REPORT ON PERFORMANCE 2005 - 2008

REPORT ON PERFORMANCE

2005 - 2008

DEPARTMENT OF ANESTHESIA

Depar tment of Anesthes ia Report on Per formance 2005-2008i

Table of Contents

Depar tment of Anesthes ia Report on Per formance 2005-2008 ii

Patient Care 13

Who We Are and What We Do 1

Education 25

Who We Are and What We Do . . . . . . . . . . . . . . . . . . . . . . . .1Message from the Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Message from the Deputy Minister, Nova Scotia Dept. of Health .3Comments from the Dean, Dalhousie Faculty of Medicine . . . . .4Messages from our Clinical Partners . . . . . . . . . . . . . . . . . . . .5Closer Look at the Department of Anesthesia . . . . . . . . . . . . . .8Organizational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10Strategic Plan: Mapping the Road We’re Travelling . . . . . . . . .11

Improving the Quality and Quantity of Patient Care . . . . . . . . .14Our Anesthesiologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Meeting Patient Needs with a Range of Clinical Services . . . . .17Women’s & Obstetric Anesthesia . . . . . . . . . . . . . . . . . . . . .17Pediatric Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Pediatric Pain Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Chronic and Acute Pain Services . . . . . . . . . . . . . . . . . . . . .19Thoracic and Transplantation Anesthesia . . . . . . . . . . . . . . . .20Cardiac Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Neuroanesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Regional Anesthesia Service . . . . . . . . . . . . . . . . . . . . . . . .22Blood Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Teaching the Next Generation of Physicians . . . . . . . . . . . . . .26Encouraging Lifelong Learning . . . . . . . . . . . . . . . . . . . . . . .27Inspiring Minds More than Ever Before . . . . . . . . . . . . . . . . .27Canadian Anesthesiologists’ Society Clinical Teacher Award . . .28Providing Excellent Opportunities at Home . . . . . . . . . . . . . . .28Atlantic Health Training Simulation Centre . . . . . . . . . . . . . . .29

Building a Research-Rich Department to Improve Patient Care .32Here and Around the WorldMoving Research from the Bench to the Bedside . . . . . . . . . .33Fostering Research Excellence Now and for the Future . . . . . .33Focusing on the Safety & Efficacy of Drugs . . . . . . . . . . . . . .34Bringing New Research and Researchers to Nova Scotia . . . . .34Chronic Pain Research . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Local Study and Knowledge of Pediatric Pain . . . . . . . . . . . . .37Funding Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Global Outreach: Anesthesia in Challenging Environments . . . .44Building Healthcare Leaders in Ghana . . . . . . . . . . . . . . . . . .45Extending Our Teaching Efforts to Rwanda . . . . . . . . . . . . . . .45Ensuring High Quality Anesthesia Care for All Nova Scotians . . .46

Research 31

Stewardship 43

The Practice of Anesthesia Then & NowUntil the mid-1800s, physicians rarely performed what was, at thetime, the rather barbaric practice of surgery. Opium, alcohol andphysical restraint by large men or strong ropes blunted pain andperception somewhat. Quality and finesse were usually sacrificed forspeed to minimize pain. The discovery that ether and chloroformcould render a patient unconscious, unresponsive to painful stimuliand immobile to surgically inflicted pain revolutionized the practiceof medicine and surgery—and anesthesia was born.

And it grew! Local anesthetics discovered in the late 1800s allowedportions of the body to be anesthetized rather than the entireperson. When critical care medicine emerged in intensive care unitsin the 1960s, anesthesiologists were recognized as uniquelyqualified to manage these gravely ill patients.

As experts in managing acute pain, it was a natural evolution for anesthesiologists to lead the attack on chronic pain. The modernanesthesiologist is fundamentally concerned with operativeanesthesia, critical care medicine and pain management, thoughthese are not the limit of the specialty.

In addition to providing patient care, academic departments ofanesthesia, like Dalhousie’s, are committed to education andresearch. Following medical school, residency training in anesthesiatakes five years. Subspecialty fellowships (e.g. in areas such ascardiac anesthesia or pain management) add up to three more years.Anesthesia research has led to many of the life-saving innovationsnow in common practice.

The bywords of anesthesia are vigilance and safety.Anesthesiologists must have expertise in the effects of anesthesiaon the brain and spinal cord, as well as the vital organ systems. Forexample, the anesthesiologist must be an expert at ensuring gasexchange by artificial means such as intubation. (The DalhousieDepartment of Anesthesia is a world leader in this field of airwaymanagement.) The anesthesiologist also understands the manynuances of blood volume management, coagulation (the process bywhich blood forms clots), temperature control and maintenance,drug interactions, patient position and a multitude of otherconsiderations for each patient and operation.

