University of Ottawa

ANESTHESIOLOGY Departmental Report 2003–2007

Submissions from Faculty and Staff Childrens’ Hospital of Eastern Ontario University of Ottawa Heart Institute The Ottawa Hospital

K M Wilson-Yang, Editor

Ottawa 2008 Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, CHEO, and The University of Ottawa Heart Institute (B309) 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9 Telephone: 613 761-4940 Fax: 613 761-5032

Cover photo credit: Homer Yang , 2007 Contents

Acknowledgements i

For the Record 1 1 Chair and Chief 7 2 Promotion and Tenure 17 3 Research 3.1Research 2003-2007 19 3.2 Gary Johnson Research Day 30 4 Education 4.1Undergraduate 32 4.2 Postgraduate 35 4.3 Simulator 41 4.4 Continuing Medical Education Activities 4.4.1.Winterlude 45 4.4.2. Visiting Professors Program 46 4.4.3. Journal Club 51 5 Clinical Services 5.1 TOH Participation and Responsibilities 57 5.2 TOH: Civic Campus 59 5.2.1 Malignant Hyperthermia Investigation Unit 61 5.3 TOH: General Campus 63 5.4 TOH: Riverside Campus 67 5.5 University of Ottawa: The Heart Institute 69 5.6 TOH Subspecialities 5.6.1. Obstetrics 74 5.6.2. Pain Clinic 76 5.6.3. Perioperative Echocardiography 81 5.6.4. Perioperative Medicine/ PAU 82 5.6.5. Regional 85 5.6.6. Thoracic 91 5.6.7. Vascular 92 5.7 CHEO: Children’s Hospital of Eastern Ontario 94 6 International Work 98

APPENDICES I Publications 2003-2007 101 II Gary Johnson Day Presentations 2003-2007 123 III Faculty and Staff 128 Acknowledgements

We acknowledge the assistance of Ms France Greenwood at the General Campus office for providing details incorporated in these reports. Ms Greenwood and Judy Dureau, Civic office, also provided statistics on undergraduate teaching. Ms Yvette Lavigne provided information on research activity at CHEO for which we are grateful. Ms Denise Wozny, at the Department of Anesthesia research office provided research funding details. We also thank Ms Angie Ross at the Heart Institute for her support. At the Civic office, Ms Holly Ladouceur provided information on the residency and fellowships; Jessica Ladouceur helped set up the STAR curriculum vita database which she and Eric Forgiel used to provide information on staffing, publications, and service positions.

Mrs 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.

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Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

For the Record Anesthesiology in Ottawa

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.

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 Heart Institute, in April 1, 1998; Children 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 Dr David Power (1967–70) Dr Lloyd Hampson (acting 1971-75) Dr Gary Johnson (1976–1986); Chief-CHEO Dr David Skene (acting 1987–88); Chief -OGH Dr J. Earl Wynands (1988–1996; Chair/Chief-OCH) Dr Denis Reid (1996–1998 Chair/Chief OGH, Chair/Chief-TOH department 1998- 2003) Dr Homer Yang (Chair/Chief-TOH; 2003-present)

1 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Resident Program Directors Drs. David Power, Lloyd Hampson, Michel Tousignant and James Lounder (Founders) 1967–70 Dr. Gary Johnson 1971–1986 Dr. David Skene Acting Program Director July 1987 to June 1988 Dr. Denis Reid 1988–1996 Dr. Patrick Sullivan 1996–2002 Dr. Paul Bragg 2002–2006 Dr. Linda Wynne 2006– 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 Memorial Lectures David Power Memorial Lecture (Yearly – General) Rachel Waugh Memorial Lecture (Yearly – CHEO) John Wrazej Memorial Lecture (every 4 years – Civic)

Passings We record the passing of seven of our friends and colleagues. They are sadly missed. Dr. Robert Ferguson March 22, 2003 Dr. David Bell May 24, 2003 Dr. Gordon MacKenzie January 17, 2004 Dr. Michael Tousignant June 10, 2004 Dr. Ronald Cumming January 18, 2005 Dr. Lionel Busque Sept. 11, 2006 Dr Elliot Rhine Feb 12, 2008

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University of Ottawa Department of Anesthesiology Participation and Responsibilities

University Committees AIME Dr. Earl Wynands Faculty Wellness Dr. Gary Johnson FCPD Dr. Linda Wynne Gender Equity Dr. Linda Wynne

University Department Committees Anesthesia University Executive Chair, Dr. Homer Yang Anesthesia University Research Vice Chair, Dr. Howard Nathan CaRMS Chair, Dr. Linda Wynne Residency Program Committee Chair, Dr. Linda Wynne University Promotion & Tenure Committee Dr. Don Miller

University Functions Persons Responsible or as Representative Academic Calendar Lynne McHardy Holiday Brunch Holly Ladouceur, Lynne McHardy Journal Club Dr. Alan Chaput, Lynne McHardy Mentoring Dinner Dr. Tammy Barrows, Holly Ladouceur Newsletter Dr. Lucie Filteau, Lynne McHardy, Holly Ladouceur

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Postgraduate Education Program Director: Dr Wynne. Drs Patti Murphy, Desiree Persaud, Donna Nicholson, Tammy Barrows, Ibrahim Abu- Shahwan, and Holly Ladouceur Postgraduate Dean Dr. Paul Bragg Simulator Resident Schedule & Teaching Dr. Michelle Chiu (coordinator), Holly Ladouceur Simulator Coordinator Dr. George Dumitrascu Simulator Drs. J Earl Wynands, George Dumitrascu, Bob Elliott, Michelle Chiu, Patti Murphy, Simone Crooks Undergraduate Coordinator Dr. Lucie Filteau Undergraduate Education (UGME) UGME co-ordinator: Dr Lucie Filteau. Dr Simone Crooks, Dr Marion Gould (CHEO), Judy Dureau, France Greenwood Vice Chair: Research Dr Howard Nathan Visiting Professor Program Dr. J. Earl Wynands & Lynne McHardy Winterlude Dr. Ashraf Fayad, Lynne McHardy, and Committee Women in Anesthesia Dr. Jane Prud’Homme (coordinator) & Holly Ladouceur

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Awards

2007 CAS Abbott Career Scientist Award: Dr Dermot Doherty TOH Physician Recognition Award: Dr Jean-Yves Dupuis CAS: Organon Canadian Research Award: Dr David Neilipovitz CAS: Clinical Teacher Award: Dr Desiree Persaud CAS: David Sheridan Research Award: Dr Michelle Chiu CAS: Residents Competition 2nd Place: Dr Anna Wyands

2006 CAS Gold Medal: Dr John Cowan CAS: Richard Knill Prize for Best Paper at the Scientific Meeting: Dr Dermot Doherty CAS: Dr J Earl Wynands Award for Research in Cardiovascular Anesthesia and/or Perioperative Blood Conservation: Dr. Jean-Yves Dupuis Heart and Stroke Foundation Grant: Dr Ashraf Fayad CAS: Baxter Corporation Canada Research Award in Anesthesia: Dr Bernard MacDonald CAS: Best Paper in Ambulatory Anesthesia: Dr Kimmo Murto University of Ottawa Award of Excellence: Dr Howard Nathan World Society of Cardiothoracic Surgeons Living Legend Award: Dr Earl Wynands McGill Anesthesia Update Course Inaugural J.Earl Wynands Royal College Lecture in honour of: Dr Earl Wynands

2005 CAS: Research Recognition Award: Dr Howard Nathan CAS: RA Gordon Research Award: Dr Greg Bryson

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2004 CAS: Baxter Corporation Canada Research Award in Anesthesia: Dr Calvin Thompson. University of Ottawa Faculty of Medicine Award of Excellence in 2004: Dr Wayne Barry.

Retirements

We report the retirement of: Dr Wayne Barry, Dr Rudolpho Borromeo, Dr Kam Chatterjee, Dr Gilles deLaSalle, Dr Benoit Samson, Dr David Skene and Dr André Boutet. It is an impossible task to thank our colleagues for their energy and wisdom, but they have a place here, always.

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Reports

1 Chair and Chief Homer Yang

The Department of Anesthesiology in the Faculty of Medicine at the University of Ottawa comprises close to 100 faculty members from The Ottawa Hospital (TOH), The University of Ottawa Heart Institute, the Montfort Hospital, the Canadian Forces Surgical Unit, and the Children’s Hospital of Eastern Ontario (CHEO). The Main Operating Room (MOR) at the TOH has 68 staff anesthesiologists, and the Cardiac Operating Room (COR) has 11 staff in addition. In 1998, during the TOH amalgamation, the University of Ottawa created a joint Chair/Chief position for the academic and clinical Departments of Anesthesiology. The current Chair/Chief started his tenure in 2003.

Many of our colleagues represent the Department provincially, nationally, and internationally. We have extensive representation on the committees and subcommittees of the Canadian Anesthesiologists’ Society including membership in the Patient Safety Working Group, the Research Committee, the Scientific Affairs committee and the Ambulatory Anesthesia section. Dr Don Miller is Editor of the Canadian Journal of Anesthesia and Dr Greg Bryson serves on its editorial board. Dr Denis Reid is the Inaugural Chair of the Section on Chronic Pain, Dr Homer Yang is the Inaugural Chair of the Perioperative Medicine Section. Dr Reid remains active in the International Education Fund. We can count three Past-Presidents, Drs Earl Wynands, David Skene and John Cowan in our ranks. Dr Greg Bryson is a member of Canadian Ambulatory Anesthesia Research and Education (CAARE) Group. Dr Geraint Lewis serves as our OMA representative, CAS Ontario Section, and serves on the Ministry of Health’s Academic Health Sciences Centre Alternate Funding Plan Task Force. Dr Ted Crosby serves on the Case Review and Legal Affairs committees of the Canadian Medical Protective Association (CMPA). Dr Denis Reid is a member of the College of Physicians and Surgeons of Ontario (CPSO) Assessment Program as a

7 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Peer Assessor. We continue to have an active presence at the Royal College Examinations: most recently Drs Jocelyn McKenna, Jarmilla Kim, Lucie Filteau and Patty Murphy have served or are serving as examiners. Dr David Neilipovitz is on the Examination Committee for Critical Care. Dr Homer Yang is the current President of the Association of Canadian University Departments of Anesthesiology (ACUDA). Dr Wayne Barry keeps his association with Medecins sans Frontières and Operation Smiles. Drs Bill Splinter, Ibrahim Abu Shahwan, and Denis Reid also continue to act as international ambassadors.

Anesthesia human resources have become a critical national issue as a result of the policy in 1992 of medical school cut-backs and the requirement of early specialty training choice. That is compounded by aging of the current cohort of practitioners. Against that background, since 2003, there have been twenty-one new clinical staff hired in all subdisciplines: Dr Abu-Shahwan (pediatrics, education, research); Dr Tammy Barrows (chronic pain); Dr Alan Chaput (epidemiology); Dr Ioana Costache (regional); Dr Simone Crooks (undergraduate education); Dr Dermot Doherty (pediatrics, research); Dr Holly Evans, (regional, research); Dr Lucie Filteau (education); Dr Amy Fraser (medical education); Dr Sylvain Gagné (thoracic, perioperative, PAU); Dr Susan Goheen, (obstetrics); Dr Stephane Lambert (cardiac echo); Dr Christine Lamontagne (pediatrics, acute pain); Dr Stephane Moffett, (thoracic); Dr Joanna Nawrocka, (pediatrics, education); Dr. Mark Odrcich (pediatrics) Dr Elizabeth Renehan (regional); Dr M. Raed Rihani (pain, leave of absence); Dr Uwe Schwarz (pediatics, research); Dr Ben Sohmer (cardiac); Dr Anna Wyands (perioperative).

The Ottawa Hospital. In 2004, the Wait Time Initiative in Ontario (WTIO) increased the number of defined surgical procedures quite precipitously. In 2003– 2004, the total number of surgical cases at the TOH and the Heart Institute was already 78 405. In a dramatic fashion, the increase exacerbated the anesthesia human resource challenges at TOH. The need to balance the academic mission of the Department against the clinical mandate was essential and sincere

8 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 appreciation must be expressed to all the members who have “pitched in” during that period. The Ottawa Hospital has also received new funding to build and has recently opened the Critical Care Wing. The Ottawa Pain Clinic opened in 2007 as a consolidated pain clinic. As well, the use of Anesthesia Assistants has expanded from the Heart Institute and CHEO to all TOH campuses. We now have eleven anesthesia assistants at the TOH. The expansion in number of operating rooms in Jan 2008, Sep 2008, and likely Jan 2009, will again increase the challenge in human resources and the need to balance the clinical and academic mandates of the Department.

As part of the Patient Safety Initiative within TOH, a specific process for adverse event reporting and patient safety has been set up. The process collects adverse events under two silos: an administrative review process versus a patient safety review process. The former process is usually as a result of events flagged by a patient on specific anesthesiologists, reviews requested by the Hospital administration, or other potentially medicolegal processes. The latter is an anonymous collection and review of events to which the Chief is not aware of the individuals involved. This is in an attempt to protect the evidence from subpoena in order to allow frank and constructive review of critical events. Research funding for patient safety has also been established by TOH, and the Department of Anesthesiology has recently been successful in obtaining funding for two projects.

Cardiac Operating Rooms. The Division of Cardiac Anesthesia has recently undergone an external review prior to the re-appointment of the current Chief of Cardiac Anesthesia, Dr Jim Robblee. Caseloads were 1 506 in 2006–2007, with 1 297 coronary bypass /off pump (CBP/OP) procedures. In the last six months, however, the wait list for coronary artery bypass (CABG) has mushroomed to over 200, likely as a result of a shift in practice pattern between the interventional cardiology and the cardiac surgery. There have been consistently 2 fellows per year. Research funding has decreased somewhat although active recruitment for a cardiac anesthesia / researcher is underway.

9 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Childrens’ Hospital of Eastern Ontario. The surgical volume at CHEO is over 7 000 per year, with about 100 cases of open-heart surgery for congenital heart disease. Although there is no transplant program, all other areas of pediatric anesthesia are well represented. There are usually 2–3 fellows per year. Dr Dermot Doherty is a researcher in the Department and has recently received the CAS Abbott Clinician Scientist Award. There has been a strong liaison between the Department and the CHEO Research Institute in developing basic science and bench research.

Research. There has been progress in attracting funding for research. Figures in the Research section show the level of peer-reviewed, and non-peer reviewed funding received, by site. The large influx of funds to OHRI from the POISE trial (CIHR; PI Dr H Yang) skewed trends in levels of funding, so many of our figures are designated POISE and NON-POISE. We have had 18 new research projects funded externally, including a large award from the Heart and Stroke Foundation to Dr Ashraf Fayad and a Career Scientist Award won by Dr Dermot Doherty. Funds made available through the newly created Chair’s Research Funds have provided support for new initiatives. The total number of publications in the Department shows a healthy increase since 2002. We have been successful in garnering many national and university level awards: these and other awards are listed in For the Record. A pooling of resources across campuses, divisions, and institutions has played a significant role in bringing some successes in research funding. Furthermore, a slow but evident change in culture regarding research is extremely important. Nevertheless, such a cultural change is still fragile.

Education. The number of anesthesia fellows has increased significantly from eight in 2002 to thirteen in 2006–7; the Residency Program has expanded from 37 residents in 203 to 48 in 2007. Our involvement in Undergraduate Problem Based Learning (PBL) Stage 1 tutoring has increased from none prior to 2003 to and involvement of twenty staff people in various roles. Tutoring Level 1 is a six- week commitment with twice-weekly meetings with the tutorial group. This is the

10 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 first exposure that a medical student will have with a staff anesthetist, so that our increased involvement at this level of training is very encouraging. We are generating a pool of trained tutors, through tutor-training workshops.

The Winterlude Symposium as a continuing medical education (CME) event has attracted over 200 attendees, including national and international anesthesiologists. Clinically, cardiac echocardiography has furthered its strengths with new recruitment and certificants at the Heart Institute as well as the recruitment and training of individuals to develop echocardiography for non- cardiac surgery at the Main Operating Rooms (MOR). The regional anesthesia program has continued to grow as a strong subspecialty in Ottawa, including the acquisition of the echo for regional anesthesia for all campuses.

Administration. The governance structure of the Department has been undergoing steady development. At TOH, the culture of participatory democracy is very strong and it has been a steady evolution to develop a workable governance structure without over-taxing members’ time commitments. Figures 1.1 through 1.4 are organizational charts which show the levels of interaction that describe the structure of the Department of Anesthesiology in both the University (Figure 1.1) and the Hospital (Figures 1.2 though 1.4). At the University level, the University Executive continues to function as the over-arching decision- making and liaison on academic issues which bridge across institutions and divisions.

Summary. The tenor of our task is to balance the directions and responsibilities of the University of Ottawa, the hospitals, the Alternate Funding Plan, and the business groups. The complexity and the work of harmonizing governance, accountability, and loyalty are onerous. With the Ontario Alternate Funding Plan (AFP) Phase 2 on the horizon, we anticipate significant strides in growth and productivity. We are striving to meet those goals by fostering a collegial environment which encourages professional growth in a balanced development of clinical excellence, research, and education.

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Figure 1.1. The University of Ottawa and The Ottawa Hospitals Governance Structure ANESTHESIOLOGY Discussed at Gary Johnson Research Day , 11 May 2007. Final approval at the Chief’s Advisory Committee, 26 Nov 2007

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12 Figure 1.2. University of Ottawa Department of Anesthesiology Organizational Chart.

13

13

Figure 1.3.TOH ( Non Cardiac) Department of Anesthesiology Organizational Chart.

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14 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Figure 1.4. Chief’s Advisory Council (CAC).

15 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Figure 1.5. Alternate Funding Committee (AFC).

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2 Faculty Promotions and Nominating Committee Don Miller

In the period 2003 to 2007 there have been three promotions in the Department of Anesthesiology to the rank of Associate Professor. See Table 2-1. We congratulate Dr Greg Bryson (2005), Dr David Neilipovitz (2006), and Dr Ashraf Fayad (2007) and anticipate the announcement of another well deserved promotion early in 2008.

In early 2007, the University Department established a Promotions and Nominating Committee which has representation from all sites. The purpose of the Committee is to encourage and assist faculty members in obtaining promotions through the academic ranks (Assistant Professor, Associate Professor, Full Professor) of the University of Ottawa Faculty of Medicine. Effectively, the Committee serves as an internal peer review body to enhance the quality of applications for promotion prior to submission, and also recommends and nominates anesthesia faculty members for clinical, teaching, service and research awards within the Academic Health Sciences Centre, the University, and relevant provincial and national medical organization and Societies. The Committee reviews curriculum vitae materials and teaching dossiers received voluntarily from faculty members, and will provide constructive peer commentary. The Committee encourages submission of application materials by mid-April each year to have such material duly considered and profiled in consideration for submission to the University by the August 1st deadline for each promotion cycle. The Committee also serves an educational role by hosting anesthesia-specific faculty seminars to address subjects such as: “Tips to successful navigation of the University promotion procedures”

17 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Table 2.1. Rank by Campus and Site.

Campus/Site Emeritus Full* Associate Assistant CHEO 0 0 2 14 Civic* 0 2 8 (+1)† 31 (-1)† Heart Institute 1 1 1 9 General 0 1 3 18 Riverside 0 0 0 5 Montfort 0 0 0 1 CFSU 0 0 0 3 Other ** 0 0 0 3 TOTAL 1 4 14 84

* Dr Homer Yang is associated with all TOH sites, but is counted once, under CIVIC ** Associated with University Department only or leave of absence † One appointment pending

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3 Research Howard Nathan

(Note: Please see the Report from the Children’s Hospital of Eastern Ontario for Paediatric Research Progress—Editor)

The University department is well known in Canada for teaching excellence and this is supported by the high number of applications for the residency program and the high rate of success of our residents on the fellowship examinations. Research, on the other hand, has been an area of weakness. Until recently only a few department members showed a serious interest in basic or clinical investigation. We are currently experiencing a renewed interest in clinical investigation. Several factors may be responsible: improved morale after issues surrounding hospital amalgamation have been accepted, an emerging group of young faculty who wish to go beyond clinical and teaching excellence and contribute to advancing the practice of anesthesia, and, importantly, the establishment of the Chairman’s Research Fund (CRF).

The CRF was established by the Department Chairman, Dr. Homer Yang, and consists of a department wide tithe of $1 350.00 per faculty per year. It provides approximately $100 000.00 per year to support research. In the past, faculty who wished to carry out research had to find their own source of funding and then hire, train and supervise assistants. This included payroll, budgetary, financial reporting, and other administrative activities. With these funds the department can now offer these services from a team of research administrators and assistants under the direction of the Vice Chair of Research, Dr. Howard Nathan. Research support is provided on a competitive basis, applications for support being received every fall and adjudicated by the Research Committee. This approach has brought great efficiencies to the process of conducting clinical research and the team has had success in implementing and conducting clinical studies. It is the Vice Chair’s opinion that knowing that projects can be completed by this team

19 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 without the need for involvement by the investigator in administrative activities has encouraged them to bring their creative ideas forward and apply for funding. It is understood that the primary role of the CRF is to allow investigators to establish a track-record strong enough to allow successful competition for extramural funding.

The Department’s research productivity is shown in the following figures. Figures 3.1a and b show the total peer-reviewed and non peer-reviewed funding level in the academic years 2002–3 to 2007–8 by site. Figure 3.1a does not include the funding amounts associated with the POISE trial (5.3 million, over five years), in order to control the scale. Figure 3.1b does include this funding, in yearly apportioned increments. Figures 3.2 a and b show the total peer-reviewed funding levels, by year and by site, non POISE and POISE, respectively. Figure 3.3 shows the total amount of non-peer reviewed funding, by year and by site. The publication record of the department is shown in Figure 3.4. We can clearly show that communication of our research interests has increased. With the recent implementation of a universal tracking system at all sites, it is hoped that these assessments can be kept up to date.

The research future of the department is best represented in Table 3.1 which shows current research activities supported, in whole or in part, by the CRF. All these projects are conducted or facilitated by the research team given in Table 3.2.

The quality and amount of research activity currently underway suggests that a critical mass of researchers has been reached and a culture of scientific enquiry is becoming established. It seems reasonable to hope that success in obtaining external funding from large peer-review grant agencies will follow and that productivity will grow. This growth of research in the department is, however, still fragile. It can only be sustained by increased intra-departmental funding to support investigators on the very challenging road to sustainable peer-reviewed investigation.

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University of Ottawa Department of Anesthesiology Total research funding: peer-reviewed and non-peer reviewed. (NON POISE) $700 $600 Non-Peer reviewed $500 Peer reviewed $400 $300 1000s $ 1000s $200 $100 $0 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 Ye ar

Figure 3.1a.Total funding levels (NON POISE): Peer and Non-Peer reviewed funding.

