martineau Award for Best Cardiovascular Thoracic Section Paper Dr. Simone Crooks University of Ottawa, Department of Anesthesia Undergraduate Award Dr. George Dumitrascu University of Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. Naveen EipeGary Johnson Research Day Award: Do the ASA guidelines for OSA correlate with polysomnography in children? France GreenwoodThe Ottawa Hospital Compass Award Dr. Gregory KrolczykGary Johnson Research Day Award: Effect of intravenous lidocaine infusion on discharge rate, functional recovery, opioid use, following abdominal hysterectomy Dr. Peter MacEwen University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Kimmo Murto Canadian Anesthesiologists’ Society Best Ambulatory Anesthesia Paper Dr. John PenningThe Ottawa Hospital Clinician Physician Award Awards 2010 Dr. Wayne Barry Canadian Anesthesiologists’ Society Gold Medal Dr. Dylan Bould Canadian Anesthesiologists’ Society Best paper in Simulation and Education Dr. Alan Chaput University of Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. Lucie Filteau University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Sylvain Gagne University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Manoj LaluGary Johnson Research Day Award: Safety of Cell Therapy with Mesenchymal Stromal Cells (MSCs): A Systematic Review. Dr. Shona NairGary Johnson Research Day Award: Long-term Functional Recovery after Coma due to Stroke, Encephalopathy or Seizures after Cardiac Surgery measured by the Glasgow Outcome Scale. Extended: The Long-GOSE Coma Study. Dr. Dan PowerGary Johnson Research Day Award: Transfusion practices at the Ottawa Hospital for Ruptured Abdominal Aortic Aneurysms Dr. Victor Neira Dr. James Robblee Holly Videto Canadian Anesthesiologists’ Society Ian Whyte Award for the best abstract on a topic of patient safety – A battery management program contributes to patient safety Canadian Anesthesiologists’ Society Best Education Paper Dr. Diem TranGary Johnson Research Day Award: Risk adjusted Analysis of Anesthesia Care Delivery at the Ottawa Heart Institute. Dave Roberts Memorial Award Denise WoznyThe Ottawa Hospital Compass Award 81 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Awards 2011 Dr. Lawrie Garnett University of Ottawa, Lifetime Achievement Award Dr. Juliet AtherstoneGary Johnson Research Day Award: A Novel Technique for Evaluating the Aortic Valve Using Transesophageal Echocardiography and Computer Modeling. Dr. Jordan Hudson University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Dylan BouldAcademy for Innovation in Medical Education - Top four oral presentations 82 Dr. Robert JeeGary Johnson Research Day Award: Inpatient Management of Obstructive Sleep Apnea. Dr. Leo Jeyaraj Dr. Michael BourkeHeart of Gold Award, University of Ottawa Heart Institute University of Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. Patti Murphy Dave Roberts Memorial Award Dr. Alan Chaput Dr. Cathy SmythThe Ottawa Hospital Clinician Physician Award University of Ottawa, Educator Award for Collaborator, Competency - Anglophone Stream Photos: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Dr. Devin SydorGary Johnson Research Day Award: The Effects of Team Dynamics on Trainees’ Ability to Challenge Authority: Measuring Health Advocacy with Patient Simulation. Dr. Stephane Lambert CME Teaching Academic Award of University of Ottawa Heart Institute Academic Medical Organization Dr. Calvin Thompson University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Homer Yang & POISE 1 Team Canadian Institutes of Health Research (CIHR) and Canadian Medical Association Journal (CMAJ) Top Dr. Stéphane Moffett University of Ottawa, Department of Anesthesia, Rachel Waugh Clinical Staff Annual Teaching Award Dr. Patti Murphy Achievement in Health Research Award Awards 2012 Dr. Natalie Clavel Canadian Anesthesiologists’ Society Best Paper in Ambulatory Anesthesia Dr. Edward