Depar tment of Anesthes ia Report on Per formance 2005-2008iii

Who we are and what we do Depar tment of Anesthes ia Report on Per formance 2005-2008 1

Who We Are and What We Do

Depar tment of Anesthes ia Report on Per formance 2005-2008 1


In the last three years, the Department of Anesthesia hasstrengthened its patient care, research and education efforts.We implemented a number of innovative initiatives focusing onrecruiting anesthesiologists, fostering a vibrant research programand delivering top notch education.

We have made great strides. The department now has a fullcomplement of anesthesiologists, enabling more surgeries andshorter wait lists.

The research team has grown to include nine dedicated researchers,effectively expanding the department’s research capacity. Ourresearch is attracting more grants in greater amounts from suchentities as the Canadian Institutes of Health Research and CanadaFoundation for Innovation. This is evident in the increase in grantfunding which totaled just over $382K in 2005 and now stands at$2.1M in 2008.

The number of faculty members who teach students and residentshas increased exponentially; in fact, department members nowspend 738 hours teaching medical students each year, up from 316hours in 2005.

The anesthesia residency program is gaining in popularity acrossCanada and abroad, garnering about 190 applicants annually for itsfive positions. I should note that upon graduation many residentspursue fellowships in any number of subspecialties. Many are alsochoosing to stay in Nova Scotia as part of our department or otherdepartments across the province.

The department’s scholarly output has surpassed a goal we set forourselves in 2005. Department members have more than 180publications and numerous books to their credit and are invited topresent and lecture around the world.

The care we provide to patients is at the heart of our progress.We have implemented stringent quality assurance measures,strengthened our subspecialty areas to provide a range of servicesand now perform more than 45,000 procedures annually. Anacademic department of anesthesia is built on a solid foundation of high-quality patient care. I am of the opinion, and it is thereputation of this department, that the care delivered by its membersrivals that delivered anywhere else in the world.

The following pages describe who we are, what we do and the stepswe have taken to respond to the needs of our communities.

Dr. Mike MurphyChair, Department of AnesthesiaDalhousie University

Message from the Chair, Department of Anesthesia

Depar tment of Anesthes ia Report on Per formance 2005-20082 Who we are and what we do


Remarks from the Deputy Minister, Nova Scotia Department of Health

Who we are and what we do

Anesthesiology represents a critical discipline in Nova Scotia’shealth care system. As such, we feel a tremendous sense of prideand are very supportive of the leadership shown by DalhousieUniversity’s Department of Anesthesia – a nationally recognizedcentre of excellence. Moreover, we are wholly committed to work-ing in partnership with the department, Capital Health, andanesthesiologists throughout our province to continue to grow ourcomplement, as well as foster world-class expertise and research in this specialty.

Working in collaboration we have already achieved remarkableresults, recruiting more than 30 anesthesiologists to the province inthe past three years. We know that this kind of success will persistby continuing to make the protection of research and scientific rigoura priority. Recognizing the demands on this profession, we willcontinue to leverage policies and resources to advance state-of-the-art patient care, research and training. We will also continue to leadthe country in offering unique academic funding plans (AFPs) toanesthesiologists to ensure that vital teaching and research time issafeguarded.

Nova Scotia is extremely fortunate to have the level of talentcurrently at the Dalhousie University Department of Anesthesia.We are fully dedicated to nurturing and further strengthening ourdistinctive relationship, and to providing ongoing funding supportthat ensures their clinical and academic achievements continue.

Cheryl DoironDeputy MinisterNova Scotia Department of Health

Comments from the Dean, Dalhousie Faculty of Medicine

Within today’s complex environment of clinical care delivery,continuing to provide a balanced and progressive approach to thecomposite spectrum of medical education and biomedical researchis always a challenge. Over the last few years, the Department of Anesthesia has admirably risen to meet new demands andexpectations. Fuelled by a progressive academic funding plansupported by multiple partners, recruitment has been facilitated,and a broader capacity for clinical, educational and research activityin the department encouraged and realized. More specifically,resources and energy have been given to initiatives covering an impressive spectrum of novel research that connects theuniqueness of anesthesiology with other specialties and basicscience departments, establishing a more robust profile indepartmental clinical and translational research capabilities.

Further, there has been renewed interest and focus on improving thequality and quantity of educational encounters by the anesthesiafaculty for undergraduate medical students, residents in training and other postgraduate trainees, through both direct and indirectencounters. The enthusiasm and momentum to push the educationalagenda forward is especially notable through increased partici-pation in the undergraduate problem-based learning program (case-oriented problem-stimulated curriculum or COPS).