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University of Ottawa Department of Anesthesiology Total research funding:peer-reviewed and non-peer reviewed. $4,000 (POISE INCLUDED) $3,500 $3,000 Non-Peer reviewed $2,500 Peer reviewed $2,000

1000s $ $1,500 $1,000 $500 $0 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 Year

Figure 3.1b. Total funding levels (with POISE): Peer and Non-Peer reviewed funding.

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University of Ottawa Department of Anesthesiology Peer-reviewed Funding (POISE excluded) $600

$500

$400 CHEO $300 Ge n e ra l

1000s $ 1000s Civic $200 Heart

$100

$0 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8

Ye ar

Figure 3.2a. Total peer-reviewed funding, POISE excluded, by site and by year.

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Unive rs ity of Ottawa Department of Anesthesia Peer-Reviewed Funding $4,000 (POISE included)

$3,000

$2,000 CHEO

1000s $ 1000s General $1,000 Civic Heart $0 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8

Year

Figure 3.2b. Total peer-reviewed funding, POISE included, by site and by year.

24 University of Ottawa Department of Anesthesiology Non-Peer Reviewed Funding $80 $70 $60 CHEO $50 Ge n e ra l $40 Civic

1000s $ 1000s $30 Heart $20 $10 $0 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8

Ye ar

Figure 3.3. Total non-peer reviewed funding, by site and by year.

25

40 University of Ottawa Department of Anesthesiology 35 Publications

30 Abstracts

25 Chapt ers

o Editorials 20 Cas e Number 15 Report s Review 10 Articles Peer- 5 2002 2003 2004 2005 2006 2007 Reviewed

0

Calendar Yea r

Figure 3.4. Number of publications by calendar year and by type.

26 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Table 3.1. Current research studies designed by local principal investigator.

Title Priniciple Brief Description Investigator (external agency) APRV JY Dupuis; Can Pressure Release Ventilation reduce lung (CAS) water in patients with CHF after cardiac surgery? APOE GL Bryson Is delirium following major vascular surgery (CAS) associated with apoE? ALERT R MacNeil Awake laryngoscopy using remifentanyl to detect difficult intubation. CD-18 D Doherty Neuroprotective effect of anti-CD18 after transient (CAS) global ischemia in mice. FMRI H Nathan Is brain activation during cognitive tasks different (HSF) in patients undergoing CABG with or without CPB? ILIA I Chaparov Can an intraoperative infusion of lidocaine reduce postoperative pain and shorten hospital stay? ICU J Robblee Analysis of factors leading to readmission to cardiac ICU POISE H Yang Can beta-blockers reduce cardiac morbidity (CIHR) following non-cardiac surgery PORI P Wilkes Pathophysiology of renal failure following cardiac surgery. PROMISE A Fayad Does isolated systolic hypertension increase risk of (HSF) perioperative myocardial ischemia? PROSE H Yang Can mobile real-time ST-segment monitoring reduce cardiac morbidity after non-cardiac surgery?

27 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Table 3.1. Current research studies designed by local principal investigator (concluded).

SEVO B Macdonald Can sevoflurane improve diastolic function (CAS) following aortic valve replacement? STARVaS D Neilipovitz Will a statin given before major vascular (CAS) surgery reduce cardiac morbidity? TPVB M Chiu Can use of intraoperative paravertebral (CAS) block reduce chronic pain after mastectomy with axillary node dissection ? CLON Murto K Effect of the addition of clonidine to ropivicaine for wound installation after abdominal surgery. AIT Murto, K Public acceptance of advanced information technology for communication in hospital setting. USCOM Murto, K Intra and inter observer reliability of the USCOM non-invasive Doppler ultrasound cardiac output monitor in children APS-Database Chaput, A Implementation of a computerized Acute Pain Service database to monitor and prevent adverse events. MHWorkstation Shinkaruk, K ; Preparation of Datex Ohmeda Aestiva 5 Nolan, K Anesthetic workstation for Malignant Hyperthermia (MH) Susceptible Patients

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Table 3.2. Anesthesiology Research Support Team —TOH Component of the University of Ottawa.

Dr Homer Yang Chair/Chief, Anesthesiology

Dr Howard Nathan Vice-Chair, Research

Denise Wozny, BA Chief Operating Officer

Sharon Finley, RN Clinical Studies Co-ordinator

Research Staff Denyse Winch, RN (FT) Sylvie Poloni, RN (FT) Diana Pepin, RN (PT) Mary Lou Crossan MLT (PT) Carmen Altoft, RN (Casual) Marlene Farrell, RN (Casual) Cathy White, RN (Casual)

29 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

3.1 Residents Research: Gary Johnson Research Day

Gary Johnson Research Day is held to recognise the research activity of our residents. As shown in Table 3.3, there has been a noticeable increase in the number and range of resident research projects since 2003: in 2007 there were thirteen resident presentations of original research. Dr Anna Wyands presented at the 2007 Canadian Anesthesiologists’ Society Meeting and was awarded second prize for residents research for her study “Does the clock drawing test detect delirium or cognitive dysfunction” Dr Jenn Backstrom Ozard presented “A program of research into sedation and analgesia in pediatric intensive care” in Lake Louise at the Canadian Critical Care Trials Group Conference.

Table 3.3. Gary Johnson Research Day Presentations: by year and type.

Year 2003 2004 2005 2006 2007 Residents 7 7 8 5 13 Fellows 2 3 1 1 0 Staff 0 0 0 5 0

Residents’ projects have comprised post-operative syndromes, sedation in pediatric care, education and skills maintenance, pre-operative co-morbidities and outcome, early extubation, attitudes towards research, comparison studies in surgical, airways in trauma patients, animal studies, and ultrasound in neurostructural studies. A full listing of titles from 2003 to 2007 is given in Appendix III.

A national or internationally recognized researcher is invited to speak and to be an assessor at the Gary Johnson Resident Research Competition. Visiting professors since 2003 have been Dr David Parsons, in 2004 Dr C. Brian Warriner, in 2005 Dr Ian Gilron, in 2006 C. David Mazer, and in 2007 Dr Peter Choi.

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Fellows and staff also have participated through presentations of ongoing research projects. At the closing dinner, first, second, and third prizes are awarded to the Research Competition participants. We recognize our graduating residents and the completion of fellowship training by the awarding of diplomas. In 2007, the dinner was held in at the Science and Technology Museum, with great success and a large attendance from all hospitals.

Our awards for teaching are also presented at this time. These awards are: the Rachel Waugh Award, chosen by post-grad PGY2 to 5; the Dave Roberts Award, chosen by PGY5 and the Undergraduate Teaching Award, chosen by the Medical Students. Winners of the Rachel Waugh Award have been Dr Stephane Gagné 2007, Dr David Neilipovitz, 2006; Dr Jarmila Kim 2005; Dr Paul Connolly, 2004; Dr Greg Bryson, 2003. The Dave Roberts Award has been given to Dr Peter MacEwan 2007; Dr Desiree Persaud 2006; Dr Paul Bragg 2005; Pat Holmes, 2004; and Dr Jean-Yves Dupuis, 2003. The Undergraduate Teaching Award, our newest award, has been won in both 2006 and 2007 by Dr Rob McNeil.

Lifetime achievement awards are also presented. Past recipients of the lifetime achievement award have been: Dr Gary Johnson 2003; Drs Helen MacNeill, Benoit Samson, Rodolpho Borromeo, 2004 and Dr Wayne Barry, 2007.

Previous organizers of resident research have been Dr Don Miller and Dr Tom Polis. Dr Peter Wilkes was organiser from 2002–2004. —Editor, with departmental files.

31 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

4 Education 4.1 Undergraduate Lucie Filteau

Many changes have taken place within the past couple of years in Undergraduate Anesthesia Education. The class size has increased considerably (approximately 130 to 160) and we have seen a corresponding increase in the number of students doing their core (3rd year) Anesthesia rotations. Anesthesia also continues to be a very popular elective rotation with medical students of all levels and from medical schools across the country. We accept approximately 50 elective students per year across the two Campuses.

A great deal of work has been done to ensure that students receive an exceptional educational experience during their Anesthesia rotation. During the rotation, students receive one-on-one teaching in the operating room from attending anesthesiologists. They also review a newly developed lecture series which covers the rotation’s core learning objectives. This lecture series is in Power Point format (with a voice over) that is web accessible and which the students can go over, individually, at their own pace. The students report that these lectures are excellent learning tools. Furthermore, these lectures have been distributed to Anesthesia Undergraduate Programs nationally and have been very well received. The newly created Anesthesia Undergraduate website also provides the students with orientation/contact information, the rotation learning objectives, lecture notes and other useful information to help them over the course of the rotation.

The Anesthesia Rotation learning objectives were modified in recent years to emphasize knowledge and skills that were more pertinent to the medical students’ overall development as clinicians (e.g. fluid/blood management, ABC’s of resuscitation, pharmacology of widely used drugs, pain management, etc). The multiple choice portion of the rotation exam was also changed two years ago to reflect these core objectives. More recently, the written portion of the exam was

32 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 changed from basic short answer questions to more clinically-oriented critical decision-making questions (LMCC-style), to provide the students with much needed exposure to this format.

Another educational initiative that was undertaken was the development of an Anesthesia Workshop, which takes place on the first afternoon of the mandatory six week Anesthesia/Emergency Medicine Rotation. This consists of an Orientation Presentation, an Airway Lecture, a hands-on Airway Workshop and two Simulation Sessions. The simulator allows the student to be introduced to the operating room environment in a non-threatening manner. They are exposed to common intra-operative problems, such as hypotension and hypoxia, and must learn to develop their critical reasoning skills while managing these problems. The debriefing afterwards emphasizes the physiology and differential diagnosis underlying these common conditions, and review handouts are provided. The student evaluations of this anesthesia half day have been consistently excellent.

From the evaluation point of view, the student evaluation cards were updated. This has allowed us to collect far more detailed and valuable information with regards to student performance. As well, a preceptor evaluation card was adopted in order to assure the quality of the medical student experience. This information is also useful for the purposes faculty academic promotion and to recognize excellence in undergraduate education. A new Undergraduate Teaching Award in Anesthesia has been created based upon nominations by medical students throughout the year. The recipient is awarded at the annual Gary Johnson Research Day dinner.

There has been increasing departmental involvement in undergraduate education at the pre-clerkship level. Initiatives have been taken to promote our participation in Problem-Based Learning (PBL) tutorials. Prior to 2003, there was no exposure in Level 1 to tutors from Anesthesia. In 2003, nine staff members took tutor training, and three staff carried Level 1 PBL tutorial groups. The Anesthesia Department will have a presence in eight blocks this year and the aim is to

33 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 maintain or exceed this level of involvement in the future. A total of twenty staff members are now involved at some level in undergraduate tutoring and lecturing. Furthermore, a deficiency was identified at the University with regards to pain education throughout the medical school curriculum. A Working Group was put together, headed by Anesthesia, to examine this issue and provide recommendations.

As outlined, much has been achieved in Undergraduate Anesthesia Education over the past two years. It remains, however, a dynamic work in progress as we continually strive for excellence!

Previous undergraduate co-ordinators have been Dr Craig Reid (2000–2004) and Dr Rob McNeil (2004–2005).

34 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

4.2 Postgraduate Linda Wynne

The Ottawa Residency program continues to provide excellent education, research and clinical experience. It has steadily increased in number from 37 residents in 2003 to 48 in 2007.

In response to a severe shortage of anesthetists in Ontario, we have been allocated an increase in the number of Canadian Residents Matching Service (CaRMS) positions for Ottawa from four in 2006 to six in 2008. In addition, we have participated in the International Medical Graduate (IMG) initiative with candidates who went to Medical School outside Canada and who have a return of service agreement with Ontario. Unfortunately, this has meant we have not had space for new Foreign Medical Graduates (FMGs). FMGs are sponsored by their country for training in Canada. Many of our recent FMGs have come from Saudi Arabia and Libya and our last FMG will graduate in 2008.

Of the current residents, 24 are CaRMs Ottawa, nine CaRMs Northeastern Speciality Residency (NESR). We have 11 IMGs, one FMG, three residents in the National Defence Medical Corps (NDMC) and one Family Practise Anesthesia resident. Of our past residents, 62% have gone on to further training (Fellowship or Masters in Education).

Provincial and National Initiatives. Nationally, there are initiatives afoot that are changing residency training. Firstly the new initiative across Canadian medical training is CanMeds 2005. The original CanMeds 2000 defined the seven aspects of a good specialist physician: Medical Expert; Collaborator; Communicator; Scholar; Professional; Health Advocate; and Manager. 2005 refined this further by refining the definitions of these and worked on exactly how to teach and evaluate the trainee in all these domains. As of 2007 all RCPSC Accreditations will be on the basis of these roles.

35 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

In an effort to increase formal teaching of the non-medical expert roles, Dr. Bragg, in his role as Vice-Dean of Postgraduate Affairs, has initiated a one-day workshop on improving one’s skill as a clinical teacher. This course has been named “RATS”, for “Residents as Teachers” and will be given University-wide to all PGY2s. The course was developed and given by Drs Dumitrascu, Ghatalia, Grabowski, and Murphy from anesthesia, and Dr. Gray from psychiatry. It was tested last spring on a cohort of psychiatry and anesthesia residents, and will be repeated this year on the remainder of the U of O PGY2s, in groups of 16 residents. The goal is to draft resident volunteers who are interested in giving this workshop, and ultimately hand the course over to the residents to teach it with less staff time commitment.

Second, for about five years now, the residents have been involved with the Residents Log Book. Each case every resident does across the country is logged (it is to be hoped) and as the database expands, we will get a good idea of what each resident experiences during their training. This is being expanded in 2007 to the Portfolio Project. A portfolio contains not only a case log but also a record of educational opportunities (such as lectures and courses attended and landmark article reviewed) in all CanMeds domains along with reflections on these.

The final new initiative taking place at the moment is the National Curriculum project. The whole anesthesia curriculum has been divided into topics. Each program was charged with summarizing the information into three levels: what a Family Practice Anesthesiologist should know; what a Fellowship Anesthesiologist should know and what is Subspecialty knowledge. Each topic will be reviewed by a different school. The combination of these initiatives will enable us to ensure that all training programs are comparable and that the examination board of the RCPSC can be confident that the examination accurately reflects knowledge gained at all centres. In addition, the one 45 system has made the collection of ITERs (In-training Evaluation Reports) a more efficient and successful process and allowed web-based access to rotation

36 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 schedules, vacation information and reports. It generates yearly staff evaluations, resident rotation evaluations, and Goals and Objectives are available for viewing.

Northeastern Specialty Residency Program. Four years ago, the symbiotic link with the Northeastern Specialty Residency program (NESR) was formed. NESR is a joint venture between the University of Ottawa and the Northern Ontario School of Medicine (NOSM). NESR began in 2002 as a response to McKendry Report (Too Many? Too Few? For 2000 and Beyond, 1999) and The George Report (The Expert Panel on Health Human Resources, 2001). To deal with the severe shortage of physicians in Ontario, several committees were formed to sort out the problem. McKendry and George were the most important ones. McKendry was responsible for recommending an increase in family medicine and enhanced skills training and George was responsible for taking some medical training out of the five urban centers on the recommendation of the decentralization of medical training. They suggested implementing clinical education campuses (CEC) in Sudbury, Thunder Bay and Windsor with a view to an eventual evolution into free standing medical schools. As part of this CEC project, Sudbury agreed to take specialty residents for part of their training. The understanding was that Sudbury would provide clinical training and the parent university, University of Ottawa, would do the rest. Sudbury now has a freestanding medical school but NESR is still a program of the University of Ottawa. Administration of the NESR program changed from Ottawa to NOSM in July 2006 with plans for NESR to become and independent program of NOSM with permanent ties to the University of Ottawa.

Each year, two candidates are accepted into a combined program in which at least 4 of 13 blocks each year are done in the north. Sudbury is the main coordinating centre but residents also go to Sault Ste Marie, Timmins, and North Bay. All of these sites have some recent Ottawa alumni. In 2008 the first four entrants to this program will graduate.

The Ottawa program has seen continued use of simulation in medical education since 1998. Each resident attends a simulation session at least twice a year which

37 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 is followed by a full debriefing session. The Surgical Skills and Simulation Laboratory is about to move into its second “temporary” location in the Lab building at the Civic Campus, as its present location is about to be used in the ICU expansion. The move is anticipated to occur some time in November, suspending access to the lab for a couple of weeks if the construction and move go as planned. The permanent location near the medical school will be several years yet, dates and final plans to be announced.

In addition, each resident takes oral exams twice a year which are performed along RCPSC guidelines. The American Board (ABA/ASA) exam is taken twice during residency and the Metrics Anesthesia Knowledge Tests (AKTs) at 6 and 18 months and optionally in PGY5 year. Each core program (3 per year) is followed by an exam and all the lectures are being recorded in VOPP (Voice Over Power Point) format, available on the website for review at any time. The website has seen a marked improvement, thanks to our webmaster and PGY5 Dr Ilia Charapov. Not only lectures but schedules, protocols, forms, the newsletter and other information are all available online.

Subspecialty rotations include Regional, Vascular, Chronic Pain, Remote- Location Anesthesia, Thoracic, Obstetric, Airway, Community Anesthesia, Cardiac, Paediatric and Pre-Assessment Unit.

Nationally and internationally, our residents do us proud. Last year Dr Anna Wyand presented her paper “Does the clock drawing test detect delirium or cognitive dysfuntion” at the Canadian Anesthesiology Society meeting and won second place. Dr Jenn Backstrom-Ozard presented her paper “A program of research into sedation and analgesia in pediatric intensive care” in Lake Louise at the Canadian Critical Care Trials Group Conference in January 2007.

Our residents pursue a wide variety of electives. Dr Natalie Dupuis was a successful applicant to the summer session of the International Space Agency. Residents have also gone as far afield as Singapore, Australia, Malta, Saudi

38 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Arabia and Libya to enhance their training. In addition many residents have accompanied Dr Wayne Barry on medical missions such as Operation Smile in diverse locations from Brazil to Africa.

The Gary Johnson Resident Research Day had a record 13 resident presentations in 2007, followed by a record 147 people attending the awards dinner at the Museum of Science and Technology that evening. In general, Ottawa prides itself on having a strong social program and excellent staff-resident relations which contributes to its high-standing among programs across the country. The mentorship dinner, the Ottawa Dinner at the CAS, the resident camping trip, the Christmas party, and Holiday brunch are just some of the social events.

Fellowships. We have a strong fellowship program. In the last twenty years we have trained 28 Cardiac anesthetists; 19 Paediatric Anesthetists; 17 Chronic Pain specialists and since 2001 there have been 11 fellows in Regional Anesthesia. Our Regional Anesthesia fellowship has received international recognition, thanks largely to the dedication of Dr Desiree Persaud (See Regional Subspeciality). We have recently offered fellowships in Perioperative Medicine; Simulation; Echocardiography, Thoracic and Airway Management. Figure 4.1 shows the number of residents and fellows versus year from 2002 to the present.

Anesthesia Assistant Program. Outside of the residency program, we have been collaborating with Algonquin College in the development of an Anesthesia Assistant program. We have provided feedback to the program administrators about their objectives and curriculum. Last year our Simulator Fellow, Jay Ross, took a major role in developing simulator scenarios for the Program. They are planning to enroll their first students in the inaugural Equipment course later this year.

39 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

University of Ottawa Department of Anesthesia

Numbers of Postgraduates

60 49 48 50 42 43

r 37 40 Residents 30 13 Fellows Numbe 20 10 10 8 6 10 0 2003-4 2004-5 2005-6 2006-7 2007-8

Ye ar

Figure 4.1 Residents and Fellows by Year.

Staff Involvement and Administrative Support. The program benefits highly from our new Program Administrator Holly Ladouceur as well as from the continued involvement of Lynne McHardy in all aspects of education. It could also not be as successful as it is without the efforts of the whole Residency Program Committee–Dr Patti Murphy (Education Director); Dr Desiree Persaud (Resident Coordinator Civic Campus); Dr Tammy Barrows (Resident Coordinator General Campus); Dr Donna Nicholson (Resident Coordinator Heart Institute); Dr Ibrahim Abu Shawan (Resident Coordinator CHEO); Dr Lucie Filteau (Undergraduate Director); Dr Joanne Madden (Resident Coordinator Sudbury) Dr Shawn Hicks (Chief Resident); Dr Amy Rodgers (Senior Resident); and Lukasz Bartosik (CHEO scheduler). Drs Kelly Shinkaruk and Ivan Hsia are sharing the responsibilities of Chief Resident for NESR.

40 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

4.3 Simulation in Anesthesia Earl Wynands

There are currently six staff physicians who are members of the Simulator Group: Dr Earl Wynands, acting director; Dr George Dumitrascu, Civic; Dr Simone Crooks, General; Dr Robert Elliott, General; Dr Patti Murphy, Civic and and Dr Michelle Chiu, Civic

The University of Ottawa, Department of Anesthesiology has a national reputation for excellence in Anesthesia Residency training. One unique and important aspect of our residency program is the degree to which our residents are exposed to learning via simulation (residents in other training programs attend once or twice in their entire residency, while our residents attend twice annually). Our reputation is such that residents from other programs (Queen’s University, McGill University and University of Montreal) routinely attended our Crisis Resource Management courses in the Ottawa SKILLS and Simulation Center.

In addition, we work closely with several other departments, including Obstetrics and Gynecology, Critical Care, Emergency Medicine, and General Surgery. Our initiative towards excellence in education strengthens the collaboration between these departments. Improved clinical care will result from focusing not only on the acquisition of medical knowledge but more importantly, on the development of effective communication strategies between specialties. It has been recently recognized that communication errors are the most important factor in the development of critical errors in patient management. Simulation is the only mode of education which addresses communication deficiencies in such dynamic circumstances.

41 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Research and Development. Dr Robert Elliott was the main developer of the Anesthesia Machine Check Protocol Dr Elliott and Dr Patti Murphy have carried the responsibility of the Simulation Centre with Dr Wynands since its inception in 1998. Currently we have three ongoing projects:

1) Drs Robert Elliott, Chiu and Dumitrascu, “Does an Experimental Teaching Session on the Anesthesia Machine Check Using the Patient Simulator Improve Anesthesia Resident Performance?” 2) Drs Chiu, Dumitrascu, Crooks and Elliott (with Dr Fraser),“Structured Communication Strategies in Anesthesia Simulation and their Effect on Measured Communication and Outcomes” 3) Drs Dumitrascu, Elliott and Chiu (with Drs Johnston and Gupta), “Effect of a Teaching Session on Subsequent Performance in Simulated Crisis Management”

Our expectation for the upcoming year is to complete these three ongoing research studies and submit them for publication in a peer reviewed journal. Team members have contributed to the development of two syllabi, noted here and two refereed publications in 2006 (listed in Appendix I of the Departmental Report):

Chiu M and Neilipovitz D. Rapid Sequence Intubation. Acute Resuscitation and Crisis Management: Acute Critical Events Simulation (ACES) Course Syllabus. University of Ottawa Press, Ottawa, 2005. Chiu M. Contributing author: Canadian Resuscitation Institute / Ontario Ministry of Health and Long-Term Care Critical Care Response Team High Fidelity Simulation Instructor Certification Course Syllabus. 2005. Chiu M. Contributing author: Acute Critical Events Simulation Instructor Certification Course Syllabus. 2004.