Crosby Dave Roberts Memorial Award Dr. Simone CrooksAcademy for Innovation in Medical Education (AIME) Best Poster Award Dr. Leo JeyarajPAIRO Excellence in Teaching Award for the University of Ottawa Dr. Leo Jeyaraj University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Manoj Lalu Canadian Anesthesiologists’ Society/LMA-Vitaid Residents’ Research Award Canadian Association for Medical Education (CAME) Merit Award Dr. Alim PunjaGary Johnson Research Day Award (Poster Presentation): Investigating the Reliability and Feasibility of a Summative Oral Examination Administered Remotely over the Internet. Dr. Chris Pysyk University of Ottawa, Department of Anesthesia Undergraduate Award Dr. Louise SunResident Research Competition Finalist Dr. Louise SunGary Johnson Research Day Award (Podium Presentation): Postoperative Tracheostomy as an Independent Predictor of Sternal Wound Infection: A Retrospective Database Study. Dr. Homer YangThe Royal College 2012 Mentor of the Year Award for Region 3 83 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 University of Ottawa Department of Anesthesiology Historical Record Academic Department In 1969, the Royal College of Physicians and Surgeons of Canada approved the creation of an academic Department of Anesthesia at the University of Ottawa. 84 Clinical Department Hospitals with affiliated research institutes, postgraduate and undergraduate rotations: The Ottawa Hospital (TOH) was formed through the amalgamation of the former Ottawa General Hospital (OGH) and the Ottawa Civic Hospital (OCH), including the University of Ottawa Heart Institute (UOHI), in April 1, 1998; Children’s Hospital of Eastern Ontario (CHEO). Hospitals with postgraduate Anesthesia elective rotations: Queensway Carleton Hospital; L’hôpital Monfort Hospitals with undergraduate Anesthesia rotations, francophone: L’hôpital Monfort; Centre Hospitalier de Gatineau Chairs and Chiefs Dr. David Power Dr. Lloyd Hampson Dr. Gary Johnson Dr. David Skene Dr. J. Earl Wynands 1967 - 1970, Chair, uOttawa Department of Anesthesia 1971 - 1975, Acting Chair, uOttawa Department of Anesthesia 1976 - 1986, Chair, uOttawa Department of Anesthesia Chief, Department of Anesthesia CHEO 1987 - 1988, Acting Chair, uOttawa Department of Anesthesia Chief, Department of Anesthesia OGH 1988 - 1996, Chair, uOttawa Department of AnesthesiologyChief, Department of Anesthesia UOHI Dr. Denis Reid 1996 - 1998, Chair, uOttawa Department of Anesthesia – Chief, Department of Anesthesia OGH 1998 - 2003, Chair, uOttawa Department of Anesthesia Chief, Department of Anesthesia TOH Dr. Homer Yang 2003 - Present, Chair, uOttawa Department of Anesthesia Chief, Department of Anesthesia TOH Resident Program Directors Drs. David Power, Lloyd Hampson 1967 - 1970 Michel Tousignant and James Lounder (founders) Dr. Gary Johnson Dr. David Skene (acting) Dr. Denis Reid Dr. Patrick Sullivan Dr. Paul Bragg Dr. Linda Wynne Dr. Desiree Persaud 1971 - 1986 1987 - 1988 1988 - 1996 1996 - 2002 2002 - 2006 2006 - 2010 2010 - Present Undergraduate Program Directors Dr. Patrick Sullivan Dr. Patti Murphy Dr. Craig Reid Dr. Lucie Filteau Dr. Nikhil Rastogi Present) (1990 – 1995) (1995 – 2000) (2000 – 2005) (2005 – 2010) (2010 – Annual Departmental Awards: Year of Inception Gary Johnson Research Award for Resident Research 1982 Rachel Waugh Memorial Award for Teaching 1987 Dave Roberts Memorial Award for Service 1998 Hockey Challenge Cup 1989 Undergraduate Teaching Award 2006 Chief Resident Award 2006 DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Memorial Lectures David Power Memorial Lecture (Held annually at the General Campus) Rachel Waugh Memorial Lecture (Held annually at CHEO) John Wrazej Memorial Lecture (Held every four years at the Civic Campus) In Memoriam We record the passing of three of our friends and colleagues. They are sadly missed. Dr. Elliot RhineFebruary 12, 2008 Dr. Khalid Chowdary 2008 Dr. John