These enhanced collaborations and interactions by the Departrmentof Anesthesia across the Faculty of Medicine have elevated andenhanced the academic stature of the department. It has driven an enhanced appreciation of the value for more meaningfulengagement by members of the Faculty of Medicine.

Not only is the local academic environment enriched throughdepartmental endeavours such as these, but our overall reputation as a faculty are effectively promoted on a national and internationalscale. The Faculty of Medicine looks forward to further develop-ments and benefits of these reinvigorated initiatives over the monthsand years ahead as our faculty continues to expand in itscommitment to quality educational and research experiences thatmeet our Maritime, national and international mandate.

Dr. Harold W. CookDean, Faculty of Medicine Dalhousie University

Depar tment of Anesthes ia Report on Per formance 2005-20084

A n a c a d e m i c a l l y i n v i g o r a t e d D e p a r t m e n t o f A n e s t h e s i a


Message from the President & CEO, Capital District Health Authority

Three years ago, Capital District Health Authority (CDHA) was incrisis with respect to our surgical programs due to a significantshortage of anesthesiologists to staff our operating rooms.Thankfully, in a collaborative effort with the Department ofAnesthesia, Capital Health has been able to effect a remarkable turnaround for which we, on behalf of the patients we serve, areextremely grateful and proud.

As we enter 2009, we are blessed with a full roster ofanesthesiologists and a team prepared to support our clinical and academic mandate. This has led to increased surgical cases,reduction of wait times and waiting lists, and the introduction ofimproved efficiencies that enable the perioperative team to managethe ever-increasing volumes.

Academically, the Department of Anesthesia renewed itscommitment to undergraduate medical education and appropriatelyboasts a robust clinical and translational research capacity.Best practice is a familiar word with this department, as evidencedby many publications and texts on airway management and otherrelated topics.

The Department of Anesthesia is an excellent example of atransformational journey undertaken as a partnership withgovernment, the Health Authority and the departmental leadership.Such great teams, coupled with an organizational commitment tosupport the direction of change, have demonstrated strength inleadership throughout the district, the province and the country.

Chris PowerPresident & CEOCDHA


I f o n l y w e c o u l d a l l w o r k t o g e t h e r t h i s w a y !



Message from the President & CEO, IWK Health Centre

The Department of Anesthesia at the IWK Health Centre serves alarge and diverse population providing tertiary and quaternary carefor children, youth and women. The department is divided into twosubspecialty groups of anesthesiologists: those providing anesthesiacare to the pediatric population; and those who care for women andobstetrics. The IWK Health Centre pediatric anesthesiologists are the only pediatric subspecialty anesthesia group in the Maritimeprovinces.

IWK anesthesiologists provide patient care support for manydepartments including Diagnostic Imaging, Cardiology &Cardiovascular Surgery, Surgery (General, Thoracic, Ophthal-mology, Otolaryngology, Oral & Maxillofacial, Urology, Orthopedics,Plastics, Neurosurgery, Pedodontics), Pediatrics (Oncology,Gastroenterology, Rheumatology, Nephrology, Neurology), the BurnUnit, Radiation Oncology, Pediatric Pain Service, Trauma Team,Trauma Surgery and more. The department has a particularexpertise in difficult airway management, a unique skill placing it atthe forefront of anesthesia care in North America.

Members of the department are actively engaged in teachingresidents, medical students and many other learners from DalhousieUniversity and other universities. Over the past year the departmenthas restructured its residency training curriculum to encompass allaspects of women’s anesthetic care such that anesthesia traineesemerge with high levels of competency in caring for women with allvarieties of disorders.

Subspecialty fellowship training is well established at the IWK inboth subspecialty areas. The anesthesia staff have developed areputation that draws top notch candidates for fellowship positionsin Pediatric Anesthesia, Pediatric Pain Management, PediatricCritical Care and Women’s and Obstetrics Anesthesia. Theseprograms have significant research components, drawing on thesubstantial research expertise of this department. The departmenthas a national reputation as a leader in research.

We take pride in the fact that graduates of our fellowship programin Pediatric Anesthesia undertake leadership roles in departments of pediatric anesthesia in Canada and around the world!

The IWK is proud to have such a wonderful, talented and dedicatedteam of subspecialist anesthesiologists providing care to thepatients we serve.

Yours truly,

Anne McGuire President & CEOIWK Health Centre

T h e I W K H e a l t h C e n t r e i s p r o u d o f t h e t a l e n t e d m e m b e r s o f i t s D e p a r t m e n t o f A n e s t h e s i a .