It is anticipated that the upcoming move to the new Multidisciplinary Simulator Center in 2009 will facilitate research both within the Anesthesia department as

42 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 well as inter-departmental levels. Such projects should be conducive towards complex trials with funding from peer-reviewed grants. Education and teaching. The Department of Anesthesiology Simulation Program has a national profile. It has employed a new teaching technique utilizing “experiential learning” which is rapidly becoming the gold standard of education within in multiple medical disciplines, especially those involving critical care.

Drs. Chiu, Crooks, Elliott, Dumitrascu, Murphy, and Neilipovitz have been involved in the National Simulator Curriculum Development and attended Meetings in 2007, 2006, 2005. New Scenario Templates have been developed and a presentation has been made to the Association of Canadian University Departments of Anesthesiology Dec 2007. Drs Elliott and Dumitrascu developed the Anesthesia Assistant Simulation Curriculum and the Anesthesia Assistant Theoretical Knowledge Base Curriculum at Algonquin College. Drs Neilipovitz and Chiu co-authored the ACES syllabus, noted above. Dr Chiu is a Master Instructor for the ACES Course (a two-day modular resuscitation course encompassing didactic lectures, workshops and simulator-based sessions) and the ACES Instructor Certification Course (a two-day course designed to teach the principles of simulator-based medical education to future ACES instructors). She expects to continue this role for the foreseeable future.

Implementing a National Simulation Curriculum in Anesthesia is a project of astounding proportions and it is anticipated that this project should be close to fruition in five years.

Future directions for Simulation include recognition of this mode as an evaluation tool. It is anticipated that within the upcoming five years that we will be working with the Royal College in evaluating this as an appropriate examination tool.

With the development and acceptance of a National Simulation Curriculum in Anesthesia, our focus in the upcoming year will be on implementing this

43 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 curriculum nationally. Our members are integral to this process and anticipate continuing recognition for their endeavours.

Fellowships. We strive to recruit one fellow per annum in our simulation program. The fellow will be centered at the new Multidisciplinary Simulation Centre (scheduled to open 2009). This placement is not campus specific, however clinical care will be at a specific site, to be determined on an individual basis.

Undergraduate and Graduate Training. Currently, all medical students have a simulator-based teaching session at the start of their Anesthesia rotation. All Anesthesia residents have a minimum of two sessions per year in the simulator, where they are the primary physician in scenarios designed to facilitate development and practice of Crisis Resource Management skills. All Obstetric/Gynecology Residents rotate through the simulator once per year. Anesthesia residents also participate in these scenarios. These multi-disciplinary sessions generate much discussion and learning around surgeon-anesthesiologist communication skills and joint patient care.

Critical Care consultant staff and fellows have received simulator instruction both regionally and nationally. Currently, Anesthesia-Family Practitioners are offered a simulation-based course twice a year. These courses focus on effective communication during crisis management and serve to highlight new and important changes in Anesthetic care. Local registered nurses receive training during annual University of Ottawa Winterlude conference.

44 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

4.4 Continuing Medical Education 4.4.1Winterlude Ashraf Fayad

The Winterlude Anesthesia Symposium is a national annual meeting held every year in February during the city’s Winterlude activities. Dr. Donald Miller and Dr. Earl Wynands, the Chairman of the Department, initiated previous symposiums that were successful continuing medical education programs. The Executive Committee of The Department made the decision to establish an annual Winterlude Symposium. It was held for the first time in 1994, under the direction of Dr Bob Elliott and targeted academic and community-based anesthesiologists from across the city. The international guest faculty for this inaugural meeting included Dr. Jeff Andrews from The University of Texas at Galvaston and Dr. James Ramsey from Emory University in Atlanta, Georgia. The number of attendees at the first symposium was 127, with almost an equal number of anesthesiologists, nurses and technologists. It consisted of a full day of lectures with a focus on “Monitoring and Equipment”. Trauma and critical events were the foci for the next two years programs. Lectures were given in the morning on a wide variety of anesthesia subjects and small group sessions and workshops were held in the afternoon from 1997 to 2005. The meeting has continued to grow and to attract anesthesiologists from mainly Ontario and Quebec. Dr Don Miller was the coordinator of this symposium from 2002–2004, a period which saw continued growth. The total number of attendees was 140 in 2004.

Dr Homer Yang appointed me as the Chairman of the meeting in 2005, and suggested a new direction in programming. With his encouragement and support, Winterlude 2005 focussed on “The Cardiac Patient for Non-Cardiac Surgery”, marking a new direction into perioperative medicine. Local, national, and international speakers were invited to the meeting. Dr Anthony Cunningham, from the Royal College of Anesthesiology, Dublin and Dr. Richard Smiley from Columbia University, New York were our international invitees. At the 2006

45 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Symposium, “Perioperative Challenges and Controversies” the number of participants exceeded 200. The duration of the meeting was expanded to include lectures on Sunday morning, for the first time in 2007. The first twelve Winterlude symposiums were held at the Château Laurier: the 2008 Winterlude symposium will be held at The Westin Hotel and is expected to be an exceptional venue. A new lecture, The Dr. J. Earl Wynands O.C. Royal College lecture, will be given by Dr. Robert Byrick, Professor of Anesthesiology ,The University of Toronto. The planning committee and I continue to work to achieve another successful Winterlude meeting for 2008. The meeting is growing and we will be exploring the possibility of a 3-day conference with greater national depth, in the coming years. —with department files.

46 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

4.4.2 Visiting Professor Program Earl Wynands

The Department has continued its active program of visiting professorships, initiated by Dr.Earl Wynands in 1989. The Visiting Professor program was introduced to enhance continuing medical education in the Department for both attending staff and residents. It has been very successful as many distinguished professors in anesthesia have accepted invitations to discuss their expertise across a wide variety of subjects. At least five distinguished professors are invited annually and two give named lectures each year. The Dr. David John Power lecture is given in October in memory of our first Chairman. The Dr. Rachel Waugh lecture is given in January in memory of an outstanding pediatric anesthesiologist at The Children's Hospital of Eastern Ontario. Every fourth year, there is an additional named lecture givin in honour of Dr John Wrazej. The Visiting Professor gives a lecture at grand rounds to the Department of Anesthesiology at the Ottawa Hospital on Wednesday morning. The rest of the morning is spent visiting the department. Following lunch, he/she meets with the residents for two hours of informal discussion which is probably the most appreciated component of the visiting professor program. On Wednesday evening there is a formal lecture to the Department. All components of the visiting professor program meet requirements for accreditation by The Canadian Anesthesiology Society and The Royal College of Physicians and Surgeons of Canada. An unforeseen benefit of the program is that many distinguished professors, who were unaware of our program, now recognize the high quality of research, resident education and teaching in Anesthesiology at The University of Ottawa. The program continues to be very successful with twenty-one visiting professors accepting invitations between 2003 and 2007. They represent national innovators in our specialty and we have been fortunate to have contributors from four universities in the United States and most University Departments of Anesthesiology in Canada.

47 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Table 4.1. Dates, Speakers, and Topics 2003–2007. Date Speaker Topic January 15, Dr. John Clark, Professor of Opioids for Intra-Operative and 2003 Anesthesiology, Dalhousie University, Chronic Pain, Old Observations Director, Pain Management Unit, Queen and New Knowledge Elizabeth II Health Sciences Centre

March 5, Dr. Sherry Litz, Anesthesiology A Practical Approach: Massive 2003 Dalhousie University Transfusion and Management of Traumatic Coagulopathies May 21, Dr. Asokumar Buvanendran, Assistant Preemptive Analgesia: New 2003 Professor, Anesthesia Rush University, Concepts Chicago

October 1, Dr. David Archer, Professor, GABA Can Be Exciting – New 2003 Anesthesiology University of Calgary Concepts of GABA Physiology and Implications for Anesthesia

October 1, Dr. David Archer, Professor, Anesthesia for Neurosurgey 2003 Anesthesiology University of Calgary

November Dr. Brian Kavanagh, Assoicate How the Perception of Co2 is 5, 2003 Professor, Department of Anesthesia & Changing in Critical Care Medicine University of Toronto Medicine and Anesthesia

November Dr. Brian Kavanagh, Assoicate Physiology Can Be Misleading 5, 2003 Professor, Department of Anesthesia & In Acute Care Medicine University of Toronto

January 21, Dr. W. Lawrence Roy, University of Drug Error: True Confessions 2004 Toronto of a Senior Anesthesiologist

April 26, Dr. A.V. Jovaisas, Asisstant Professor of New Treatment Options in Pain 2004 Medicine University of Ottawa Management

48 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Table 4.1. Dates, Speakers, and Topics 2003–2005 (continued).

Sept. 15th, Dr. Robert Lee, McMaster “Some new insights into the use of 2004 Univ. papaverine and skeletonization procedure during CABG”

Oct 20th, Dr. Anne Wong, McMaster Beyond the Operating Room: New 2004 Univ. Paradigms in Anesthesia Educational Research April 20th, Dr. Rosemary Craen, Univ. Sevoflurane: Added Benefit or just Added 2005 of Western Ont. Cost

Oct. 12, Dr. Steven Backman Physiology and Pharmacology of the 2005 Professor & Chair, Transplanted Heart: Anesthetic Concerns Department of Anesthesiology McGill University

November Dr. James Ramsay, Periopeative Myocardiacl Infarction 2, 2005 Professor Emory University

January 25th, Dr. Peter Davis, Professor Transitional tasks of the newborn 2006 University of Pittsburgh

April 5, Dr. Alan Mutch, Professor Biologically Variable Life Support – An 2006 University of Manitoba Overview from Mathematics to the Microcirculation

October 4, Dr. Gregory Hare, Assistant Genomics, Proteomics and Inforamtics in 2006 Professor the Management of Peri-operative Patients: University of Toronto What can we learn and what can’t we learn

November Dr. Robert Sladen, Professor Perioperative Oliguria – is there a magic 7,8, 2006 Columbia University bullet?”

49 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Table 4.1. Dates, Speakers, and Topics 2003–2005 (concluded).

January 24, Dr. Mark Ansermino, Director of When Anesthesiologists Become 2007 Research Machines University of British Columbia

April 4, Dr. Andre Denault, Associate Ultrasound guided venous and 2007 Professor arterial access: a new area of University of Montreal expertise for the anesthesiologist

October 3, Dr Line Jacques, Assistant Professor, Medical Devices for the Treatment 2007 Depart. Of Neurology,McGill of Refractory Pain University Health Centre, Montreal (Dr David Power lecture) November Dr. Scott Reuben Recent Advances in the 7th Professor of Anesthesiology, Pain Management of Acute Medicine and Orthopedics Postoperative Pain Tufts University School of Medicine Springfield, MA

December Dr. Bruce Spiess The Development of a Blood 5th Professor, Cardiac Anesthesia Management Program Medical College of Virginia

January 16, Rachel Waugh Memorial lecture Pain matters! …Can cannabinoids 2008 Fiona Campbell Assistant Professor, help? University of Toronto Hospital for Sick Children

50 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

4.4.3 Journal Club Jean-Yves Dupuis

Until September 2003, the Department held five to six Journal Clubs each year. All Journal Clubs were sponsored by pharmaceutical companies and were held in restaurants in the city of Ottawa. This formula led to interesting academic evenings for many years. However, Journal Clubs insidiously became more of a social than academic activity over the previous two to three years. Faculty and residents’ participation highly correlated with the quality of the restaurant where the Journal Club was held. In fact, the attendance was declining considerably: the first journal club of each year tended to be well attended (25 to 35 participants), but by the end of the academic year, less than 20 people came to the Journal Club. Consequently, major changes in the organization and content of the Journal Clubs were made at the beginning of the academic year 2003–4. In collaboration with our new Chairman, Dr. Homer Yang, the following organizational changes were made at the beginning of the academic year in September, 2003: 1. Instead of being organized by the individual Divisions, the Journal Club was coordinated by a group of staff anesthesiologists representing each Division. From 2003 to 2007, the Journal Club Coordinators were Dr. Ibrahim Abu-Shahwan (CHEO), Dr. Gregory Bryson (Civic Campus), Dr. Jean-Yves Dupuis (Heart Institute) and Dr. Calvin Thompson (General Campus). In September 2007, Dr. Alan Chaput became in charge of the Journal Club with a mandate to improve the residents’ ability to appraise research methodology. 2. Journal Club and Research Seminars used to be separate activities. However, the Journal Club Coordinators felt that critical appraisal of medical literature and research are closely related. We therefore decided to put the two activities under a same umbrella. Our objective is to have four annual Journal Clubs and two Research Seminars allowing the presentation of current or future projects within our Department.

51 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

3. Journal Club Content: For each Journal Club, three or four articles related to a specific theme are presented. Copies of those articles and a list of specific learning objectives are mailed to all residents, Faculty members and anesthesiologists working in the city of Ottawa, at least two weeks in advance. In addition to the presented articles, other references are mailed to everyone. Those additional references are only distributed, but not presented at the Journal Club. They are used to provide a better background of the Journal Club theme and to stimulate better discussions between the presenters and the attendees. 4. Research Seminars Content: Two research projects are presented by residents or faculty members at each research seminar. During those sessions, the presenter summarizes his or her research project and presents preliminary results, if available. To encourage the audience participation and stimulate reading on the presented research topics, one or two highly relevant articles per project are sent to the participants two weeks before the event. Those articles usually provide good background information on the research project. 5. Presentation Format: All members of the Department, including staff (not only Residents and Fellows), can present articles or research projects. A period of 5 to 10 minutes is allowed for presentation of the articles at the Journal Club using Power Point to highlight the important points of the articles. Each presentation is followed by a 10–20 minute discussion. When appropriate, more than one article is presented before starting a discussion. During Research Seminars, presenters are given 15–20 minutes to present their project before inviting questions and comments from the audience.

The changes made in 2003 have been greatly appreciated by the residents and faculty members. The attendance to the Journal Club/Research Seminars now varies between 35 to 55 (average of 40 attendees) per session. As of September 2007, Dr Alan Chaput is the new journal club coordinator.

52 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

The following table gives the dates, the list of topics, the number of presenters, the total number of articles distributed for Journal Club preparation and the number of articles presented for each Journal Club/Research Seminar held since September 2003.

A detailed list of all the articles and learning objectives for each the above mentioned Journal Club and Research Seminar is available from Jean-Yves Dupuis, Associate Professor, Department of Anesthesiology, Cardiac Division, Heart Institute, for the years 2003–2007.

Table 4.2. Journal Club Topics, Number of Presenters and Articles. Date Academic Year 2003–4 Topics #Presenters # Articles 2003-09- SARS, other viral infections, physicians’ 2 Residents 12 distributed 22 knowledge and behaviour towards universal 2 Faculty 4 presented precautions.” 2003-10- Everything old is new again – residual 2 Residents 5 distributed 20 neuromuscular blockade redux 2 Faculty 4 presented 2003-11- Research Seminar – 2 projects were 1 Resident 3 distributed 17 presented: 1) Thoracic Epidural Adrenaline and 1 Faculty Meperidine (TEAM) Trial. A prospective evaluation of the addition of adrenalin to meperidine for post-thoracotomy epidural analgesia. 2) Neuroprotective effect of mild hypothermia in cardiac surgical patients. 2004-01- Normal Saline and Lactated Ringer’s 2 Residents 5 distributed 12 Solution for Perioperative Fluids: Are They 2 Faculty 4 presented Equivalent?

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Table 4.2. Journal Club Topics, Number of Presenters, and Articles (continued). 2004-03- Research Seminar – 2 projects were 2 Faculty 4 distributed 08 presented: 1) A randomized trial comparing the safety and efficacy of conventional dose of hyperbaric bupivacaine versus low-dose isobaric bupivacaine-fentanyl-morphine for spinal anesthesia during Cesarean section. 2) Ketamine versus ketamine plus morphine for post-tonsillectomy analgesia in children. Date Academic Year 2004–5 Topics #Presenters # Articles 2004-09- Anesthesia-Related Cardiac Arrest. 2 Residents 7 distributed 20 2 Faculty 4 presented 2004-11- The Cochrane Database: Does it have any 2 Residents 4 distributed 08 use for 1 Faculty 1 presented anesthesiologists? 2004- Research Seminar – 2 projects were 2 Faculty 3 distributed 1201 presented: 1) Cardiac diastolic dysfunction in patients undergoing aortic surgery. 2) To Compare the Effects of Caudal Epidural Morphine with Combined Sciatic and Femoral Nerves Block in Children undergoing Clubfoot Repair. 2005-01- Cardiopulmonary resuscitation 2 Residents 7 distributed 17 2 Faculty 4 presented 2005-02- Single dose glucocorticosteroids: is it a 2 Residents 5 distributed 28 panacea for perioperative pain 2 Faculty 4 presented and complications?

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Table 4.2. Journal Club Topics, Number of Presenters, and Articles (continued). 2005-04- Research Seminar – Presentation on Clinical 3 Faculty 7 distributed 11 Equipoise followed by presentation of 2 projects: 1) Clinical Equipoise: When is randomization ethical? 2) Neuroprotective strategies for the elderly surgical patient. 1. Delirium: predictive value of Apolipoprotein E genotype and effect on postoperative cognitive function. 3) Psychogenic pain and somatization, past history and current status: Dismantling the concepts. Date Academic Year 2005–6 Topics #Presenters # Articles 2005 New Advances in Regional Anesthesia 3 Residents 4 distributed -09-19 3 presented 2005-10- Anesthesia Simulation-Based Education 3 Residents 4 distributed 17 3 presented 2005-11- Research Seminar – 2 projects were 1 Resident 4 distributed 28 presented: 1 Fellow 1) Awake Laryngoscopic Evaluation with Remifentanil Trial (ALERT) 2) A study investigating the effects of sevoflurane and propofol on diastolic dysfunction, markers of myocardial injury and length of hospital stay in patients with aortic stenosis undergoing aortic valve replacement.” 2006-01- Hyperglycemia in surgical and critically ill 3 Residents 7 distributed 16 patients: is it really bad? 3 presented 2006-02- Cardiovascular considerations in obstetric 3 Residents 7 distributed 20 anesthesia 3 presented

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Table 4.2. Journal Club Topics, Number of Presenters, and Articles (concluded). 2006-03- Research Seminar – 2 projects were 2 Faculty 4 distributed 20 presented: 1) Ischemic Brain Injury and the Leukocyte: Possible Mechanisms for Neuroprotection. 2) Airway pressure release ventilation versus conventional positive pressure ventilation in cardiac surgical patients requiring prolonged mechanical ventilation. Date Academic Year 2006–8 Topics #Presenters # Articles 2006-09- Bupivacaine cardiotoxicity: have we found 3 Residents 4 distributed 18 means to treat it? 3 presented 2006-10- Anesthesia for thoracic surgery: A 3 Residents 5 distributed 16 potpourri of interesting topics 3 presented 2006-11- Research Seminar – 2 projects were 2 Residents 3 distributed 20 presented: 1) Intraoperative Lidocaine Infusion for Analgesia (Best known as the ILIA study) 2) The clock drawing test as screening tool for postoperative delirium 2007-01- The use and safety profile of aprotinin 3 Residents 7 distributed 08 3 presented 2007-02- Anesthesia and the Operating Room 3 Residents 7 distributed 19 Efficiency 3 presented 2007-09- Perioperative statin use and cardiovascular 3 Residents 3 distributed 17 outcomes 3 presented 2007-10- Pregabalin and gabapentin for periop pain 3 Residents 5 distributed 22 3 presented 2007-11- A practical example of the steps required to 3 Residents 3 distributed 19 ask a good research question and come up with a study design to answer it. 2008-01- Cardiovascular risks of NSAIDs 3 Residents 4 distributed 14 3 presented

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5 Department of Anesthesiology Clinical Divisions

5.1 The Ottawa Hospital Participation and Responsibilities

TOH Department and Hospital Committees Alternate Funding Committee (Anesthesia) Chair, Dr. Nadira Naraine Anesthesia Human Resource Committee Chair, Dr. Louise Gauthier Chief Advisory Committee Chair, Dr. Homer Yang Civic Executive Business Group Dr. David Neilipovitz (manager), Dr. Greg Bryson (treasurer) General Executive Business Group Dr. Peter Duffy (manager), Dr. Chris Wherrett (treasurer) Hospital Safety Medication Committee Dr. Pat Sullivan Civic Campus Research Chair, Dr. Greg Bryson General Campus Research Chair, Dr. Don Miller TOH Pharmacy & Therapeutics Committee Dr. Alan Chaput TOH Anesthesia Patient Safety Committee Drs. Pat Sullivan, Ted Crosby

TOH Functions Persons Responsible Equipment Drs. Paul Connelly, Pat Sullivan Post-Anesthesia Care Unit (PACU) Drs. Tammy Barrows, Ashraf Fayad

TOH Subspecialty Areas Persons Responsible Airway Drs. Ted Crosby, Paul Connelly, David Neilipovitz

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Chronic Pain Drs. Cathy Smyth, Denis Reid, Tammy Barrows, Linda Wynne, Geraint Lewis Cardiac Echography for non cardiac Surgery Drs. Ashraf Fayad, David Neilipovitz Hyperbaric Medicine Dr. Peter Duffy Neuroanesthesia Dr. Tom Polis Obstetrical anesthesia Drs. Cathy Gallant (General Campus); Susan Goheen (Civic Campus) Peri-operative Medicine (PAU/APS) Drs. Greg Bryson, Sylvain Gagné, John Penning, Don Wilson, Paul Connelly Regional Anesthesia Drs. Desiree Persaud, Holly Evans Thoracic Anesthesia Drs. Larry Byford, Calvin Thompson, Sylvain Gagné, Stephane Moffett Transplant Anesthesia Dr. Chris Wherrett Vascular Anesthesia Drs. Ashraf Fayad, Don Miller, David Neilipovitz, Jon Hooper, Pat Sullivan, Ian Zunder

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5.2 The Ottawa Hospital—Civic Campus Michael Curran

At the time of writing this report, it has been a year and a half since Dr Ian Zunder handed over the reins of site chief to me.