AtkinsonNovember 18, 2011 Retirements 2007-2012 It is an impossible task to thank our colleagues for their energy and wisdom, but they have a place here, always. We report the retirement of: Dr. Robert McBurney, 2012 Dr. John Cowan, 2012 Dr. Louise Gauthier, 2012 Dr. Gary Johnson, 2010 Dr. Robert Lawrie Garnett, 2010 Dr. Wayne Barry, 2008 Dr. Andre Boutet, 2007 Dr. David Skene, 2007 85 Photo: Mélanie Provencher DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 STAFF LISTS Administrative Team TOH Department of Anesthesia Civic Site Anesthesiology Site Chief: Dr. Dave Ewing 86 Administrative Team TOH Department of Anesthesia General Site Anesthesiology Site Chief: Dr. Donald Miller uOttawa Anesthesiology Program Director: Dr. Desiree Persaud Deputy Anesthesiology Site Chief: Dr. Edward Crosby TOH Fellowship Director: Dr. Amy Fraser Anesthesia Daily Coordinators: Dr. Tammy Barrows Executive Committee Chairman: Dr. Mike Curran Dr. Paul Connelly Vascular Fellowship Director: Dr. Ashraf Fayad Dr. Peter Duffy uOttawa Simulation Centre Director: Dr. Viren Naik Dr. Cathy Gallant Echocardiography Fellowship Director: Dr. Ashraf Fayad Dr. Stephan Moffett Regional Anesthesia Fellowship Director: Dr. Ann Lui Dr. Calvin Thompson Anesthesia Simulation Co-Director: Dr. Michelle Chiu TOH Medical Director - Hyperbaric Unit: Dr. Peter Duffy Acute Pain Fellowship Director: Dr. John Penning TOH Medical Director - Pain Clinic: Dr. Tania DiRenna TOH Medical Director - PAU: Dr. Sylvain Gagné Research Director uOttawa Department of Anesthesia: Dr. Greg Bryson TOH Anesthesia Undergraduate Director: Dr. Nick Rastogi Site Medical Director PAU: Dr. Alan Chaput Obstetrical Anesthesia Lead: Dr. Cathy Gallant Site Director PACU: Dr. Naveen Eipe Regional Anesthesia Lead: Dr. Alan Lane Obstetrical Anesthesia Lead: Dr. Susan Goheen Thoracic Anesthesia Co-leads: Site Anesthesia Undergraduate Coordinator: Dr. Leo Jeyaraj Drs. Calvin Thompson/ Larry Byford Site Anesthesia Resident Coordinator: Dr. Anna Wyand Research Director - General Site: Dr. Sylvain Boet TOH Malignant Hyperthermia Director: Dr. Kevin Nolan Site Medical Director - PACU: Dr. Stéphane Moffett Site Anesthesia Equipment Coordinator: Dr. Pat Sullivan APS Director - General Site: Dr. Michael Szeto Manager: Lynne McHardy Resident Coordinator: Dr. Stéphane Moffett Office Staff: Elaine Stinson Managing Partner: Dr. Peter Duffy Michelle Fortier Treasurer: Dr. Chris Wherrett Joel Richard Office Manager:France Greenwood Kelsey Larocque Office Staff:Francine Gravel Sylvie Paquette Justine McNeely Chloé Houlton DEPARTMENT OF ANESTHESIOLOGY REPORT 2007 TO 2012 Administrative Team – University of Ottawa Heart Institute Division Chief since November 2011; CSICU group Dr. Jean-Yves Dupuis Administrative Team – Children’s Hospital of Eastern Ontario Anesthesia Chief Dr. Philipp Mossdorf Resident Site Coordinator Dr. Amy Roeske Director of Perioperative Database; CSICU group Dr. Michael Bourke Undergrad Site Coordinator Dr. Antoinette Corvo CSICU group Dr. Charles Cattran Fellowship Director Dr. Leslie Hall Fellowship Coordinator; TEE teaching group Dr. Sean Dickie Deputy Academic Chief, Director of Research Dr. Kimmo Murto Resident Coordinator; Research group; Dr. Christopher Hudson TEE teaching group IMG Coordinator Dr. Anna Shadrina Office Staff: Jennifer Borup Deputy Chief and Director of Perioperative TEE Dr. Mark Hynes Mike Tennian Deputy Chief; TEE teaching group Dr. Stéphane Lambert CSICU group Dr. John Macdonald Director CSICU Dr. Bernard McDonald TEE teaching group Dr. Donna Nicholson Division Chief until November 2011 Dr. James Robblee Managing Partner; TEE teaching group Dr. Benjamin Sohmer Research Director; CSICU group Dr. Peter Wilkes Scholar (to become full-time consultant staff in 2012) Dr. Diem Tran CSICU group Dr. Sanjay Acharya Office Staff:Angie Ross Cheryl Alie Carrie Haffner 87
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