A Few Words from Our Colleagues“The Department of Anesthesia has built a synergy with surgeonsand nurses that is based on open communication, respect,understanding and shared goals. It has shown great flexibility by providing services at all Capital Health sites, at Scotia Surgery in Dartmouth and at CFB Stadacona in Halifax. Thereby,anesthesiologists have set an example of how to move to district-wide delivery of patient services. I’m very pleased that successfulrecruitment of anesthesiologists has enabled Capital Health toincrease the number of surgeries by more than 10 per cent over2007.”

Dr. Jaap BonjerChair, Department of SurgeryDalhousie University

“With the increased complement of anesthesiologists as well as the innovation by members in your department, we have propelledcontemporary post-operative care to a new level. I envy and emulateyour departmental management and look forward to continuing towork with you.”

Dr. David BellChair, Department of UrologyDalhousie University

“On behalf of our department, I would like to acknowledge and thank the Department of Anesthesia for its support and assistancein the provision of patient care, teaching and research. The effectiverecruitment of anesthesiologists in a relatively short time frame hasallowed predictable, efficient scheduling of surgery.”

Dr. Reg GooddayChief, Department of Oral & Maxillofacial SurgeryCapital Health

“The wait times for gynecologic oncology have improved from apeak of 35 days in 2006 to an average of 25 days in 2008. Theprimary factor in this has been the constant availability of operatingroom time facilitated by a full complement of anesthesiologists. Therecent improvements in access to anesthesia have helped improvethe care of women with gynecological cancers.”

Dr. James BentleyChief, Division of Gynecologic OncologyQEII Health Sciences Centre



A Closer Look at the Department of Anesthesia

U n d e r g r a d u a t e e d u c a t i o n

Anesthesia faculty teach undergraduate medical students andstudents from pharmacy, dentistry, pharmacology, physiology & biophysics, immunology & microbiology, and anatomy &neurobiology. In 2005/2006 there were 43 students; in 2006/200760 and in 2007/2008, 67. The department routinely uses simulationtechnology as an interdisciplinary teaching tool, having establishedthe first human patient simulation centre east of Ontario.

P o s t g r a d u a t e e d u c a t i o n

Dalhousie’s fully accredited, five-year residency program in anesthesia attracts close to 190 applicants each year.Residents rotate through all of anesthesia’s subspecialty areas andare mentored by department members at three core teachinghospitals: QEII Health Sciences Centre, IWK Health Centre, and SaintJohn Regional Hospital. Upon successful completion of the programand Royal College exams, graduates are designated as fellows of theRoyal College of Physicians and Surgeons of Canada (FRCPC).Ninety-five per cent of Dalhousie anesthesia residents aresuccessful upon their initial attempt at the Royal College exams.

D a l h o u s i e F a c u l t y o f M e d i c i n e

Established in 1818, Dalhousie University is the largest Canadianuniversity east of Montreal. The Dalhousie Faculty of Medicine wasfounded in 1868, making it one of the oldest medical schools in thecountry. The faculty’s four-year undergraduate medical educationprogram has about 100 students per year and confers a Doctor of Medicine degree (MD). Approximately 489 residents areenrolled in postgraduate medical education programs, 27 of whomare enrolled in anesthesia.

D e p a r t m e n t o f A n e s t h e s i a

The Department of Anesthesia at Dalhousie was created in 1945. Ithas grown to provide a full spectrum of critical care and generalclinical services. In addition, it provides leading edge programs inblood management, pain management and regional anesthesia. Itsubspecializes in cardiac surgery, neurosurgery, obstetrics,pediatrics, thoracic surgery and transplantation. The Department ofAnesthesia provides expertise locally through community-basedinitiatives; nationally through a variety of committees, boards andagencies; and internationally through its outreach program. Its96 anesthesiologists perform more than 45,000 proceduresannually. Anesthesiologists are located at four main facilities in NovaScotia and New Brunswick: QEII Health Sciences Centre, IWK HealthCentre, Hants Community Hospital and Saint John Regional Hospital.

The department has a $20M budget and a four-fold mandate:

1. To provide safe, quality patient care2. To educate a new generation of anesthesiologists while at the

same time ensuring that attending staff remain current3. To conduct research in a climate of curiosity and collaboration

In response to the current world environment and trends, theDepartment broadened its mandate to include:

4. To contribute to the stewardship of people’s health at home andabroad

P a t i e n t c a r e

Safe, vigilant patient care is the Department of Anesthesia’shallmark. With this fundamental principle guiding all departmentalactivities the department has seen unparalleled growth in the past three years. Between 2006/2007 and 2007/2008, surgicalprocedures increased by approximately 1,000, and operating roomhours by more than 2,200.