Staffing. The Civic Campus Site and Anesthesia Associates 1992 welcomed Drs Amy Fraser and Anna Wyands in 2007. We also said goodbye to Dr Ben Sohmer who took a staff position at the Heart Institute. Dr. Andy Boutet has retired from the Riverside Ambulatory Surgical Suite this November. Last year we had five Fellows join us for further training in various subspecialties, this year we have three.

Accolades. On the heels of the University of Ottawa’s recognition of Dr Wayne Barry’s contributions to anesthesia training worldwide, last year, the CAS recognized Dr John Cowan’s contributions to Canadian Anesthesia. This year the CAS recognized yet another member of our department, Dr. Desiree Persaud, with the Clinical Teacher Award at this year’s meeting in Calgary.

In Retrospect. Over the past year a great deal of time and effort has been spent on the proposal put forward by the OMA/MOHLTC sponsored Operative Anesthesia Committee (OAC) for Anesthesia Care Teams (ACTs). The Ottawa Hospital was chosen as one of the demonstration sites and because of this the Civic campus has seen the addition of several new anesthesia assistants (AAs). The addition of AAs is meant to increase efficiencies in OR that will result in more cases being done specifically for oncology, total joints (knees and hips) and cataracts. Their assistance should also help with the increasing number emergency cases. There was pressing and heated discussion regarding the Cataract Anesthesia Proposal (CAP) with the MOH just prior to the summer holidays. There has been no further discussion since that time. Should this proposal receive favorable support from the Ministry it could mean an infusion of at least 5 more

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AAs in Ottawa, most of whom would be stationed at the Riverside campus’s Eye Care Centre.

Space. While our colleagues at the General site have already moved into their new administrative quarters we are bursting at the seams at the Civic Campus. To accommodate more staff, we have cut offices in half and have constructed additional office space in the corridor adjoining urology providing much needed space for our research assistants. While space is very “tight” at the Civic Campus there is no indication that we will be able to reclaim and rejuvenate the space left behind when we vacated the “old” ORs at the east end of the building eight years ago.

Non-Clinical Activity. Activity has increased outside the operating room. The staff has shown a keen interest in educating and training both graduate and undergraduate students both inside and outside (Simulator) the operating room. Combined with increasing involvement in research and the development of subspecialties, these activities have placed an added strain on non clinical time (NCT) allocation and scheduling.

Challenges. Renovations near or in the OR suites during the summer have had an impact on the movement of patients into and out of the OR. The corridors have recently been reopened after structural work was completed for the ICU extension and a retrofit for room 7 to accommodate Minimal Invasive General Surgery. The refit now provides a Beta Educational Centre for MIS procedures for the region.

We are currently running 15 rooms in the OR suites with extended times (to 1800hrs) for 4 rooms during the week. On weekdays, two rooms continue the emergency list until 2300 hours and on weekends two rooms are open during the day on Saturday with increasing pressure to open a second room on Sunday.

The MOH is seeking to increase efficiencies to make sure they meet the targets on Wait Times for cataracts, oncology, total knee and hip joints. The amount of

60 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 trauma coming to the Civic Campus along with the emergency surgery brought by other services like vascular and neurosurgery has contributed to a long list of emergency cases. Another scheduled “emergency” room has been added three times a week. These proposed increases in surgical service are conditional on the availability of nursing staff and relocation of surgical services. In addition there is more “out of the OR suite” work in Angio (coiling, vascular stenting procedures), at the dental clinic and the Riverside Gynecological Unit. There is continued pressure from the hospital’s administration to add more late rooms during the week and add more rooms to the weekend schedule. The concern has been that this will limit the availability of staff for other non-clinical activity and add to the potential burn out of staff.

Anticipating future staff needs is very difficult because of the changing timelines for adding more ORs and the uncertainty surrounding the directives that will be forthcoming from the new (Local Health Integration Network) LHIN. The LHIN for the Eastern Ontario region will decide where surgical services will be provided. The challenge is to try and meet these demands with these uncertainties.

5.2.1 Malignant Hyperthermia Investigation Unit Kevin Nolan

The Malignant Hyperthermia (MH) Investigation Unit at the Civic Campus of the Ottawa Hospital is 30 years old. It was established by the pioneering efforts of Dr Vivian Morton, an anesthetist at the then Ottawa Civic Hospital. Following a clinical experience with a 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: Dr Wayne Lambert, Dr Charles Cattran, Dr Greg Allen, Dr Gord Reid. Through all of this time, a steady course was maintained by Mary Lou Crossan, our dedicated lab technician/coordinating person. Through the years we have answered many phone and written requests from

61 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 individual patients possibly at risk and the health care practitioners caring for them. We have developed a substantial family tree database of MH susceptible families, and copies of related medical records. We are active members and contributors to the North American Malignant Hyperthermia Registry, an extensive database of MH susceptible individuals. We have regularly attended meetings sponsored by the MH Association of the United States. We correspond regularly with members of this group as well as MH investigators in Europe. We have assisted in the development of several publications in peer reviewed journals. We are now involved in selecting individuals for genetic assessment in Dr Julian Loke's lab in Toronto or through resources in the USA. We serve patients from all over Canada and receive e-mail correspondence from a variety of other countries. Presently we are one of the two remaining MH investigation units (the other being in Toronto); previous centers in Winnipeg and Calgary having closed.

Table 5.1. Malignant Hyperthermia Case Summary. Mary Ann Crossan

Year Clinic PAU/ Research/Educ. Referrals Calls/email Muscle Pts seen Hospital Activities inquiry Biopsies 2004 3 31 0 27 67 3 2005 2 31 9 23 90 7 2006 4 21 20 16 124 3 2007 0 28 24 25 168 5

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5.3 The Ottawa Hospital—General Campus Bob Elliott

New Critical Care Wing Project. The year 2007 has been the transition year for the General Campus Operating Room Suite and the Anesthesiology Department into our new quarters in the long-awaited Critical Care Wing (CCW). Many hours of planning sessions over the past five years have finally come to fruition.

The Department of Anesthesiology offices were moved into spacious first-floor accommodations in the new CCW late in November 2006 following a year of construction noise and interruptions in our old location. Although the distance to walk to the existing OR suite was increased, the new office suite offers an environment much more conducive to efficient work with natural light and more space and privacy. Every staff person, fellow, locum and nurse has his/her own workspace. The Watson Anesthesia Library has expanded and offers study space and computer access for residents and medical students. Our new kitchen/lounge is very comfortable. And lastly we have our own conference room. Concerns continue about the location of our on-call sleep room in a corridor which is busy in the early morning.

The ICU moved to its new location in the CCW at the end of May, 2007. It now consists of two “pods” of 16 beds, each with modern ceiling-column patient services and monitors. The entire physical move was well-planned and transfer of all ICU patients was accomplished in less than six hours.

The summer and fall of 2007 is being spent to get ready for the move of the OR suite. All ancillary services such as Logistical Services (equipment sterilization, inventory, etc.) will be ready to go in early fall. The new and expanded PACU will be ready to go mid-fall and the last piece of the puzzle, the Same-Day Admit Unit, will be finished late in the fall, once the Hyperbaric Unit has been relocated and expanded with a second chamber.

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Meanwhile, the ORs themselves will have undergone extensive testing of ventilation balancing and the installation of ceiling-column mounted services and sophisticated computerized network systems. The move of the Operating Suite to the CCW is scheduled for the slow-down period over Christmas at the end of 2007. The 17 new ORs are all 600 sq. ft. or larger and six of these ORs will be equipped with the latest in Minimally-Invasive Surgical (MIS) instrumentation.

The current 12–13 daily ORs will be expanded to 15 daily ORs in January 2008. This increase in available OR time is badly needed, because of increased demands by an aging population and by longer case-times due to complexity of surgery (often because of MIS techniques). This expansion to 15 and ultimately 17 ORs presents a hiring challenge for the Department.

Surgical Information Management System. After many years of lobbying, in 2006, the Ottawa Hospital committed funding and energy to implementing an OR-specific Surgical Information Management System (SIMS). It had been the previous plan to develop in-house, in conjunction with the vOacis project, our own OR solution. However, time constraints and urgent demands for fiscal accountability along with the impending expiration of current software forced a re-think and tenders from independent vendors were requested in summer 2006. Over the spring of 2006, many hours were spent with all “stake-holders” including Anesthesia, to develop a comprehensive Request-for-Proposal. The evaluation process was limited to the top three vendors based on a scoring system and intensive demo sessions were held in August. Site visits to various centres in both Canada and the US (including MD Anderson Cancer Centre in Houston, TX) aided in the decision to award the contract to PICIS.

The scope of this project is large and will cost approximately $6.5 million. It will be implemented in several phases and will include all three campuses, although roll-out will involve the General campus first. The first phase covers the infra- structure of operating the ORs since the current ancient software expires in March 2008. Much work is being done to analyze the procedures and systems involved

64 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 in booking patients for surgery, allocating OR time slots and attendant specific equipment requests with conflict-checking, surgeons’ preferences, et cetera. The pathway for patient pre-op assessment will be integrated into the process to improve efficiency and eventually much of this may be accomplished on-line from the surgeon’s office.

Once this infra-structure phase is completed and networked at all three campuses, the next phase will look at clinical documentation, both nursing and anesthesia. We will finally move to a paperless, electronic integrated perioperative patient record–from pre-op assessment through arrival at the DCU/SDA unit, to the OR and finally the PACU. The challenge will be to implement the user-friendly anesthesia electronic record that our staff has been eagerly awaiting. This segment of the project will require considerable planning and testing of prototype software templates to accomplish a successful implementation.

Practice Challenges. The past few years have presented an assortment of practice challenges which have been a constant source of stress for our Department. The future appears to be bringing some solutions along with new challenges.

Manpower and the search for new staff-members is a continuing problem. Several years ago, Anesthesia was so short of staff that the Hospital was forced to implement OR closures which did little for the popularity index for Anesthesia. Recently we have been able to meet the service requirements for the OR but at times this is a moving target due to nursing shortages and hospital crowding. As mentioned above, the OR suite at the General will expand, initially from 12–13 ORs to 15 and eventually 17 ORs with the move to the CCW. This comes at a time of year (January) when it is difficult to attract new staff to join us. The first half of 2008 may once-again be a stressful period when Anesthesia is unable to provide as much OR coverage as we are asked to do. Hopefully by July 2008, we will have new additions to our staff to “smooth the waters”.

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Another source of pressure is the Province of Ontario initiatives to address the wait-times for some identified surgical procedures: total joints, cancer and cataracts. At the General, we have added an “extended” day to 16:15 hrs to allow for four total joints to be booked in one OR list. There have been challenges to make this work consistently. It works well when all four patients are uncomplicated from both an orthopedic and an anesthetic point of view. Unfortunately sometimes it doesn’t work and the last patient of the list gets cancelled due to lack of time. Efforts to make the day run more “efficiently” are being launched. For the past year we have had an Anesthesia Technician/Assistant (AAs) to aid in the placing of regional blocks pre-op in the PACU to avoid delays. More AAs are being trained and are scheduled to be hired to expand this project. However, complaints about “efficiency” and delays in “cut-time” persist and the MOH is launching an Efficiency Evaluation Project in the fall 2007 and TOH Anesthesia will be part of this Demo Pilot evaluating the use of AAs.

As mentioned elsewhere, the move to Minimally Invasive Surgery (MIS) cases and more complicated cancer surgery has increased the demand for a longer work day to allow two long cases to be completed. At the General, we currently provide anesthesia staff for one OR a day to run to 18:00hrs with two “late” ORs on Mondays for a total of six late ORs per week. We have agreed to increase this to nine late ORs per week starting in Jan 2008. There are indications that the Hospital would like to add more “late” ORs in the future. The time period after 15:30hrs is valuable non-clinical time for Anesthesia staff to attend meetings— both Departmental and Hospital related. It is also useful time for academic activities which are vital to fulfill our University mandate. There appears to be a collision-course developing here.

Non-clinical time for our anesthesia staff has been a luxury in the past. This time was used for academic pursuits such as teaching and research as well as administrative duties. Much of this work has been done after-hours and at home with encroachment on family life and subsequent work “burn-out”. The MOH has in recent years recognized that the Academic Health Science Centres need an

66 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 additional compensation mechanism to attract new staff to embark on an academic career and has instituted an Alternate Funding Plan. We are now entering Phase 2 of the Plan and the challenge will be to develop equitable and transparent mechanisms to allocate this additional funding. The AFP may be a key element in addressing our growing manpower needs in the coming years.

5.4 The Ottawa Hospital—Riverside Campus Robert McBurney

The Riverside Campus is an ambulatory care unit with several outpatient clinics plus six operating rooms, a ten-bed PACU, and a lithotripsy unit on the main floor and four operating rooms and an eight-bed PACU located in the Eye Care Centre on the third floor. The anesthetic services are provided by four permanent onsite staff plus rotating staff members from the Civic and General Campuses

The Riverside Hospital converted to an ambulatory care centre in June 1999 when the hospital merged with the Civic and Grace hospitals to form the Ottawa Hospital. Since that time the former wards at the Riverside have all been converted to up to date modern out patient clinics. The former third floor maternity unit was converted into the Eye Care Centre which has outpatient eye clinics plus two fully equipped operating rooms for general anesthesia, regional or local with sedation along with two operating rooms for regional or local eye procedures only. Anesthesia coverage is provided for the four operating rooms by two anesthesiologist and one Respiratory Therapist/ Anesthesia Assistant and three nurse assistants. One of the operating rooms is used mainly for retinal procedures and averages approximately four to five cases per day. The other three operating rooms average about twelve to fifteen cases per day. For the year 2006– 2007 the total number of cataract cases done at the ECC was 8742. The Eye Care

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Centre has had numerous compliments from patients and medical staff for its efficiency and patient friendly environment.

The operating rooms on the main floor are essentially the same with minor adjustments as they were when the Riverside was an inpatient service facility. The one major addition was the Lithotripsy Unit which now services Eastern Ontario so that patients do not have to go to either Toronto or Montreal. Since the merger in June 1999, a regional anesthetic program under the leadership of Dr Desiree Persaud has greatly improved the post op pain control of orthopedic ambulatory patients. With the introduction of in dwelling nerve catheters many patients are now able to have their orthopedic procedure done as an outpatient and be relatively comfortable without excessive use of narcotics In recognition of the success of this regional program the Ottawa Hospital purchased an ultrasound machine this year for the Riverside OR to aid in the teaching, efficiency and safety of regional anesthesia

The surgical caseload for ambulatory patients is similar to most other ambulatory centers. For the year 2006–2007 there were a total of 6825 surgical procedures done. The total number of patient transfers for the same period required to the inpatient campuses because of perioperative complications was only twenty-nine or 0.4%. Similar to the Eye Care Centre the Riverside OR has received many accolades for its efficient and friendly service.

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5.5 University of Ottawa—The Heart Institute Division of Cardiac Anesthesiology James Robblee

The Division of Cardiac Anesthesiology has undergone significant changes over the five year period 2002–2007. Many changes were undertaken to place the Division on a stronger academic framework that arose from a retreat held in 2004 and to accommodate significant changes that have occurred in Cardiac Anesthesiology and Perioperative Medicine, Cardiac Surgery, and Invasive Cardiology. During the period, the complement of full-time staff increased by an additional anesthesiologist and assistant staff were added to provide in-house on- call coverage for the CSICU.

Divisional Retreat April 3, 2004 The Division of Cardiac Anesthesiology held a visioning and planning retreat at the University of Ottawa Heart Institute on April 3, 2004. The goal of the one-day retreat was to develop a strategic plan for the next five years and to discuss strategic initiatives that would lead to the execution of the strategy. Manpower and the economics of current and future practice were discussed. Individual divisional members with core Divisional responsibilities made a presentation to the group to initiate discussion. Prior to the meeting, all members of the Division were requested to outline their opinion of the strengths and weaknesses. These were compiled and presented as part of a SWOT analysis.

a. Stakeholders: i. Patients and families, ii Heart Institute Surgeons, Cardiologists and Rehabilitation Specialists iii. Anesthesia Technicians and Respiratory Therapists iv. Anesthesia Research Personnel v. University Department of Anesthesiology vi. Other Heart Institute Personnel

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vii. Heart Institute and University of Ottawa viii. MOHLTC

b. Core Strategies i. Increased Intensive Care Involvement ii Expansion of Research iii. Increased Divisional Capability in Echocardiography

Personnel (September 2007) a. Full-time Consulting Staff—12 Dr Michael Bourke–Medical Director CSICU Dr Charles Cattran–Managing Partner Dr Jean-Yves Dupuis–Fellows Program Co-ordinator Dr Mark Hynes–OR Committee, TEE teaching group Dr Stephane Lambert–TEE teaching group Dr Bernie McDonald–Deputy Director CSICU Dr Howard Nathan–Director Research Dr Donna Nicholson–Resident Co-ordinator, TEE teaching group Dr Ben Sohmer–TEE Teaching group Dr Peter Wilkes–CSICU Research Dr James Robblee–Chief, Division of Cardiac Anesthesiology Dr Sanjay Acharya–CSICU (Associate)

b Assistant Staff (CSICU)—3 Dr Malek Kass Dr Dino Shukla Dr Ismeil Amhalal c. Administrative and Research Staff—7 Angie Ross–Administrative Assistant Denise Wozney–Research Manager Sharon Finlay–Research Co-ordinator Denise Winch–Research Co-ordinator Lily Tong–Database

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Sandra Vranjes–Database Brittany Warren–Research Secretary

d. Anesthesia technicians—6 Bob Boxell Tara Lussier Jackie Pritchard Hayes Sandy Goldsmith Shannon Fancey Joyce Dutrisak–Casual

e. Staff Additions Dr Donna Nicholson–July, 2003 Dr Stephane Lambert–October 1, 2005 Dr Ben Sohmer–June 1, 2007

f. Staff Departures Dr Maryse Mathieu–July 2005 Dr Gilles de la Salle–December 2006

g. Fellows (2002–2007) 2002–03 Dr Ahmad Abuzaid Dr Faisal Al Ghadam Dr Donna Nicholson 2003–04 Dr Devashish Chakeavarty Dr William Li Pi Shen 2004–2005 Dr Rayka Tzerovska Dr Vynka Lash

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2005–2006 Dr Caroline Ghosh Dr Abdulmosen Al Harbi 2006–2007 Dr Rene Allard Dr Rob Tanzola

New Programs and Initiatives a. Peri-operative TEE i. Staff, fellow and resident education ii. Clinical program

b. CSIC Increase of beds from 14 to 19 i. Strategic alliance with the University program ii. Fellows education iii Critical Care Research

c. Clinical programs i. Pulmonary Thromboendarterectomy ii. Multiple and Single Vessel Small Thoracotomy iii. Surgical A-fib Ablation iv. Anesthesiology for Electrophysiology 1. A-fib ablation 2. ICD

Research, Presentations and Publications (provided under separate cover) Clinical Activity a. Cardiac Surgical Suite: Case Load Table 5.2 b. Cardiology Procedures: Table 5.3 c. CSICU Activity: Table 5.4

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Table 5.2. Case load by type by year.

Case Type 2002/03 2003/04 2004/05 2005/06 2006/07 CABG 898 792 771 635 685 CABG & Valves 155 171 162 183 161 Valves Only 212 267 264 243 295 Other Open Heart 115 159 139 194 141 Transplants 10 11 8 17 13 Artificial Hearts & VADS 11 3 4 7 2 Subtotal CPB/OP Procedures 1401 1413 1348 1279 1297 Other Procedures 224 208 216 214 209 Total All Procedures 1625 1611 1564 1403 1506

Table 5.3. Patient days , number of beds by year.

2002/03 2003/04 2004/05 2005/06 2006/07 Patient Days 3787 3865 5045 4960 5163 Beds 16 16 16 17 19 Table 5.4. CSICU activity by year.

2002/03 2003/04 2004/05 2005/06 2006/07 PFO/ASD 29 34 19 55 39 Complex Ablations 49 85 81 88 AICD 125 177 222 235 235 Cath/PCI 33 65 104 99 Cardioversion 176 261 302 277 Total 469 652 777 738

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5.6 Subspecialities 5.6.1 Obstetrics—The Ottawa Hospitals Susan Goheen

The Ottawa Hospital is the largest provider of obstetrical care in Eastern Ontario with 7 000 to 7 500 deliveries per year. More specifically, it is the only tertiary care centre east of Kingston in Ontario that does high-risk obstetrical care—high risk gravid women, as well as high risk neonates: approximately one third of all the deliveries at the TOH are high risk. The optimum care of these patients often has conflicting priorities between disciplines, therefore demanding good communication and a very high level of expertise.

Within our department, it serves us well to have a subspeciality group of obstetrical anethesiologists, so that expertise is maintained at expected tertiary care levels. At the current time, there exists core subspecialty groups at both campuses. At the Civic campus physicians associated with the Obstetrical Anesthesia Subspecialty Group are: Drs. Susan Goheen (lead), Patti Murphy, Linda Wynne, Rob McNeil, John Penning, Carolyn Tallmadge, and George Dumitrascu.

Initiatives in strife of clinical improvement include a corporate (Civic and General sites) effort in the enhancement of programs offered, productive teaching of our residents and fellows, participation in nursing education/skills augmentation efforts and standardization of routine procedures. Some examples of these initiatives are: standard of care guidelines (use of emergency drugs, patient education and preparation); resident and fellow education curriculum development; clinical program development including skills maintenance, and participation in multidisciplinary obstetrical committees (Bariatric Committee, QA Obstetrical Review, and Perinatal Committees). We have also developed an Obstetrical Anesthesia Consult Clinic in conjunction with the Obstetric High Risk Unit so that patient care, and communication about these patients is improved.

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A renewed effort is being put forth for Obstetrical Anesthesia Research so that a reputable Fellowship program can be maintained, and resident research encouraged. As part of the curriculum, any future fellow in OB Anesthesia will be required to present a research project either at our Gary Johnson Research day, or at a peer-reviewed conference. In the last three years, the following projects have been undertaken in the subspecialty of obstetrical anesthesia:

Bryson, GL, MacNeil, R, Jeysraj, Rosaeg OP. Small dose spinal bupivacaine for caesarian delivery does not reduce hypotension but accelerates motor recovery. (see Appendix 1 for publication information , 2007) Fayad, A, Dumitrascu. Changes in LV filling and post delivery. Completed. Abstract submitted WAC and CAS Fayad, A. Intraoperative echocardiology rules in pregnant patients with cardiac lesion. In progress.

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5.6.2 The Ottawa Hospital Pain Clinic Cathy Smyth

Physical Plant/Equipment After much planning and preparation, the “Pain Management Unit” at the General campus and the “Pain Clinic” at the Civic campus moved into one unit on November 7th, 2006. It is a 4 500 square foot clinic on the 1st floor of the CCW at the General campus. It comprises a 4-bed recovery area and 6 treatment rooms including a lead-lined fluoroscopy suite. There are an additional two rooms which can be used for patient consultation and examination. There is space for a patient waiting room, booking clerk and receptionist, file storage, a staff lounge/desks and locker rooms. A significant amount of equipment has been purchased for The Ottawa Hospital Pain Clinic and includes: C-arm and image intensifier, Bayliss radiofrequency ablation device, Zonaire ultrasound, four vital signs monitors and a radiolucent X-Ray table.

Human Resources. The Pain Clinic was originally designed to accommodate two staff physicians working simultaneously, each occupying half of the clinic. However, in practice, the Pain Clinic could easily accommodate three staff physicians working simultaneously with one of the physicians devoted to fluoroscopy (3.0 FTE). At the current time, the clinic is being underutilized because of a shortage of physicians and because of limitations in our staffing budget (RN, RPN, clerk, X-Ray tech). There is currently only sufficient budget for 1.6 FTE physicians. This 1.6 FTE has been divided into 3.5 clinics for the Civic physicians and 3.5 clinics for the General physicians. The extra 0.5 of a clinic is generally devoted to inpatient consults/visits and patient letters/prescriptions. However, we have been unable to run the clinic to the full capacity that our budget allows because of a physician shortage. In September 2007, Drs. Wynne and Lewis will represent the Civic Campus as Dr. Rihani is leaving and Drs. Smyth, Reid and Barrows will represent the General campus. Staff shortages, vacation, on-call and nonclinical responsibilities (i.e. OMA,

76 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 resident coordinator) all contribute to less than optimal scheduling in the Pain Clinic. Scheduling in the Pain Clinic comes after the Anesthesia call schedule is complete and we are often left with large gaps in the clinic as a result. Dr. Rihani has asked for a one year leave of absence from the Pain Clinic for family reasons. He will be leaving the clinic in August 2007 and all of his current patients will have to be discharged back to their family doctor. In July 2008, Dr. Howard Nathan is interested in joining the Pain Clinic three days per week (0.6) after completing a preceptorship in Ottawa. In addition, there is another highly skilled applicant interested in working two days per week in the Clinic (0.4). An impact analysis and business proposal will have to be presented to TOH administration to allow us to increase our Pain Clinic budget sufficiently to hire these individuals.

Fellows. Dr. Kattan and Dr. Al Harbi completed six-month Fellowships in Chronic Pain in the 2006/2007 academic year.

The Pain Fellowship continues to be well-subscribed. Fellowship objectives have been outlined, a fellowship book with relevant/current articles has been generated. In general, the Fellows will work three days in the Pain Clinic, one day in the OR and one day NCT. We are planning to organize four pain journal clubs over the course of 2007/2008 with the fellows presenting on various pain topics. In addition, each of the Fellows will be expected to become involved in at least two research projects over the course of their Fellowship. Several suggestions/ideas on research topics will be presented to the Fellows to consider approximately one month before they begin their fellowship

Administrative. We have made significant progress in the administration of the Pain Clinic. A consultation tool for new referrals and a triage strategy has been developed and is being applied to new consults. The patient-physician contract for opiates has been revised and updated. Nursing standards of care and a nursing policy and procedure manual for all pain clinic procedures has been developed. Prior to the amalgamation, approximately 2 000 consultations were assessed for

77 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 suitability, duplication and necessity. The wait list was reduced by 50% with these efforts. All of the new consults have been entered onto our database and we are now able to predict wait-list times. We have not been able to keep up with the number of new referrals and our wait list has increased in size again to close to 1 500 patients. Our current wait list time is over 5 years and this is the worst in Canada (Canadian Pain Society Meeting, May 2007).

Clinical. Several new clinical areas are being developed in TOH Pain Clinic. 1 Radiofrequency ablation is being routinely utilized for the management of lumbar and cervical facet joint pain. This is a new skill for the Pain Clinic. It is also being applied in pulse lesion mode to other neuropathic pain conditions (i.e. Meralgia paresthetica, neuropathic dental pain, CRPS (RSD) etc...) 2 Intrathecal Pumps and Spinal Cord Stimulation. Liaisons between TOH Pain Clinic and Dr. Jacques’ Neuromodulation clinic at the MNI have been established. Several of our patients are being prioritized to receive intrathecal pumps or spinal cord stimulators. At the current time we have 5 patients (all Failed Back Surgery Syndrome) with intrathecal pumps requiring regular filling and programming. We have worked with a compounding pharmacist (Ron Donnelly) at TOH to prepare 4% bupivicaine for use in these pumps. We are also looking into the particulars of compounding fentanyl and clonidine for use in these intrathecal pumps as well. 3 CT-guided Celiac Plexus Blocks. In the last year, Dr. Margaret Fraser- Hill, radiologist, has very graciously assisted us with CT-guided neurolytic celiac plexus blocks. In certain patients with very difficult anatomy and benign abdominal pain, CT guidance intuitively improves safety and efficacy. A number of patients have benefited from these blocks (malignant and nonmalignant pain) and we have seen some true successes in discharging patients from hospital and weaning off of opiates. In the last 6 months we have utilized 10% ammonium sulphate rather than EtOH or phenol for these blocks. I am

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drafting a protocol for the management of patients receiving CT-guided neurolytic celiac plexus blocks. 4. Interventional Cancer Pain Management. The links between the Pain Clinic and Palliative Care/ORCC/Oncology continues to grow. There is a significant number of cancer patients (acute and chronic) being cared for in the Pain Clinic. I will be able to estimate percentage by early July. We will be booking a full day Complex Cancer Clinic on Tuesdays starting September 2007 so that Gini Jarvis, Ed Fitzgibbon and/or John Seely may be involved for conjoint care. We have developed a program and policy for managing cancer patients with refractory pain control with continuous home IV lidocaine therapy. This is a unique program in Canada (and likely internationally) which has benefited over 17 patients of TOH in the last 2 years. We have completely changed our long-term intrathecal/epidural catheters from Dupen to the Port-A-Cath system. There have been fewer failures and technical problems and displacements with the Smith Medical Port-A-Cath catheters. After discussions with Home Care and education of the nursing staff, patients will now be able to be discharged to the community (home) with an epidural or intrathecal catheter in place. 5 Peer Assessment. Dr. Reid is a chronic pain peer assessor for the College of Physicians and Surgeons of Ontario.

Teaching. This spring we conducted the Pain Core Program for our Anesthesiology Residents. All of our staff as well as Acute Pain, TRC and Palliative Care took part in the program. The Core Program was “shadowed” electronically by the Palliative Care Fellows that were interested in several of our lectures.

Courses/Training. Dr. Smyth and Rihani attended a two-day course at Sunnybrooke focusing on fluoroscopic-guided nerve blocks and the use of radiofrequency ablation. Further training in this area is being offered in October 2007 and all of the physicians in TOH Pain Clinic have expressed an interest in attending. Dr. Barrows and Rihani attended a two day course on spinal cord

79 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 stimulation and intrathecal pumps and Dr. Smyth will be attending the same course the weekend of September 15/16th. Dr. Smyth attended Dr. Line Jacques’ clinic at the Montreal Neurologic Institute January 18th to learn about neuromodulation and the organization of this type of clinic. Dr. Smyth attended a 1 day workshop in Toronto on Neuropathic Pain November 18th, 2006 (Pfizer).

Future Initiatives. One of our identified missions in TOH Pain Clinic is to provide education and support to physicians in the community caring for patients with chronic malignant or nonmalignant pain. Given the high incidence of chronic pain (25%), it is impossible for one pain clinic to follow/assess all of the chronic pain problems in the area. A possible model that we would like to explore is one of a central hub (Academic Pain Clinic) with links to several interested Family Health Teams in the Ottawa Area. In this model, our role of the Academic Pain Clinic would be to provide support/education of the Family Health Team and to provide advanced interventional pain techniques when necessary. In return, the Family Health Team would follow and be primarily responsible for their patients which would decrease the primary care in the Academic Centre and allow for more flow through the clinic itself. This concept is being tested in a link that has been established between TOH Pain Clinic and a Family Health Team practicing in Bancroft, ON. In addition, further development of this model could ensue by working with Dr. Cathy Gillis (Psychiatry) as she has received Ministry funding to apply a similar model in the Psychiatry population. Dr. Geraint Lewis has suggested that this type of model would be perfect for the type of initiative being explored in the current AFC negotiations.

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5.6.3 Peri-operative Echocardiography Program, Civic Campus Ashraf Fayad

This document highlights the perioperative echocardiography program activity at the Civic site by the Department of Anesthesiology. This is the first perioperative echocardiography program for non cardiac surgery in the country. It started on October 2004.

Clinical Services. This service provides echocardiography services for emergency and elective cases. The program is mainly focused on providing intra- operative services for major vascular procedures, for patients with cardiac lesions presenting for surgery and for hemodynamically unstable cases. Future planning: to provide echocardiography services for PAU patients; for echocardiography to be a routine monitor for vascular procedures and patients with cardiac lesions; and for postoperative hemodynamically unstable patients. Expansion of the service is expected to involve the general campus at the end of 2007.

Research Projects. Acute diastolic dysfunction (DD) research studies have been underway since last year (2005). The first pilot study was published in the CJA (Febraury 2006). Recently (June2006) with the support of the GE Company and a portable ecocardiography machine we were able to finish a research pilot project in obstetric anesthesia. The project was mainly focused on hemodynamic changes after delivery. The abstract has been already submitted to the WCA for March 2008. Future planning is to apply for a grant to study the DD effect on the perioperative outcomes. The proposal has been submitted (September 2007).

Education Activity. We started the perioperative echocardiography fellowship program on September 2006 with our first fellow (Dr.Simbawa). The Fellowship trial identified some arrangement issues with other services (ie Heart Institute, Echo Lab). Meetings have been held to overcome these issues. We are hoping to

81 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 restart the Fellowship program in 2008. Future planning is to start a series of recognized CME echocardiography lectures and to initiate a national echo course.

5.6.4 Perioperative Medicine Greg Bryson, John Penning, Sylvain Gagné

Perioperative Medicine combines the activities of Acute Pain Services (APS) and Pre-Admission Units (PAU) of the Ottawa Hospital. Both APS and PAU function independently but come together in the Perioperative Medicine Fellowship and a PGY1 rotation, both currently sited at the Civic Campus. Leaders in Perioperative Medicine include: Dr John Penning (APS) Civic Campus, Dr Paul Connelly (APS) General Campus, Dr Greg Bryson (PAU) Civic Campus, Dr Sylvain Gagné (PAU) General Campus (see also under General Campus Report), and Dr Don Wilson (PAU) Riverside Campus.

Clinical Care. Anesthesiologists at all three campuses of the Ottawa Hospital offer Perioperative Medicine services. Perioperative Medicine is multidisciplinary in nature with daily care in clinics and on the wards provided by both anesthesiologists and nurses. Multidisciplinary collaboration in acute pain management was strengthened in 2005 with the addition of nurse specialists Susan Madden and Colin Labonte to the APS. Close relationships with Cardiology and Hematology have translated into fellowship training experience in cardiovascular testing and perioperative management of anticoagulants.

Perioperative Medicine has actively pursued policies and procedures to facilitate care for surgical patients. The APS has long had detailed protocols for the titration and cessation of parenteral and neuraxial analgesia. The Perioperative Navigator was published in collaboration with Nursing and Admitting to streamline and clarify pre-admission processes for elective surgery. Guidelines for Perioperative

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Management of Pacemakers and Implantable Defibrillators were developed in collaboration with the Rhythm Devices Clinic at the Ottawa Heart Institute. The Guideline is now in use at the Civic Campus and will soon expand to the General and Riverside Campuses. A Medical Directive for Preoperative Testing was implemented to clearly define the indications for laboratory testing and delegate responsibilities for test ordering to PAU nurses. Finally, a policy defining the Perioperative Management of Patients with Obstructive Sleep Apnea has defined and facilitated perioperative care for these challenging patients.

Education. PAU has long offered electives and standard PGY1 rotations. These rotations expose the trainee to challenges of preparing the patient with multiple medical comorbidities for elective surgery. In 2006 the PGY1 rotation was expanded to include a week of APS to teach the essentials of perioperative pain management but also to provide perspective on postoperative outcomes. In 2006, a unique Fellowship in Perioperative Medicine was established. The first of its kind, the University of Ottawa Fellowship in Perioperative Medicine has thus far admitted three fellows: Drs Nasser Tawfeeq, Michael McMullen, and Wilton van Klei.

Perioperative Medicine leaders have been actively involved in continuing medical education. Dr Homer Yang is the founder and past President of the CAS Section on Perioperative Medicine Dr Greg Bryson has been an invited speaker at the past four CAS meetings, the inaugural Canadian Perioperative Anesthesia & Medicine Meeting, and Columbia University, New York. Dr John Penning has presented at the Canadian Pain Society and Queen’s University.

Research. Evidence based medicine is the foundation of Perioperative Medicine and research is essential to advancing care across the perioperative period. Publications and grants are detailed elsewhere in this report but several investigators and should be highlighted. The POISE trial was completed in 2007 and primary investigator Dr Homer Yang and co-investigators from around the world anticipate publication of this important trial in early 2008. Peer-reviewed

83 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 research grants support trials evaluating the influence of atrovastatin on cardiovascular outcomes (Dr David Neilipovitz), paravertebral blocks on chronic pain following mastectomy (Dr Michelle Chiu) neurocognitive outcomes following aortic surgery (Dr Greg Bryson), and post-thoracotomy analgesia (Dr Calvin Thompson). Dr Wilton Van Klie, in collaboration with the University Health Network, Toronto published an evaluation of the value of the preoperative ECG in the prediction of myocardial infarction. Bryson published on the utility of preoperative testing and selection criteria for ambulatory surgery. Publication of ongoing research and new grants will ensure continued innovation in perioperative care.

The Future. The recent opening of the Critical Care Wing at the General Campus will soon lead to the relocation of the General’s PAU. Plans for the new clinic are complete and construction is set to begin in 2008. The resulting changes in work area should allow for new initiatives and improved patient throughput and flow. Expansion of the PGY1 and Fellowship programs to the General Campus is anticipated and will broaden clinical training in subspecialty areas such as oncology, thoracics, and joint arthroplasty. The Ottawa Hospital has committed to the PICIS surgical information management system that includes a pre- admission assessment database. It is anticipated that this electronic health record will facilitate communication and care in across the perioperative period and between campuses. Integration of PICIS with the Ottawa Hospital’s DataWarehouse will provide exciting research opportunities for staff, fellows, and residents. As research opportunities increase the addition of formal research methods training to the Perioperative Medicine fellowship is being considered.

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5.6.5 Regional Anesthesiology–The Ottawa Hospital Desiree Persaud

The Regional Anesthesia subspecialty at the Ottawa Hospital comprises clinical, research and educational activities at all three campuses. Director Dr Desiree Persaud, is the director and campus lead at the Civic and Riverside Campuses and Dr Holly Evans is the campus lead at the General Campus

Subspecialty Core Group members at the Riverside and Civic Campuses are Drs Desiree Persaud, Anne Lui, Michelle Chiu, and Caroline Tallmadge. At the General campus, the core group members are Drs Holly Evans, Cathy Smyth, Alan Lane, (starting July 08) Ioana Costache, Jocelyne McKenna, Elizabeth Renehan, In addition there are seven staff who provide support for this service: Drs David Ewing, Civic/Riverside, Patrick Sullivan, Civic/Riverside, Linda Wynne, Civic/Riverside, Susan Goheen, Civic/Riverside, Jonathan Hooper, Civic, Denis Reid, General and Michael Szeto, General

Fellowship trained regional anesthesiologists greatly contribute to the Department on a number of levels. We enhance patient care particularly in the area of postoperative pain management. Institutional fiscal pressure has stimulated a reduction in hospital length of stay following a variety of surgical procedures. Adequate postoperative analgesia has greatly facilitated short-stay or ambulatory surgery. Peripheral nerve blocks and ambulatory perineural infusions provide good quality postoperative analgesia, minimize opioid consumption, reduce opioid-related side effects and enable rapid postoperative recovery and hospital discharge. Here at least, there is a concordance with improved patient care as Regional anesthesia provides an important component in “care of the acutely ill” and in “quality of life”. Table 5.5 shows the types and volumes of clinical cases performed by this group.

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Table 5.5 Clinical Cases and Core Group Split.

Type of cases (shared) TOH Annual % Core % Rank- Vol. Group and-file Single Injection Brachial Plexus Blocks Interscalene 180 50% 50% Supraclavicular 20 100% 0 Infraclavicular 100 50% Axillary 10 50% 50% Distal Upper Extremity 50% Bier Block Femoral Nerve Blocks Single Injection 300 25% 75% Continuous Catheter 300 50% 50% Ambulatory Infusions 20 100% 0 Popliteal Fossa Nerve Blocks Single Injection Continuous Catheter 50 50% 50% Ambulatory Infusions 200 75% 25% 150 100% 0 Ankle Block 20 25% 75% Miscellaneous Cervical Plexus Block 5 25% Intersalene Cervical plexus 10 100% Cervical Epidural lioinguinal/hypogastric 1 100% Fascia Iliaca 2 50% 5 50%

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The addition of one more FTE with a proven research background is required in our group. The addition of one more FTE with formal training in ultrasound nerve block procedures would be ideal.

Funded non clinical days for this subspeciality are required for administration, education of colleagues within The Ottawa Hospital, presentations to colleagues occurring outside of the Ottawa area, for time for research and publications. Follow up of patients with ambulatory peripheral nerve block infusions also are performed within non clinical time.

It will become necessary for submissions to the Capital Equipment Committee. We will need additional dedicated regional anesthesia ultrasound units, as ultrasound technology continues to improve and demands for vascular access are placed on our current machines. We will need as a matter of course additional needle/catheter sets.

Education and Knowledge Translation. All anesthesia residents of the University of Ottawa and the Northern Ontario (Sudbury/Ottawa) program receive one mandatory block (4 weeks) of Regional Anesthesia training. This block is based at the Civic/Riverside campus. One block per year is reserved for external electives. Post-graduate education includes resident and regional anesthesia fellow teaching in OR, lectures for regional anesthesia core program and instruction for the regional anesthesia core program cadaver workshop.

Our fellowship training program continues to develop on a firm foundation. It has been in existence since 2000. It is one of only two Canadian University Fellowships officially listed by the American Society of Regional Anesthesia and is also listed in A Textbook of Regional Anesthesia and Acute Pain Management. Hadzic A (ed), McGraw-Hill, 2007. Dr Desiree Persaud’s extensive involvement in the development of this fellowship program earned her the 2007 CAS Clinical Teacher Award for “outstanding contributions to both clinical service and

87 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 resident, fellow, and medical student education and administration in regional anesthesia techniques”.

We are seeing regional, national and international knowledge translation from the Regional Anesthesia Fellowship. We have former successful fellows practicing in Jeddah, Saudi Arabia and in Singapore. We have fellows who have initiated or revived the practice of regional anesthesia in Halifax, Saskatoon and more locally at the Monfort Hospital and at the Brockville General Hospital.

“Knowledge translation” is an ongoing focus in other areas. Current information is disseminated to anesthesia colleagues, perioperative nurses and surgeons. Communication and education of patients and care givers are critical components of our practice and are continually updated. It is, as a matter of course, provided in both official languages.

As part of our extended and continuing medical educational contributions, core group members routinely give lectures internationally, nationally and locally. Dr Persaud has lectured yearly since 2002 at the Making a Mark Anesthesia Review Course, targeting PGY-5 anesthesia residents and has been a guest lecturer and workshop presenter throughout Canada was the guest speaker at the TOH President’s dinner and recently was a Visiting Professor at Brigham and Womens Hospital, Harvard University. Members of the core group at active at the University of Ottawa Winterlude Symposium, McGill, the University of Toronto aand at the University of Western Ontario. Drs Holly Evans, Elizabeth Renehan and Desiree Persaud are also active in Nursing education, giving the Kellam Lecture on Regional Anesthesia: for Ottawa Area Orthopedic Nurses in 2000 (DP) and in 2006 (ER).Dr Holly Evans has presented at the Annual International Symposium on Hip Surgery.

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Current Research. Publications by the members of the Regional Anesthesia Group are included in Appendix I. Current research includes the following projects:

1. Efficacy of Thoracic Paravertebral Block in Reducing Chronic Pain and Disability after Breast Cancer Surgery with Axillary Lymph Node Dissection": $10,000 CAS 2007 David Sheridan Award, $25,500 2007 Ottawa Regional Cancer Foundation Research Grant (PI Michelle Chiu) 2. PAINfRE trial: protocol development, ethics submission and competition for departmental funding 3. FAST-track knee hemiarthroplasty trial: protocol development, extensive interdepartmental collaboration and competition for CIHR funding 4. Effect of pregabalin on incidence of chronic pain following total hip arthroplasty: protocol development, interdepartmental collaboration and competition for Pfizer funding 5. Management of local anesthetic toxicity: resident research project supervision, interuniversity collaboration 6. Ultrasound measurements of volunteer epidural and intrathecal spaces, resident research project: 3rd place Award U of Ottawa Gary Johnson research day 7. Review of OR records and compilation of statistics pertaining to number of peripheral nerve blocks performed annually and estimate of staffing needs based on these statistics 8. Anesthesiologist practice survey: supervision of regional anesthesia fellow 9. Regional anesthesia database: supervision of regional anesthesia fellow’s research that will lead to development of regional anesthesia database

Future Initiatives. Educational and Research programs will continue to grow and adapt on the existing foundations. We list here plans for the development and maintenance of clinical programs. These will, by necessity contribute to our research and educational directions. It is hoped that they will also provide insights

89 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 that will make Regional Anesthesia at the University of Ottawa and the TOH a center of excellence.

Development and Maintenance of Clinical Programs 1. Femoral (± sciatic) nerve blocks for total and hemi knee arthroplasty 2. Ambulatory femoral nerve blocks for outpatient hemiarthroplasty 3. Infraclavicular brachial plexus blocks for AV fistula 4. Ambulatory infraclavicular brachial plexus block for elbow/wrist surgery 5. Interscalene brachial plexus blocks for shoulder surgery 6. Ambulatory Interscalene brachial plexus blocks for shoulder surgery 7. Cervical interscalene plexus block for Carotid endarterectomy 8. Sciatic block/catheter for lower limb amputation 9. Popliteal fossa sciatic nerve blocks for foot/ankle surgery 10. Ambulatory popliteal sciatic nerve blocks for outpatient foot/ankle surgery 11. Paravertebral block for mastectomy surgery 12. Multidisciplinary collaboration for development of standardized preoperative analgesia order forms for use in the PAU, orthopedic clinical pathways and standardized orthopedic postoperative orders. 13. Development of standardized peripheral nerve block documentation form 14. Ongoing equipment acquisition This has involved procurement of an ultrasound machine, nerve stimulators, a regional anesthesia equipment cart, nerve block needles and catheter sets, sterile nerve block trays, clonidine for perineural injection, ambulatory perineural infusion pumps. This involves ongoing liaison with equipment representatives, OR purchasing, OR managers and OR clinical directors. 15. Ultrasound-guided peripheral nerve blocks Development of ultrasound guided nerve block program 16. Development of monitoring system for detection of complications following regional anesthesia

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5.6.6 Thoracic Anesthesiology—General Campus Calvin Thompson

There are currently four subspecialty leads in Thoracic Anesthesiology and include Drs. Larry Byford, Calvin Thompson, and Sylvain Gagné. Most recently, Dr. Stephane Moffett joined the subspecialty group July 2007.

Education. Teaching has been a major focus of the SSG. Dr. Sylvain Gagné and Dr. Khaled Tibar completed six months each of Thoracic Fellowships. A formal Anesthesiology Resident rotation was put together this year for senior residents. It is structured around four clinical cases (one each week of the rotation) to highlight key principles and issues for thoracic anesthesia. One resident has completed the rotation this year.

Research. The TEAM trial (Thoracic Epidural Adrenaline and Meperidine) was completed. Results will be presented at a Poster Discussion at the CAS this June in Calgary. The manuscript has also been accepted for publication in the Canadian Journal of Anesthesiology. We have completed a protocol for the PREDICT trial (A PRospective Evaluation of the Determinants of Immediate and Chronic pain in Thoracic Surgery). This is a multidisciplinary evaluation with Principal Investigators Drs Calvin Thompson and Andrew Seeley (Thoracic Surgery). This is ready for submission to OHREB, and will hope to start Sept 2007. Drs Sylvain Gagné and Calvin Thompson have submitted a Case Report for publication to the Canadian Journal entitled “Prophylactic airway management of malignant tracheo-carinal stenosis prior to radiation therapy.”

Clinical Activities. We have been involved with recent changes to clinical pathways developed for thoracic surgery patients. We have been involved with coordinating postoperative care of esophagectomy patients to recover in PACU rather than ICU. We were actively involved with the evaluation and purchase of a new High Frequency Jet Ventilator for use in airway surgery at the hospital. Dr

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Sylvain Gagné has developed recommendations for “Fluid management in Thoracic Surgery”, as well as “Ventilation Strategies of Patients for Thoracic Surgery”. One of our goals is to develop a more standardized perioperative analgesia protocol for thoracic surgery patients this upcoming year.

5.6.7 Vascular Anesthesia—Civic Campus Ashraf Fayad

The vascular anesthesia subspeciality is resident at the Civic Campus. Core group members are Drs Ashraf Fayad , Lead; David Neilipovitz, John Hooper Pat Sullivan, Ian Zunder.

Clinical activity; Vascular cases include Abdominal Aortic Aneurysms (AAAs), Thoracic Aortic Aneurysms (TAAs), and Thoracoabdominal Aortic Aneurysms (TAAAs). The vascular core group performs less than 50% of the AAA cases, 70% of the TAA and 100% of the TAAA. The rest of the cases are performed by the rank-and-file members.

Table 5.6. Vascular Case Load.

Type of cases TOH Annual % Cases per Core Volume Group Thoracic Aortic Aneurysm 20 70% (TAA) Thoracoabdominal Aortic 10 100% Aneurysm(TAAA) Abdominal Aortic Aneurysm 120 <50% (AAA)

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We are intensifying and extending the skill level in the subdiscipline by limiting core group numbers. The core group members will keep current through focussed research and attendance at national and international scientific conferences. It is hoped that this will establish connections with pioneering centers nationally and internationally. We are initiating three-month rotations for non-core members with the aim that in three years’ time all members of the rank and file will have had critical experience in the vascular subdiscipline.

Our use of intraoperative transesophageal echocardiography is now well established in some AAA, TAAA and TAA cases, and it is intended that echocardiography will be a standard monitor for all cases involved TAAA and TAA. Establishing the intraoperative echocardiography for the AAA, TAA and TAAA will make our Department a unique tertiary center to provide the highest standard of patient’s care.

Teaching Activity; A vascular anesthesia rotation for residents was established for the first time in 2006. The vascular anesthesia fellowship was re-developed in 2005–6 The vascular Fellowship provides the trainee with a good number of cases in addition to the echocardiography training. A new fellow has recently joined us and we are looking forward to continue the growth of these programs, including a mandatory research project. . Our research activity extends to projects in the following areas: acute diastolic dysfunction; perioperative diastolic dysfunction and outcomes; and outcome studies in AAA cases.

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5.7 Children’s Hospital of Eastern Ontario Pediatric Anesthesia Philipp Mossdorf

The Children’s Hospital of Eastern Ontario (CHEO) is a freestanding hospital in Ottawa. Over 7000 surgeries are performed at CHEO per year including about 100 cases of open-heart surgery for congenital heart disease. All surgical specialties and subspecialties are represented at CHEO except that we do not have an organ transplant program. Almost all our patients are seen preoperatively in our preoperative assessment clinic. Outside the OR we provide anesthesia for interventional cardiology, diagnostic imaging, oncology and other smaller procedures.

Our pediatric anesthesia department has presently 15 members and is growing. We hope to expand our services as we recruit more pediatric anesthesiologists. We have an active research group and have developed several educational initiatives.

Education Fellowship Program. We have a successful fellowship program, which is well known internationally as we are receiving applications from all over the world. We consistently have two to three fellows at a time. Considering the shortage of pediatric anesthesiologists our program is an important source for recruitment. Besides their clinical activity our fellows are encouraged and mentored to participate in or complete a research project. Our fellows are participating in our weekly joint resident and fellow rounds. They are also presenting regularly during the year at our departmental rounds. The program is under the leadership of Dr. Gary Johnson.

Postgraduate Medical Education. About four to six anesthesia residents per month rotate through our department. Most of them are from the University of

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Ottawa. We also have an affiliation with Queen’s University. Most of their residents are doing a three-month rotation at CHEO. Additionally, we welcome anesthesia residents from other places to rotate through our department. We have daily rounds with the residents where we discuss our pain patients. Once a week we have interactive rounds together with our residents and fellows. Journal clubs are organized twice a month. Our residents participate in our department rounds schedule. If a resident shows particular interest in pediatric anesthesia, he/she will receive support regarding further career planning. We also support residents regarding research, if they demonstrate an interest to join our group of researchers. The pediatric anesthesia rotation is coordinated and under the leadership of Dr. Ibrahim Abu-Shahwan.

Undergraduate Medical Education. We have medical students rotating through our department. We specifically put emphasis on basic pediatric anesthesia understanding, airway and IV access skills.

Other. Pediatric residents, Pediatric ICU and ER fellows, Adult ER residents, RTs and paramedics rotate through our department.

Research Our department has an active group of anesthesiologists that is dedicated to clinical and bench research. There is an outstanding relationship to CHEO’s Research Institute. Our research group presented three posters at this year’s CAS meeting. We are extremely proud to announce that Dr. Dermot Doherty won this year’s competition of the CAS/Abbott Laboratories Ltd Career Scientist Award in Anesthesia. All publications are listed below in Appendix I

New Programs/New Services Integrated Pain Service at CHEO. Dr. Christine Lamontagne, Director and Chair of the Pain Service Committee; Dr. William Splinter, Neil Cowan, Liz Winters, Dr. Philipp Mossdorf

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Sedation Task Force. Establishing guidelines regarding sedation in children throughout the hospital. Dr. Philipp Mossdorf, Chair; Dr. Leslie Hall, Dr. Jabbour, Dr. Halton, Liz Winters, Judy Dennis. Preoperative Screening Program. Patients from Baffin Island will be pre- screened prior to transfer to CHEO to reduce OR cancellation rates and flight costs. Renee Blouin, Dr. Philipp Mossdorf Difficult Airway Management Committee. Dr. Dermot Doherty. Supervising education and training of CHEO staff regarding management of difficult airways Developing scale based Day Care and Recovery Room discharge score. Dr. Kimmo Murto Developing screening tool for pts with OSA undergoing T&A to decide need for postop hospital admission. Dr. Kimmo Murto Developing educational fund for DC/RR staff. Dr. Kimmo Murto

Integrated Pain Service. The Pain Service Committee has been established to develop an integrated pain service. Several departments that are involved in the treatment of acute and chronic pain are represented on this committee. The core piece to a functioning service is availability of nursing staff to assist with admission, therapy, follow up care, education and research. The Pain Service Committee made it the highest priority that staff necessary for a functioning pain service will be recruited at CHEO.

Sedation Task Force. The Task Force will establish guidelines regarding sedation procedures to ensure the same standard of care throughout CHEO. A pathway will be developed to reliably identify and respond to emergencies. A quality assurance plan will be in place to measure outcomes and address necessary changes to enhance safety and quality of care.

Preoperative Screening Program. Patients from Baffin Island are routinely flown out to Ottawa to receive diagnostics or surgery under anesthesia. These children are presently not screened regarding fitness for anesthesia resulting often in cancellations once they are assessed at CHEO. To reduce costs regarding flight

96 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 and lost OR time we will establish a preoperative screening program in Baffin Island.

Difficult Airway Management Committee. The Committee will establish guidelines and pathways regarding management of difficult airways at CHEO. Education and training regarding recognition and management of difficult airways is required at CHEO to avoid adverse outcome. Quality assurance is part of the committee work to measure outcome and implement required changes in practice.

Challenges. Our group of pediatric anesthesiologists is small compared to adult anesthesia departments. Full pediatric anesthesia practice requires one year of clinical fellowship in addition to residency. Anesthesiologists are needed everywhere in the country. Therefore few Canadian trained residents decide to continue with a fellowship after their residency. To recruit pediatric anesthesiologists remains a major challenge and small changes in the number of staff affect the clinical service. Nevertheless, we were able to manage the clinical load in the operating room and off site. However, the variety of clinical tasks and research activity is growing, and the amount of service is expanding. To meet these demands we have to be able to sustain growth within our department. Most importantly, we have to maintain and develop our fellowship program in order to be able to attract and retain well-trained academic physicians.

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6 International Work

Kathmandu, Nepal Dr Denis Reid was invited to speak at the South Asian Congress of Anesthesiology, which was held in Kathmandu in February. He gave a plenary session talk on Intravenous Lidocaine in Pain Management and co-chaired a symposium on Education in Anesthesia in the SACA countries. One of the discussion topics was the "poaching" of anesthetists by the west.

Trinidad and Tobago

Dr Bill Splinter and Dr Abu-Shahwan continue to go to Trinidad and Tobago from one to four times a year to provide anesthesia services for children undergoing cardiac surgery. They work with a multidisciplinary team including surgeons from Canada, USA, UK and India and pediatric critical care nurses from Ottawa and UK. The caseload is typically10 children/run, but varies from 8–13 children. On occasion, residents from the University of Ottawa Anesthesiology Residency Program have assisted the CHEO-based teams. While in Trinidad and Tobago, the focus is on clinical care, but teaching is provided to local staff and registrars in Anesthesia. Also, we have presented at rounds and attended anesthesia weekly rounds. Administrative support for these ventures is provided by Caribbean Heart Care with support from the government of Trinidad and Tobago.

Africa, Asia, and South and Central America

Dr Wayne Barry was presented with a Lifetime Achievement Award on the occasion of his retirement, at the 2007 Gary Johnson Research Day. The

98 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007 following is drawn from the introduction given by Dr Homer Yang summarizing Dr Barry’s extensive international work.

Through more than ten years of pro bono service in medical missions as an educator and as a clinician, Dr Wayne Barry has demonstrated an exemplary level of integrity, compassion, and humility.

With Médecins sans frontières (MSF), he provided clinical services in Rwanda, just six months after the period of major atrocities had ended in 1995. He then returned to Africa the following year, to Burundi, again with MSF. From 1998 to 2004, he joined the Operation Smiles team, assisting in the repair of cleft lips and palates. He has worked in Vietnam, the Philippines, Kenya, China, Honduras, Brazil, Morocco, and Venezuela.

Through the Canadian Anesthesiologists Society (CAS) International Education Fund, he gave medical instruction in Addis Ababa in 1997. In 2000 he returned to Ethiopia to give a concentrated course in obstetrical anesthesia which included one-on-one clinical training. In 2003, in response to a dire need, he gave a comprehensive anesthesia review course in Antsirabe, Madagascar.

He has said that the tremendous need for safe anesthesia motivates his international efforts. But he has also said that his educational service has been the most enriching. The enthusiasm he sees in residents and nurse anesthetists is beyond explanation and that leaving knowledge and skills behind has given the greatest sense of satisfaction.

Dr Barry has been an outstanding international ambassador for the Faculty of Medicine of the University of Ottawa and for Canadian anesthesia. He was the recipient of a Faculty of Medicine Award of Excellence in 2004. The Lifetime Achievement Award presented in 2007 commemorates his retirement as well as his remarkable record of international service.

99 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

Operation Smiles March 2007: The work continues.

September 2007: The Founding Conference of The Ethiopian Society of Anesthesiologists Professional Association. Dr Barry is in the back row, centre.

100 Department of Anesthesiology University of Ottawa and Affiliated Hospitals Report 2003–2007

APPENDIX I Publications Department of Anesthesiology 2001–2007

Articles–Original Research: 2007 (14)

Abu-Shahwan I. Ambulatory anesthesia and the lack of consensus among Canadian pediatric anesthesiologists: A survey. Pediatric Anesthesia, 2007; 17 (3):223–229.

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):846–50.

Abu-Shahwan I, Mack D. Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy-paediatric anesthesia. Pediatric Anesthesia, 2007; 17 (5): 460–463.

Baxter AD, Kanji S. Protocol implementation in anesthesia: Beta-blockade in non-cardiac surgery patients. Can J Anesth 2007; 54: 114–23.

Boodhwani M, Rubens F, Wozny D, Rodriguez R, Nathan HJ. Effects of sustained mild hypothermia on neurocognitive function after coronary artery bypass surgery: a randomized, double-blind study. J Thorac Cardiovasc 2007; 134(6): 1443–50.

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 Anesth 2007; 54:(11):882–90.

Bryson G, Rosaeg OP, MacNeil R, Jeyaraj L. Small dose spinal bupivacaine for caesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anesth 2007; 54(7):531–7.

Jarvis, V, Smyth, C, Fitzgibbon, E. Options for management of intractable pain. Continuous lidocaine infusion in the home. Oncology Exchange 2007; 6(2): 35–8.

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Nathan HJ, Rodriguez R, Wozny D, Dupuis JY, Rubens FD, Bryson GL, Wells G. 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): 1206–11.

Neilopovitz DT, Crosby ET. Does rapid sequence induction reduce aspiration during airway management? Can J Anesth 2007; 54(9):748–64.

Rubens FD, Boodhwani M, Mesana T, Wozny D, Wells G, Nathan HJ; Cardiotomy Investigators. 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):I89–97.

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):211–8.

Miller D, Wozny D. Research awards program of the Canadian Anesthesiologists’ Society/Canadian Anesthesia Reseach Foundation: Survey of past recipients. Can J Anesth 2007; 54: 314–19. van Klei WA, Bryson GL, Yang H, Kalkman CJ, Wells GA, Beattie WS. The value of routine preoperative electrocardiography in predicting myocardial infarction after non- cardiac surgery. Ann Surg 2007; 246 (2): 165–70.

2006 (18) Abu-Shahwan, I, Chowdary, K, Schwarz, U, Murto, K, Splinter, W. The effect of subhypnotic doses of propofol on the incidence of vomiting in children undergoing strabismus repair. Can J Anesth ON LINE 2006; 53: 26298

Boodhwani M, Lam BK, Nathan HJ, Mesana TG, Ruel M, Zeng W, Sellke FW, Rubens FD. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double- blind, within-patient comparison. Circulation. 2006; 114(8):766–73. Epub 2006 Aug 14.

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Boodhwani M, Rubens FD, Wozny D, Rodriguez R, Alsefaou A, Hendry PJ, Nathan HJ. Predictors of early neurocognitive deficits in low-risk patients undergoing on-pump coronary artery bypass surgery. Circulation. 2006; 114(1 Suppl):I461–6.

Boodhwani M, Nathan HJ, Lam BK, Rubens FD.The internal thoracic artery skeletonization study: a paired, within-patient comparison [NCT00265499].Trials. 2006; 7:1.

Bryson GL, Wyand A. Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anesth 2006; 53(7):669–77.

Bryson GL, Wyand A, Bragg PR. Preoperative testing is inconsistent with published guidelines and rarely changes management. Can J Anesth 2006; 53:236–41.

Danzer E., Robinson L.E., Davey M.G., Schwarz U., Volpe M.A., Adzick N.S., Hedrick H.L. Tracheal occlusion in fetal rats alters expression of mesenchymal nuclear transcription factors without affecting surfactant protein expression. Journal of Pediatric Surgery 2006; 41(4): 774–80.

Davey, M.G., Danzer E., Schwarz U., Robinson L., Shegu S., Adzick N.S., Flake A.W., Hedrick H.L. Prenatal glucocorticoids improve lung morphology and partially restores surfactant mRNA expression in lambs with diaphragmatic hernia undergoing fetal tracheal occlusion. Pediatric Pulmonology 2006; 41(12): 1188–96.

Doherty D, Salewski R, Lockwood J, Hawkins C, Josselyn S, Frankland P, Hutchison JS. Leukocyte Anti-adhesion Therapy Provides Neuroprotection after Transient Global Cerebral Ischemia in the Mouse. Circulation 2006; 118(18) II–423.

Fayad A, Yang H, Nathan H, Bryson G, Cinà C. Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery. Can J Anesth 2006; 53: 168–73.

Honan D, Doherty D, Frizelle H. A comparison of the effects on bispectral index of mild vs moderate hypothermia during cardiopulmonary bypass. European Journal of Anaesthesiology, 2006; 23(5): 385–90.

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Kim J, Neilipovitz D, Cardinal P, Chiu M, Clinch J. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Critical Care Medicine 2006; 34(8):2167–74.

Marcar V.L., Schwarz U., Leonneker Th., Martin E. How depth of anesthesia influences the blood oxygenation level-dependent signal from the visual cortex in children. American Journal of Neuroradiology 2006; 27(4): 799–805

Rodriguez RA, Watson MI, Nathan HJ, Rubens F. Do surface-modifying additive circuits reduce the rate of cerebral microemboli during cardiopulmonary bypass? J Extra Corpor Technol. 2006; 38(3):216–9.

Rodriguez RA, Rubens F, Rodriguez CD, Nathan HJ. Sources of variability in the detection of cerebral emboli with transcranial Doppler during cardiac surgery. J Neuroimaging. 2006; 16(2):126–32.

Rodriguez RA, Rubens F, Belway D, Nathan HJ. Residual air in the venous cannula increases cerebral embolization at the onset of cardiopulmonary bypass. Eur J Cardiothorac Surg. 2006; 29(2):175–80. Epub 2006 Jan 11.

Wong E, Irwin D, Doherty D, Thomas M, Vaillancourt R. A Retrospective Comparison of Variable Concentrations versus Standardized Concentrations on 24-hour Drug Infusion Volumes in a Paediatric Intensive Care Unit. Canadian Journal of Hospital Pharmacy (59):40. 2006

Yang H, Raymer K, Butler R, Parlow J, Roberts R. The effects of perioperative beta- blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 2006; 152(5):983–90.

2005 (11)

Baxter AD, Allan J, Bedard J, Malone-Tucker S, Slivar S, Langill M, Perreault M, Janzen O. Adherence to simple and effective measures reduces the incidence of ventilator- associated pneumonia. Can J Anesth 2005; 52: 535–41.

Belway D, Rubens FD, Wozny D, Henley B, Nathan HJ. Are we doing everything we can to conserve blood during bypass? A national survey. Perfusion. 2005; 20(5):237–41.

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Brindley P, Neilipovitz DT, Kim J, Cardinal P, et al. The Acute Critical Events Simulation (ACES) Program: A novel Canadian educational initiative to improve care of the critically ill. Crit Care Rounds 2005; 6(2):1–6.

Chowdary K, Thornton J, Abu-Shahwan I, Schwarz U, Murto K, Rosen D, Mossdorf P, Chow S, Splinter W, Gaboury I. Ultrasound study to determine the accuracy of needle placement for rectus sheath block by conventional method in children. 2005.

Davey MG, Biard JM, Robinson L, Tsai J, Schwarz U, Danzer E, Adzick NS, Flake AW, Hedrick HL. Surfactant protein expression is increased in the ipsilateral but not contralateral lungs of fetal sheep with left-sided diaphragmatic hernia. Pediatric Pulmonology 2005; 39(4): 359–67.

Danzer E, Schwarz U, Wehrli S, Radu A, Adzick NS, Flake AW. Retinoic acid induced myelomeningocele in fetal rates: characterization by histopathology and magnetic resonance imaging. Experimental Neurology 2005; 194(2):467–75.

Goldszmidt E, Kern R, Chaput AJ, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anesth 2005; 52:971–7.

Hardy, Doug. Relief of Pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia. Can J Anesth 2005; 52(2):186–190.

Kulik A, Rodriguez RA, Nathan HJ, Ruel M.Intraoperative neuromonitoring in cardiac surgical patients with severe cerebrovascular disease.Can J Anaesth. 2005; 52 (3):335–6.

Rodriguez RA, Williams KA, Babaev A, Rubens F, Nathan HJ. Effect of perfusionist technique on cerebral embolization during cardiopulmonary bypass. Perfusion. 2005 ; 20(1):3–10.

Rodriguez RA, Tellier A, Grabowski J, Fazekas A, Turek M, Miller D, Wherrett C, Villeneuve PJ, Giachino A. Cognitive dysfunction after total knee arthroplasty: effects of intraoperative cerebral embolization and postoperative complications. Journal of Arthroplasty 2005; 20(6):763–71.

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2004 (8) Baird JM, Wilson RD, Johnson MP, Hedrick HL, Schwarz U, Flake AW, Crombleholme TM, Adzick NS. Prenatally diagnosed giant omphaloceles: short—and long-term outcomes. Prenatal Diagnosis 2004; 24(6):434–9.

Kulik A, Ruel M, Bourke ME, Sawyer L, Penning J, Nathan HJ, Mesana TG, Bédard P. Postoperative naproxen after coronary artery bypass surgery: a double-blind randomized controlled trial. Eur J Cardiothorac Surg. 2004 Oct;26(4):694–700.

Nathan HJ, Parlea L, Dupuis JY, Hendry P, Williams KA, Rubens FD, Wells GA. Safety of deliberate intraoperative and postoperative hypothermia for patients undergoing coronary artery surgery: a randomized trial. J Thorac Cardiovasc Surg. 2004 May;127(5):1270–5.

Marcar VL, Strässle AE, Loenneker T, Schwarz U, Martin E. The Influence of Cortical Maturation on the BOLD Response: An fMRI Study of Visual Cortex in Children. Pediatric Research 2004; 56 (6): 967–74.

Marcar VL, Loenneker T, Strässle AE, Schwarz U, Martin E. What Effect Does Measuring Children under Anesthesia Have on the Blood Oxygenation Level-Dependant Signal? A Functional Magnetic Resonance Imaging Study of Visual Cortex. Pediatric Research 2004; 56 (1): 104–10.

Parlow JL, Costache I, Avery N, Turner K. Single-dose haloperidol for the prophylaxis of postoperative nausea and vomiting after intrathecal morphine. Anesth Anal 2004 Apr; 98(4): 1072–6.

Sohmer B, Bryson GL, Bencze S, Mouroukas M. EMLA® cream is an effective topical anesthetic for bronchoscopy. Can. Resp. Journal 2004;11(8): 587–8.

Yang H, Choi PTL, McChesney J, Buckley, N. Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery. Can J. Anesth 2004; 51 (7): 660–667.

2003 (4) Bryson GL, Yang H. Best evidence in anesthetic practice: goal directed therapy with pulmonary artery catheter is not better than standard therapy. Can J Anesth 2003; 50: 614–6.

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Davey MG, Hedrick HL, Bouchard S, Mendoza JM, Schwarz U, Adzick NS, Flake AW. Temporary tracheal occlusion in fetal sheep with lung hypoplasia does not improve postnatal lung function. Journal of Applied Physiology 2003; 94: 1054–62.

Gao YJ, Yang H, Teoh K, Lee, RMKW. Detrimental effects of papaverine on the human internal thoracic artery. J Thorac Cardiovasc Surg 2003; 126: 179–85.

Lacherade JC, Cook D, Heyland D, Chrusch C, Brochard L, Brun-Bruisson C; French and Canadian ICU Directors Groups. Prevention of Venous thromboembolism (VTE) in critically ill medical patients: a Franco-Canadian cross-sectional study. J Crit Care 2003; 18(4):228–37.

2002 (6) Bryson GL. Neuroanesthesia and intensive care. Best evidence in anesthetic practice— Harm: albumin neither increases nor decreases mortality in critically ill patients. Can J Anaesth 2002; 49(6):620.

Campbell N, Bryson GL, Rosaeg OP, Crossan ML, Bragg P, Bell M. Does intravenous dexamethasone prevent nausea and vomiting after reduction mammoplasty. Can J Plast Surg 2002; 10(5):206–209.

Fraser AB, Nolan RJ. Subcutaneous emphysema secondary to malignant bronchocutaneous fistula: A Case Report. J Thorac Imaging. 2002; 17(4):319–21.

Rodriguez RA, Cornel G, Alghofaili F, Hutchison J, Nathan HJ. Transcranial doppler during suspected brain death in children: Potential limitation in patients with cardiac "shunt". Pediatr Crit Care Med. 2002; 3(2):153–7.

Rodriguez RA, Giachino A, Hosking M, Nathan HJ. Transcranial doppler characteristics of different embolic materials during in vivo testing. J Neuroimaging. 2002;12(3):259–66.

Wherrett CG, Mehran RJ, Beaulieu MA. Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen. Can J Anaesth. 2002; 49(1):96–9.

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2001 (15) Cook D, McMullin J, Hodder R, Heule M, Pinilla J, Dodek P, Stewart T. Prevention and diagnosis of venous thromboembolism in critically ill patients: a Canadian survey. For the Canadian ICU Directors Group, Crit Care Med 2001; 5(6): 336–42.

Cook D, Laporta D, Skrobik Y, Peters S, Sharpe M, Murphy P, Chin D, Crowther M. Prevention and diagnosis of venous thromboembolism in critically surgical ill patients: a cross-sectional study. For the Canadian ICU Directors Group, J Crit Care 2001; 16(4): 161–6.

Carr MM, Muecke CJ, Sohmer B, Nasser JG, Finley GA. Comparison of postoperative pain: tonsillectomy by blunt dissection or electrocautery dissection. J Otolaryngol 2001; 30(1):10–4.

Giachino AA, Rody K, Turek MA, Miller DR, Wherrett CG, Moreau G, O’Rourke K, Grabowski J, McLeish W, Fazekas A. Systemic fat and thrombus embolization in patients undergoing total knee arthroplasty with regional heparinization. Journal of Arthroplasty 2001;16(3): 288–292.

Moenkhoff M, Schwarz U, Fanconi S, Gerber A, Bänziger O. Cerebral blood flow velocity during anaesthesia with Sevoflurane and Halothane. Anaesthesia & Analgesia 2001; 92(4): 891–6.

Nathan HJ, Wells GA, Munson JL, Wozny D. Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: a randomized trial. Circulation. 2001; 104 (12 Suppl 1):I85–91.

Neilipovitz DT, Bryson GL, Nichol G. The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis. Anesth Analg 2001; 93:573–80.

Neilipovitz DT, Murto K, Hall L, Splinter W. Does Tranexamic Acid Reduce Blood Exposure During Major Spinal Procedures? Anesth Analg 2001; 93:82–7.

Neilopovitz DT, Murto K, Hall L, Splinter W. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 2001; 93:82–87.

Podymow T, Wherrett C, Burns KD. Hyperbaric oxygen in the treatment of calciphylaxis: a case series. Nephrol Dial Transplant 2001;16 (11):2176–80.

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Rodriguez RA, Letts M, Jarvis J, Clarke W, Murto K. Cerebral microembolization during pediatric scoliosis surgery: A transcranial doppler study. Journal of Pediatric Orthopedics 2001; 21:532–36.

Rosaeg OP, Krepski B, Cicutti N, Dennehy KC, Lui AC, Johnson DH. Effect of preemptive multimodal analgesia for arthroscopic knee ligament repair. Reg Anesth Pain Med. 2001; 26(2):125–30.

Waggoner JR, Wass T, Polis T. The effect of changing transfusion practices on rates of perioperative stroke and myocardial infarction in patients undergoing carotid endarterectomy: A retrospective analysis of 1114 Mayo Clinic patients. Mayo Clin Proc 2001; 76:376–83.

Weiss M, Schwarz U, Dillier D, Fischer J, Gerber AC. Use of the intubating laryngeal mask in children: an evaluation using video-endoscopic monitoring. European Journal of Anaesthesiology 2001; 18: 739–44.

Weiss M, Schwarz U, Dillier C, Gerber AC. Teaching and supervising tracheal intubation in paediatric patients using video-laryngoscopy. Paediatric Anaesthesia 2001; 11 (3): 343– 8.

CASE REPORTS

2007 (3) 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):947–8.

Fayad, A Left ventricular outflow obstruction in a patient with undiagnosed hypertrophic obstructive cardiomyopathy. Can J Anaesth. 2007; 54(12):1019–20.

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; 54(10):848–9.

2005 (1) Szerb J, Persaud D. Long current impulses may be required for nerve stimulation in patients with ischemic pain. Can J Anesth 2005: 52(9): 963–6.

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2004 (1) Dowlatshahi, D, Hogan, MJ, Sharma M, Wherrett CG. A 32-year-old man with acute bilateral leg weakness following recreational diving. CMAJ 2004; 170 (12): 1792

2003 (1) Thompson C, Bergstrome D, Parlow JL. Limitations of preoperative dobutamine stress echocardiography in identifying severe left main coronary artery stenosis: a report of two cases and a brief review. Can J Anaesth 2003; 50(9):933–9.

2001 (1) Crosby E. Clinical case discussion: anesthesia for cesarean section in a parturient with a large intrathoracic mass. Can J Anesth 2001; 48: 575–83.

REVIEW ARTICLES

2007 (3) Crosby ET. Medical malpractice and anesthesiology: literature review and role of the expert witness. Can J Anesth 2007; 54: 227–41.

Fayad, Ashraf, Yang Homer. Is peri-operative isolated systolic hypertension a cardiac risk factor. Critical Care Reviews. 2008 ;4, in press.

Karkouti K, Beattie WS, Crowther MA, Callum JL, Chun R, Fremes SE, Lemieux J, McAlister VC, Muirhead BD, Murkin JM, Nathan HJ, Wong BI, Yau TM, Yeo EL, Hall RI. The role of recombinant factor VIIa in on-pump cardiac surgery: proceedings of the Canadian Consensus Conference. Can J Anaesth. 2007; 54(7):573–82.

2006 (1) Crosby ET. Airway management in adults after cervical spine trauma. Anesthesiology 2006; 104: 1293–318.

2005 (4) Devereaux PJ, Beattie WS, Choi PTL, Badner NH, Guyatt GH, Villar JC, Cina CA, Leslie K, Jacka MJ, Montori VM, Ghandari M, Avezum A, Biasi, Cavalcante, A, Giles JW, Schricker T, Yang, Homer, Jackobsen CJ, Yusuf S. How strong is the evidence for the use of perioperative ß-blockers in non-cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. BMJ. 2005; 331: 313–321.

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Evans H, Steele SM, Nielsen KC, Tucker MS, Klein SM. Peripheral Nerve Blocks and Continuous Catheter Techniques. Anesthesiology Clinics of North America 2005; 23(1): 141–162.

Klein SM, Evans H, Nielsen KC , Tucker MS, Warner DS, Steele, SM. Peripheral Nerve Block Techniques for Ambulatory Surgery. Anesthesia and Analgesia 2005; 101(6): 1663–76.

Renehan EM, Enneking FK, Varshney M, Partch RE, Dennis DM, Morey TE. Scavenging nanoparticles: an emerging treatment for bupivacaine cardiac toxicity. Reg Anesth Pain Med 2005; 30(4):380–384.

2004 (3) Alvarez GG, Fergusson DA, Neilipovitz DT, Hebert PC. Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic review. Can J Anaesth 2004; 51:425–31.

Bryson GL, Chung F, Finegan BA, Friedman Z, Miller DR, van V et al. Patient selection in ambulatory anesthesia - an evidence-based review: Part I. Can J Anesth 2004; 51(8):768–781.

Bryson GL, Chung F, Cox, R, Crowe MJ, Fuller J, Henderson C, et al. Patient selection in ambulatory anesthesia: An evidence-based review: Part 2. Can J Anaesth 2004; 51(8):782–94.

2002 (7) Crosby ET. Perioperative use of erythropoietin. Am J Therapeut 2002: 9: 371–6.

Crosby ET. Re-evaluating the transfusion trigger: how low is safe? Am J Therapeut 2002: 9: 411–6.

Crosby ET. Airway management after upper cervical spine injury: what have we learned? Can J Anesth 2002: 49: 733–44.

Phillips B, Zideman D, Garcia-Castrillo L, Miguel F, Schwarz U. European Resuscitation Council Guidelines 2000 for Basic Paediatric Life Support—A statement from the Paediatric Life Support Working Group and approved by the Executive Committee of the European Resuscitation Council. Resuscitation 2001; 48 (3): 223–9.

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Schwarz U, Galinkin JL. Anesthesia for fetal Surgery. Seminars in Pediatric Surgery 2003; 12 (3): 196–201.

Thompson, Ellen. On Fibromyalgia. The Parkhurst Exchange March 2002.

Thompson, Ellen. On Myofascial Pain Syndrome. The Parkhurt Exchange September 2002.

2001 (1) Reid D. Post-operative Pain Management in Patients with Chronic Pain Syndromes. Canadian Journal of Anesthesia 2001; 48:R6.

BOOKS, MONOGRAPHS, AND BOOK CHAPTERS

2007 (13) Crosby ET. Airway management in adults with cervical spine disease. Anesth Clin North Am, 2007 (in press)

Crosby ET. “The Difficult Airway in Obstetric Anesthesia” In Airway Management: Principles and Practice, 2nd ed. Ed. C Hagberg. St. Louis; Mosby Year Book: 2007.

Doherty D, Hutchison JS. “Hypoxic Ischemia Encephalopathy” In Pediatric Critical Care Medicine; Basic Science and Clinical Evidence. Ed. Derek Wheeler, Hector Wong. CITY: Springer-Verlag: 2007.

Evans H, Nielsen KC, Greengrass R, Steele SM. “Equipment for Continuous Peripheral Nerve Blocks” In Textbook of Regional Anesthesia and Acute Pain Management. Ed.A. Hadzic. McGraw-Hill, 2007.

Evans H, Nielsen KC, Steele SM. “Regional Anesthesia for Ambulatory Surgery” In Handbook of Ambulatory Anesthesia. Ed R Twersky and B Philip, Springer-Verlag 2007. in press.

Evans H, Nielsen KC, Greengrass R, Steele SM. “Equipment for Continuous Peripheral Nerve Blocks” In Textbook of Regional Anesthesia and Acute Pain Management. Ed. A Hadzic, New York: McGraw-Hill, 2007.

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Evans H, Steele SM, Nielsen KC et al. “Paravertebral Anesthesia” In Principles of Anesthesia. Ed. D. Longnecker, D Brown, M. Newman, W Zapol. New York: McGraw- Hill, in press.

Evans H, Steele SM. “Regional Anesthesia for Cosmetic Surgery” In Anesthesia for Cosmetic Surgery. Ed. BL Freidberg. Cambridge, in press

Ilfeld BM, Renehan EM, Enneking FK. “Continuous Peripheral Nerve Blocks in Outpatients” In Textbook of Regional Anesthesia and Acute Pain Management. Ed. A. Hadzic. New York: McGraw-Hill, 2007.

Law A, Jagoda A, Crosby ET. “Airway management of a patient with an acute severe head injury following an MVA.” In Airway management and monitoring manual Ed M. Murphy, O. Hung. New York; McGraw Hill, 2007, in press.

Murphy M, Crosby ET. “Difficult and failed airway management: the algorithms” In Airway management and monitoring manual. Ed. M. Murphy and O Hung. New York; McGraw Hill, 2007, in press.

Pytka S, Carroll-Perez I, Crosby ET. “Aspiration: risks and prevention.” In Airway management and monitoring manual. Ed. M. Murphy and O Hung. New York; McGraw Hill, 2007, in press.

Schlosser R, Nielsen KC, Evans H et al. “Peripheral Nerve Blocks for Outpatient Surgery” In Textbook of Regional Anesthesia and Acute Pain Management. Ed. A Hadzic, McGraw-Hill, 2007.

2006 (4) Crosby ET. “Disorders of the vertebral column” In Obstetric Anesthesia and Uncommon Disorders, 2nd ed. Ed. DR Gambling and MJ Douglas. Cambridge: Cambridge University Press, 2006.

Galinkin JL, Schwarz U, Motoyama EK. “Anesthesia for Fetal Surgery” In Smith’s Anesthesia for Infants and Children, 7th ed. Philadelphia: Mosby, 2006

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Neilipovitz, D. “Airway” In Critical Care Response Team. Ed. RV Hodder. Ottawa: Canadian Resuscitation Institute, 2006.

Neilipovitz,D. “Circulation” In Critical Care Response Team. Ed. RV Hodder,. Ottawa: Canadian Resuscitation Institute, 2006.

2005 (9) David T. Neilipovitz ed., Acute Resuscitation and Crisis Management., Ottawa: University of Ottawa Press, 2005.

Kim J, Neilipovitz DT. “Crisis Resource Management.” In Acute Resuscitation and Crisis Management. Ed. DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Chiu M, Neilipovitz DT. “Rapid Sequence Intubation.” In Acute Resuscitation and Crisis Management. Ed. DT. Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT, Cardinal P. “Approach to the Critically Ill Patient.” In Acute Resuscitation and Crisis Management. Ed. DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT. “Medical Errors.” In Acute Resuscitation and Crisis Management. Ed, DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT, Gallacher W. “Advanced Airway Management.” In Acute Resuscitation and Crisis Management. Ed. DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT. “Medications for Airway Management.” In Acute Resuscitation and Crisis Management. Ed. DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT, Cardinal P, Brindley P. “Management of Shock.” In Acute Resuscitation and Crisis Management. Ed. DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT. “Vasoactive Medications.” In Acute Resuscitation and Crisis Management. Ed, DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

Neilipovitz DT, Hooper J, Brindley P. “Hemodynamic Monitoring.” In Acute Resuscitation and Crisis Management. Ed. DT Neilipovitz. Ottawa: University of Ottawa Press, 2005.

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2004 (2) Crosby ET. “Musculoskeletal Disorders.” In Obstetric Anesthesia: Principles and Practice, 3rd ed. Ed. DH Chestnut. St. Louis: Mosby Year Book, 2004.

Crosby ET, Duffy PD. “When is an epidural blood patch indicated?” Evidence-based practice of anesthesiology. Ed. LA Fleischer. Philadelphia: Saunders / Elsevier, 2004.

2002 (1) Neilipovitz DT, Hébert P. Blood Transfusion and Sepsis.” In The Sepsis Text. Ed. JL Vincent, J. Carlet, SM Opal. Boston: Kluwer Academic Publishers, 2002.

2001 (1) Crosby ET, Lui ACP. “The Spine.” In Manual of Clinical Anesthesia, 2nd ed. Ed RR Kirby, N. Gravenstein. Philadelphia: W.B. Saunders, 2001.

ABSTRACTS

2007 (2) Wyand A, Bryson GL, Wozny, D, Nathan H. Does the Clock Drawing Test Detect Delirium or Cognitive Dysfunction? Accepted June 2007 Canadian Anesthesiologists’ Society meeting

Yang H , Fayad A, Watters J, Ruddy T, Wells G Perioperative myocardial ischemia in isolated systolic hypertension (PROMISE): a preliminary report. New Zealand Annual Scientific Meeting, 2007, Auckland , in press.

2006 (12) Abu-Shahwan I, Chowdary K, Schwarz U, Murto K, Splinter W. The Effect of Subhypnotic Doses of Propofol on the Incidence of Vomiting in Children undergoing strabismus repair. Can J Anesth 2006; 53:June, Annual Meeting Abstracts 26298.

Doherty D, Salewski R, Lockwood J, Hawkins C, Josselyn S, Frankland P, Hutchison JS. Leukocyte Anti-adhesion Therapy Provides Neuroprotection after Transient Global Cerebral Ischemia in the Mouse. Circulation 2006; 114: II–423.

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Fayad A, Yang H, Abib L. Coronary sinus lactate concentration during myocardial reperfusion. Can J Anesth 2006; 53: 26474.

Fayad A, Yang H. Hemodynamic changes during off-pump coronary artery bypass grafting. Can J Anesth 2006; 53: 26476.

Fayad A, Abouzahr L. Valve repair is feasible in complex mitral pathology. Can J Anesth 2006; 53: 26480.

Shaye, RE, Doherty, D, Lockwood, J, Salewski, R, Gendron, N, Alexander E. MacKenzie, AE, Hutchison, JS. TAT-BIR123xt inhibits caspase activity and apoptosis following nitric oxide exposure in NG108-15 cells and global cerebral ischemia in the mouse.

MacNeil R, Bryson GL, Jeyaraj L, Rosaeg OP. Mini-dose Spinal Bupivacaine for Casearean Section. Can J Anesth 2006; 53: 26337.

Murto K, Chowdary K, Abu-Shahwan I, Bryson G, Barrowman N, Molinski B, Schwarz U, Splinter W. A pilot study: videophones in a pediatric day care setting. Can J Anesth 2005;52:A104.

Murto K, Schwarz U, Chowdary K, Abushahwan I, Bryson GL, King J, Moher D, El- Emam K, Splinter WA. Survey: technology in a pediatric day care setting. Can J Anesth 2006 53: 26364.

Schwarz U., Murto K., Abu-Shahwan I, Mueller Th. Misinterpretation of train-of-four responses: some consideration and short discussion. Can J Anesth June 2006; 53 (S1): A25398. van Klei WA, Bryson GL, Beattie WS, Yang H, Wells GA. Effects of transfusion on the incidence of postop myocardial infarction in patients on beta-blockers. American Society of Anesthesiologists, Chicago, Illinois. October 2006; A1739.

Wong E, Irwin D, Doherty D, Thomas M, Vallaincourt R. A Retrospective Comparison of Variable Concentrations versus Standardized Concentrations on 24-hour Drug Infusion Volumes in a Paediatric Intensive Care Unit. Canadian Journal of Hospital Pharmacy 2006 (59):40.

2005 (9)

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Abu-Shahwan I, Chowdary K, Schwarz U, Murto K, Splinter W. Propofol remifentanil deep sedation for gastrointestinal endoscopy in children. Can J Anesth 2005; 52:A101.

Abu-Shahwan I, Chowdary K, Schwarz U, Murto K, Splinter W. Post-operative confusion and the practice of pediatric anesthesia. Can J Anesth 2005; 52:A102.

Abu-Shahwan I, Chowdary K, Schwarz U, Murto K, Splinter W. Patient selection criteria for ambulatory surgery in children. Can J Anesth 2005; 52:A103.

Abu-Shahwan I, Nawrocka J, Chowdary K, Murto K, Schwarz U. Cardiovascular collapse during induction of anesthesia in a child with severe dilated cardiomyopathy. Can J Anesth 2005; 52:annual suppl

Chowdary K, Murto K, Splinter W, Barrowman N. Efficacy of brachial plexus block after elbow fracture repair in children. Can J Anesth June 1, 2005; 52:Annual Suppl.

Doherty DR, Sutcliffe IT, Shih J, Stanimirovic D, Hutchison JS. Post-Ischemic hypothermia therapy inhibits inflammatory gene transcription and leukocyte recruitment in cerebral microvessels. Can J Anesth 2005; 52:A2.

Fayad AA, Yang H, Cina CS, Bryson GL, Nathan H. Acute Diastolic Dysfunction: A new entity recognized by transesophageal echocardiography in thoraco-abdominal aortic aneurysm surgery. Can J Anesth 2005; 52: A14.

Klein SM, Evans H, Nielsen KC et al. Peripheral Nerve Block Techniques for Ambulatory Surgery. Anesthesia and Analgesia 2005; 101(6): 1663–76.

Murto K, Chowdary K, Abushahwan I, Bryson G, Barrowman N, Splinter B. Are opioids indicated in pediatric strabismus surgery? Can J Anesth 2005;52: A100.

Murto K, Chowdary K, Abushahwan I, Bryson G, Barrowman N, Molinski B, Schwarz U, Splinter W. A pilot study: videophones in a pediatric daycare setting. Can J Anesth 2005;52: A104.

2004 (6) Doherty D, Hutchison J, Parshuram C. Lower Temperatures are associated with improved survival after cardiac arrest in children. Critical Care Medicine; 38(S-1):45.

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Fayad A, Yang H, Ling E. Cardiac anesthesia: A Canadian survey. Can J Anesth 2004; 51: A48.

Fayad A, Abouzahr L. Diastolic dysfunction recognized by transesophageal echocardiography in thoracoabdominal aortic aneurysm surgery. Can J Cardiol 2004; 20 (Suppl. D): 133.

Fayad A, Yang H, Ling E. Cardiac Anesthesia: a Canadian Survey. Can J Anesth 2004; 51: A48.

Honan D, Doherty D, Chambers F, Frizelle H. A comparison of the effects of moderate versus mild hypothermia during cardiopulmonary on the EEG BiSpectral Index. Eur J Anaesthesiol; 19(S-27):A-15.

Neilipovitz DT. Tranexamic acid for major spinal surgery. Eur Spine J 2004;13(Suppl 1):S62-5.

Yang, H, Raymer, K, Butler, R, Parlow, J, Roberts, R. Metoprolol after Vascular Surgery (MaVS). Can J Anesth 2004; 51:A7.

2003 (1) Bhananker S, Azavedo L, Murto K, Splinter W. Addition of Morphine to Local Anesthetic Infiltration does not affect analgesia after pediatric dental surgery. Anesthesiology 2003; 99:A1433.

2001 (3) Meade M, Stewart T, Mazer D, Bradley C, Russell J, Lapinsky S, Cook D, Baxter A, Laufer B, Skrobik Y. Ensuring adequate separation in a trial of two PEEP strategies in acute lung injury. Crit Care Med 2001; 29: A26.

Chiu M, Kemp TJ, Bryson GL, Cleland MJ, Crosby ET. A new mathematical model predicting heating of blood by a water bath. Can J Anesth 2001; 48(5II): A55.

Splinter W, Corvo A, Axavedo L, Ghananker S, Hall LE, Murto K. High dose acetominophen vs codeine for analgesia after pediatric tonsillectomy. Anesth Analg 2001; 92:S285.

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NON-PEER REVIEWED PUBLICATIONS, EDITORIALS, BOOK REVIEWS, AND LETTERS

2007 (3) Baxter A. Problems with the MERIT study. Can J Anesth 2007: in press.

Miller D, Donati F. Peer review policies and the Canadian Journal of Anesthesia: An update for authors and readers. Can J Anesth 2007; 54: 1–8.

Yang H, Raymer K, Butler R, Parlow J, Roberts R. Response to the Letter to the Editor by Dr Wijeysundera. American Heart Journal May 2007; 153 (5): e17–e19.

2006 (3) Baxter AD. Critical care outreach programs in Canada. CMAJ 2006; 174(5): 613–5.

Chiu M, Yang H, Po J, Wynands E. What have we really learned from SARS? Canadian Journal of Anesthesiology 2006; 53(2):113–6.

Donati F, Miller D. The role of scientific journals in continuing medical education. Can J Anesth 2006; 53:1207–12.

Miller D. Canadian Journal of Anesthesia: 2006 and beyond. Can J Anesth 2006; 53:1–5.

2005 (4) Bevan JC, Miller D. Medical journals and cross-cultural research ethics. Can J Anesth 2005; 52:1009–16. Bryson GL. Has preoperative testing become a habit? Can J Anesth 2005;52(6): 557–61.

Crosby E. The unanticipated difficult airway B evolving strategies for successful salvage. Can J Anesth 2005; 52(6):562–7.

Miller D. Canadian Journal of Anesthesia 2005: changing of the guard. Can J Anesth 2005; 52:121–4.

Thompson, EN Letter to the Editor. Pain 2005; 113: (1–2):244;discussion 245–7.

2004 (3)

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Devereaux PJ, Yusuf S, Yang H, Choi, PTL, Guyatt GH. Are the recommendations to use perioperative ß-blocker therapy in patients undergoing noncardiac surgery based on reliable evidence? CMAJ. 2004; 171: 245–247. Invited commentary

Devereaux PJ, Leslie K, Yang H. The effect of perioperative beta-blockers on patients undergoing noncardiac surgery—is the answer in? Can J Anesth 2004; 51:(8) 749–55.

Neilipovitz DT. Rapid sequence intubation: how do we define success? Can J Anaesth 2004; 51:857–9.

2003 (1) Miller D. Arrhythmogenic potential of antiemetics: perspectives on risk-benefits. Can J Anesth 2003; 50:215–20.

2002 (3) Crosby ET. Modelling the difficult airway; how real is faking it? Can J Anesth 2002; 49: 448–52.

Miller D, Tierney M. Observational studies and ‘real world’ anesthesia pharmacoeconomics. Can J Anesth 2002; 49:329–34.

Thompson E, Merskey H. Nerve blocks and cognitive therapy: A beneficial failure. Pain Res Mang 2002; 7 (4). Comment on Pain Res Manag. 2002 Winter; 7(4):185–9.

2001 (4) Doherty D, Cunningham A. Survey of Anesthesiology. 2001; 45: 150, Cerebral Haemodynamic Response to the Introduction of Desflurane, A Comparison with Sevoflurane. Invited Commentary on Bedforth NM, Hardman JG. Nathanson MH. Anesth Analg; 21(1):152–5.

Doherty D, Cunningham A. Survey of Anesthesiology. 2001; 45: 31. The effects of propofol with and without ketamine on human cerebral blood flow velocity and CO2 response. Invited Commentary on Sakai K, Cho S, Fusaki M, Shibata O, Sumikawa K. Anesth Analg 90(2):377–82.

Orser B, Miller D. Propofol benzodiazepine interactions: insights from a ‘bench to bedside’ approach. Can J Anesth 2001; 48:431–4.

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Thompson EN. Medical Experts, Independent or Ignorant. Pain Res Manage 2001; 6(1):11–2.

BOOK REVIEWS

2006 (3) Evans H. Book review: Mayo Clinic analgesic pathway. Canadian Journal of Anesthesia 2006; 53(9): 967.

Miller D. Book review: Scientific Style and Format: The CSE Manual for Authors, Editors and Publishers. Can J Anesth 2006; 53:1167.

Yang H, Raymer K. Book review: The Pharmcology of Inhaled Anesthetics. Can J. Anesth 2003; 50: 530.

2004 (1) Neilipovitz DT. Book review: Seizures in Critical Care. Varelas PN (ed.). New Jersey: Humana Press, 2004. Can J Anaesth 2005; 52:554–5.

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Syllabi, Guidelines, and Recommendations

2005 (4) Chiu M and Neilipovitz D. Rapid Sequence Intubation. In Acute Resuscitation and Crisis Management: Acute Critical Events Simulation (ACES) Course Syllabus. University of Ottawa Press, Ottawa, 2005.

Chiu M. Canadian Resuscitation Institute / Ontario Ministry of Health and Long-Term Care Critical Care Response Team High Fidelity Simulation Instructor Certification Course Syllabus. Contributing author, 2005.

Crosby ET. Part 2: Adult basic life support. International Liaison Committee on Resuscitation. Resuscitation 2005; 67: 187–201. (Worksheet author: #150 - What interventions are safe, effective and feasible when performing CPR in victims with suspected cervical spine injury?).

Dumitrascu, George. Internet-based "Anaesthesia Equipement Problem Info base". Canadian Anesthesiologist's Society. Developed 1998–1999, on-line fall 2000–2005 (http://www.anesthesia.org/cas/).

2004 (2) Chiu M. ACES Instructor Certification Course Syllabus. Contributing author, 2004.

Dumitrascu, George. Simulator Program Website. http://anesthes.uthscsa.edu/simman/simman.html, 2004.

2003 (2) Dumitrascu, George. Obstetrical Anesthesia Resident Manual, 2nd edition. Department of Anesthesiology, UTHSCSA, 2003.

Dumitrascu, George. CD-Rom: 3D virtual model of the upper airway as a teaching tool for fiberoptic intubation. Collaboration with the Department of Anesthesiology, University of Strasbourg, France, 2003.

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APPENDIX II Gary Johnson Research Day Presentations 2003–2007

May 11 2007 Residents’ Research: 13 presentations Dr. Tania Di Renna Postoperative Vaso-vagal Syncope: Is Intrathecal Anesthesia the Cause? Dr. Gavin Gracias Perioperative Hypothermia at the Ottawa Hospital Dr. Jennifer Backstrom- Sedation Practice in Paediatric Intensive Care: A Systematic Ozard Review Dr. Amy Frasera Structured Communication Strategies in Critical event Simulation Dr. Jordan Cuthbert The Role of Antacid Medications in Reduction of PONV Dr. Christopher Hudson A Comparison of Open vs Laparoscopic Bowel Resection Dr. Gavin Gracias Attitudes and Obstacles to Anesthesia Resident Research at the University of Ottawa Dr. Yvette Grabowski An Epidemiological Analysis of Preoperative Comorbidity, Surgical Priority and Outcome in Cardiac Surgery Dr. Ahmed El-Alfy Empression of Mineralocorticoid Receptors in the Brain and Heart of Rats with Post-Myocardial Infarction Left Ventricular Dysfunction Dr. Chris Pysyk Ultrasound measurement of Epidural and Neuraxial Structures Dr. Shawn Hicks A Survey of Airway Management in Trauma Patients Dr. Anna Wyand Does the Clock Drawing Test Detect Delirium or Cognitive Dysfunction? Dr. Lukasz Bartosik Early Extubation Following Abdominal Aortic Aneurysm (AAA) Surgery at The Ottawa Hospital. Are There Any Benefits?

2006, May 12th Residents’ Research: 5 Presentations Dr. Joanne Kawchuk PPart – Peri-operative pressure in anesthesiologists and resident trainees. Dr. Abeer Arab Continuous femoral nerve block accelerates mobilization following total knee arthroplasty

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Dr. Ian Ozard Postoperative nausea and vomiting prophylaxis practice audit. A quality assurance study. Dr. Kevin Gagne Esmolol use during electroconvulsive therapy at the Royal Ottawa Hospital Dr. Jennifer Backstrom Hypomagnesemia-induced intraoperative myoclonic movements: Paediatric case presentation.

Fellows’ Research: 1 presentation Dr. Wilton Van Klei Effects of transfusion on the incidence of postoperative PAU myocardial infarction in patients on beta-blockers.

Staff: 5 presentations Dr. Calvin Thompson Thoracic epidural adrenaline and meperidine (TEAM) trial. Civic Campus Dr. Bernard McDonald The protective effect of sevoflurane on diastolic cardiac Heart Institute function in patients undergoing aortic valve replacement for aortic stenosis. Dr. Jean-Yves Dupuis Airway pressure release ventilation versus conventional Heart Institute positive pressure ventilation in cardiac surgical patients requiring prolonged mechanical ventilation Dr. Greg Bryson Neuroprotective strategies in the elderly: Does Civic Campus Apolipoprotein E genotype predicts delirium and cognitive dysfunction following abdominal aortic aneurysm repair.

Dr. Dermot Doherty The anti inflammatory effects of Anti-CD18 therapy after CHEO transient global ischemic brain injury in the mouse.

May 13, 2005 Residents’ Research: 7 presentations Dr. Miriam Berchuk Preoperative analgesia for patients undergoing lumbar microdiscectomy Dr. Khaled Tibar Hospital discharge occurs sooner after carotid endarterectomy performed under regional as compared to general anesthesia. Dr. Amy Rogers Retrospective chart review examining the relationship between time to surgery and complications in patients with hip fractures.

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Dr. Amy Fraser Update on pharmacoeconomics parameters in The Ottawa Hospital operating rooms. Dr. Khalid Makki Management choices for the difficult airway. How confident are you? Dr. Anna Wyand Does perioperative testing at the Civic Campus of The Ottawa Hospital reflect published guidelines? An update. Dr. Sylvain Gagné Thoracic epidural adrenaline and meperidine (TEAM) trial.

Fellows’ Research: 1 Presentation Dr. Leo Jeyaraj, Mini dose spinal bupivacaine for caesarean section. A Obstetrics randomized trial of the effect on maternal hemodynamics and quality of recovery.

2004, May 14th Residents’ Research: 7 presentations Dr. Ben Sohmer Does induction of general anaesthesia with phenylephrine influence redistribution hypothermia? Dr. Greg Bosey The use of the fractional excretion of sodium to assess renal function following cardiac surgery Dr. John Macdonald Abdominal aortic aneurysm surgery—Perioperative Mortalities at The Ottawa Hospital (Civic Campus) 2000– 2003 Dr. Stephane Moffett Mortality and complications following pulmonary and GI resections: A retrospective chart review Dr. Simone Crooks IV flow rates: Does size really matter? Dr. Khalid Makki Constructing Surveys: Does question order matter? Dr. Anna Wyand Does preoperative testing at the Civic campus of The Ottawa Hospital reflect published guidelines? Fellows’ Research: 3 presentations Dr. Jennifer Szerb The management of post-operative pain in patients after Regional forefoot surgery—A retrospective review (Civic) Dr. Jennifer Szerb Continuous sciatic nerve blocks in patients undergoing Regional forefoot surgery at the Ottawa Hospital—A quality assurance study Dr Davishish Cardiovascular collapse after anesthetia induction in cardiac Chakravarty, Cardiac surgical patients.

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2003, May 14th

Residents’ Research: 7 presentations Dr. Ben Sohmer The efficacy of EMLA cream for bronchoscopy Dr. Greg Bosey When post-op antiemetics Fail: A chart review of one year at the Ottawa Hospital Dr. Rob Sharpe Infrared Tympanic Temperature Monitoring in a Laparoscopic Patient Population – A Quality Assurance Study Dr. Maan Kattan Respiratory syncitial virus (RSV) associated multilobar pulmonary interstital emphysema (PIE) Dr. Scott Duggan Effect of Gabapentin on locus coeruleus noradrenergic activity in a model of intrathecal strychnine induced allodynia Dr. Natalie Buu Perioperative morbidity associated with sleep apnea Dr. Abdul Alharbi Failure rate of spinal anesthesia for total knee replacement

Fellows’ Research: 2 presentations Dr. Uma Parekh A retrospective review of perioperative fresh frozen plasma Pediatrics transfusion practice in a children’s hospital Dr. Uma Parekh Effect of intravenous fluid replacement on outcomes Pedriatrics following pediatric day care surgery

Visiting Professors and Assessors 2003–2007 May 11 2007 Visiting Professor Prevention of Cardiorespiratory Complications: Current and Dr. Peter Choi Future Research University of British Columbia May 12 2006 Cardiovascular Anesthesia Research: Have all the questions Visiting Professor already been answered? Dr. C. David Mazer University of Toronto

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May 13, 2005 “It hurts when I do this” Mechanisms and management of Visiting Professor movement-evoked postoperative pain Dr. Ian Gilron Queens University May 14 2004 Oxygen carrying agents—Will we ever get to use them? Visiting Professor Dr. C. Brian Warriner University of British Columbia May 9 2003 Post Operative cognitive dysfuction —Anesthesia’s dirty Visiting Professor little secret. Dr. David Parsons Memorial University

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APPENDIX III Faculty and Staff Faculty

Professor Emeritus Dr Earl Wynands Professor Emeritus; O.C.

Professors Dr Edward Crosby Professor; General Campus Dr Howard Nathan Professor; Heart Institute Dr Denis Reid Professor; General Campus Dr Homer Yang Professor; Civic, General and Heart Institute Campuses

Associate Professors Dr Alan Baxter Associate Professor; Civic Campus Dr Greg Bryson Associate Professor; Civic Campus Dr Larry Byford Associate Professor; Civic Campus Dr Jean-Yves Dupuis Associate Professor; Heart Institute Dr Ashraf Fayad Associate Professor; Civic Campus Dr Gary Johnson Associate Professor; CHEO Dr Jack Kitts Associate Professor; Civic Campus Dr Jocelyne McKenna Associate Professor; General Campus Dr Donald Miller Associate Professor; General Campus Dr David Neilipovitz Associate Professor; Civic Campus Dr John Penning Associate Professor; Civic Campus Dr David Skene Associate Professor; General Campus Dr William Splinter Associate Professor; CHEO Dr Patrick Sullivan Associate Professor; Civic Campus

Assistant Professors Dr Ibrahim Abu-Shahwan Assistant Professor; CHEO Dr Sanjay Achraya Assistant Professor; CFSU

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Dr Tammy Barrows Assistant Professor; General Campus Dr Wayne Barry Assistant Professor; Civic Campus Dr Michael Bourke Assistant Professor; Heart Institute Dr André Boutet Assistant Professor; Riverside Campus Dr Paul Bragg Assistant Professor; Civic Campus Dr Charles Cattran Assistant Professor; Heart Institute Dr Alan Chaput Assistant Professor; Civic Campus Dr Michele Chiu Assistant Professor; Civic Campus Dr Paul Connelly Assistant Professor; General Campus Dr James Conway Assistant Professor; Civic Campus Dr Antoinette Corvo Assistant Professor: CHEO Dr Ioana Costache Assistant Professor; General Campus Dr John Cowan Assistant Professor; Civic Campus Dr Simone Crooks Assistant Professor; General Campus Dr Michael Curran Assistant Professor; Civic Campus Dr Dermot Doherty Assistant Professor; CHEO Dr Peter Duffy Assistant Professor; General Campus Dr George Dumitrascu Assistant Professor; Civic Campus Dr Robert Elliott Assistant Professor; Civic Campus Dr Holly Evans Assistant Professor; General Campus Dr David Ewing Assistant Professor; Civic Campus Dr Mark Farrell Assistant Professor; Civic Campus Dr Lucie Filteau Assistant Professor; Civic Campus Dr Amy Fraser Assistant Professor; Civic Campus Dr Ian Frost Assistant Professor; Riverside Dr Sylvain Gagné Assistant Professor; General Campus Dr Catherine Gallant Assistant Professor; General Campus Dr Lawrie Garnett Assistant Professor; Civic Campus Dr Louise Gauthier Assistant Professor; General Campus Dr Samir Ghatalia Assistant Professor; Montfort Dr Susan Goheen Assistant Professor; Civic Campus Dr Marion Gould Assistant Professor: CHEO Dr Leslie Hall Assistant Professor; CHEO Dr Douglas Hardy Assistant Professor; Civic Campus (leave of absence)

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Dr Richard Hladkowicz Assistant Professor; Civic Campus Dr Jonathan Hooper Assistant Professor; Civic Campus Dr Mark Hynes Assistant Professor; Heart Institute Dr Jarmila Kim Assistant Professor; CHEO Dr Stephane Lambert Assistant Professor; Heart Institute Dr Christine Lamontagne Assistant Professor; CHEO Dr Geraint Lewis Assistant Professor; Civic Campus Dr Anne Lui Assistant Professor; Civic Campus Dr Peter MacEwen Assistant Professor; Civic Campus Dr Robert MacNeil Assistant Professor; Civic Campus Dr Robert McBurney Assistant Professor; Riverside Campus Dr Bernard McDonald Assistant Professor; Heart Institute Dr Sharissa Microys Assistant Professor; CFSU Dr Stephane Moffett Assistant Professor; General Campus Dr Philipp Mossdorf Assistant Professor; CHEO Dr Patti Murphy Assistant Professor; Civic Campus Dr Kimmo Murto Assistant Professor; CHEO Dr Nadira Naraine Assistant Professor; General Campus Dr Joanna Nawrocka Assistant Professor; CHEO Dr Donna Nicholson Assistant Professor; Heart Institute Dr Kevin Nolan Assistant Professor; Civic Campus Dr Mark Odrcich Assistant Professor; CHEO Dr Gail Oneschuk Assistant Professor; Riverside Dr Desirée Persaud Assistant Professor; Civic Campus Dr Joseph Po Assistant Professor; CFSU Dr Tomasz Polis Assistant Professor; Civic Campus Dr Jane Prud’Homme Assistant Professor; General Campus Dr Gillian Ramsey Assistant Professor; CHEO Dr Elizabeth Renehan Assistant Professor; General Campus Dr M. Raed Rihani Assistant Professor; Civic Campus (leave of absence) Dr James Roblee Assistant Professor; Heart Institute Dr Linda Robinson Assistant Professor Dr David Rosen Assistant Professor; CHEO Dr Gail Ryan Assistant Professor; CHEO

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Dr Uwe Schwarz Assistant Professor; CHEO Dr Gary Skidmore Assistant Professor; General Campus Dr Cathy Smyth Assistant Professor; General Campus Dr Benjamin Sohmer Assistant Professor, Heart Institute Dr Caroline Tallmadge Assistant Professor, Civic Campus Dr Calvin Thompson Assistant Professor; General Campus Dr Ellen Thompson Assistant Professor; Civic Campus (leave of absence) Dr John Watson Assistant Professor; General Campus Dr Christopher Wherrett Assistant Professor; General Campus Dr Peter Wilkes Assistant Professor; Heart Institute Dr Donald Wilson Assistant Professor; Riverside Campus Dr Anna Wyand Assistant Professor; Civic Campus Dr Linda Wynne Assistant Professor; Civic Campus Dr Ian Zunder Assistant Professor; Civic Campus

Consultants Dr BJ Grewal Dr Gwen Thomas

STAFF

Clinical Services Support CHEO Anesthesia Assistants Laury Logan Diane Lefrancois D.Lee Kirk Ana M. Ramirez Louise Beique Austin Kimberly Villeneuve Varin Vicky Paradis Claude Andree Dubois Nancy Lauzon Vickie Legare

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TOH Anesthesia Assistants Paul Aboueid Ivanette Stubbert Kristin Blimkie Gabriel Caporale Anesthesia Nurse Andrea Cashman Nicole Delisle Lucie Desrochers Mylene Gagnon Acute Pain Service Nurses Paula King Susan Madden Carrie Merritt Colin Labonte Manon Rousseau Erin Sernoskie

Administrative Support Academic Departmental and Office of the Chief and Chair Mrs Lynne McHardy Department Manager Mrs Holly Ladouceur Assistant to the Residency Program Director

CHEO Ms Yvette Lavigne Administrative Coordinator Ms Cindy McCuaig Anesthesia Billing Clerk

TOH Civic Campus Mrs Judy Dureau Scheduling, Civic Campus Mr Eric Forgiel Administrative Assistant

TOH General Campus Mrs France Greenwood Department Manager: General Campus Mrs Francine Falardeau Administrative Assistant Ms Naomi Stegenga Billing Officer

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Research Support Denise Wozny Chief Operating Officer and Analyst Sharon Finlay Clinical Studies Coordinator Denyse Winch Clinical Research Coordinator Sylvie Poloni Clinical Research Coordinator Diana Pepin Clinical Research Coordinator Marlene Farrell Clinical Research Coordinator Mary Lou Crossan Clinical Research Coordinator (Malignant Hyperthermia) Carmen Altoft Clinical Research Coordinator Marlene Farrell Research Nurse Cathy White Research Nurse

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