A Closer Look at the Department of Anesthesia (cont’d)

C o n t i n u i n g e d u c a t i o n

In keeping with the Department of Anesthesia’s belief in continuouslearning, the department offers a broad range of continuing medicaleducation opportunities ranging from rounds and journal clubs to workshops, forums and seminars. Sessions are webcasted todepartment members as far afield as Rwanda, allowinganesthesiologists to remain current on the latest practices no matterwhere life takes them. Department members are frequently invitedto lecture and present nationally and internationally at suchacademic institutions as Harvard, the Mayo Clinic, and Stanford. Thedepartment provides the core faculty for a highly regarded NorthAmerican airway management training program entitled DifficultAirway Course.

R e s e a r c h

A vibrant and productive research environment is critical to creatingnew knowledge that advances the science and practice ofanesthesia. The department has demonstrated its commitment toresearch through the creation of an Office of Research. This office,charged with moving the research agenda forward, combined witha policy of protected time for physicians engaged in researchprograms, has led to an increase in the number of researchers andfunding. In the last three years, our researchers grew in numberfrom three in 2005 to nine in 2008; our funding from just over$382K in 2005 to $2.1M in 2008.

S t e w a r d s h i p

The Department of Anesthesia administers the AnestheticServices Program Encompassing Nova Scotia (ASPENS).ASPENS is a consultation service designed to assist and supportdepartments of anesthesia in hospitals across Nova Scotia toprovide safe, high-quality anesthesia care. Part of its mandateincludes optimizing new standards of care, equipment andtechnology.

Anesthesia faculty and residents regularly ‘give back’ by sharingtheir expertise through a variety of outreach initiatives including the department’s International Outreach Program. Current effortsinclude the development and delivery of a remote-locationsanesthesia training program and on-site training programs inRwanda, Ghana and Thailand.


Who we are and what we doDepar tment of Anesthes ia Report on Per formance 2005-200810

Department Organizational Chart

ACADEMIC

DEAN DALHOUSIE

FACULTY OF MEDICINE

VP OF CDHA MEDICINE

CHAIR / CHIEF DEPARTMENT OF ANESTHESIADALHOUSIE & CAPITAL HEALTH

CLINICAL

SPECIALTY TRAINING

COMMITTEE

EXECUTIVE COUNCIL

EXECUTIVE DIRECTOR, RESEARCHPROGRAMS & STRATEGIC PLANNING COMPTROLLER SENIOR DIRECTOR

RESEARCH

ANESTHETIC SERVICESPROGRAM

ENCOMPASSINGNOVA SCOTIA

SIMULATIONBLOOD

MANAGEMENTPAIN

MANAGEMENT

QUALITY ASSURANCEPATIENT SAFETY

SITE CHIEFS

ANESTHESIOLOGISTS

IWKRESIDENCYPROGRAM

MANAGINGDIRECTORRESEARCH

MANAGINGDIRECTOR

EDUCATION

PROVINCIALPROGRAMS

INTERNATIONALOUTREACH

COORDINATOR

Who we are and what we do Depar tment of Anesthes ia Report on Per formance 2005-2008 11

In September 2007, with the department gaining strength andmomentum, members came together to determine their collectivevision, mission, and the road map to get them there; in other words,the department’s strategic plan. The strategy is about movingforward. It marks the destination, the directions in which to travel,the roads to take and the essential pit stops.

The Department of Anesthesia’s vision, mission and directionsas established in 2007:

V i s i o n

A culture of excellence in anesthesia clinical practice and programs,research and education

M i s s i o n

To deliver anesthesia services through up-to-date clinical carebased on the latest evidence (research) and knowledge (education).

D i r e c t i o n s

To realize its vision and carry forward its mandate, the departmentidentified seven strategic directions/priorities and outlined thenecessary actions for each. At the end of five years, the departmentwill have:

#1 A clinical department that continues to provide world-leading anesthesia services and programs in support of our clinical partners’ vision and mission.

#2 A cadre of well-supported and renowned researchers,educators and clinicians.

#3 An Office of Research with an appropriate infrastructure (space, staff, funding) that facilitates research endeavours, istransparent and is accountable.

#4 An Office of Education with an appropriate infrastructure (space, staff, funding) that facilitates education endeavours, istransparent, and is accountable.

#5 A communications plan that helps keep departmental staff andthe broader community informed and up to date on anesthesiaactivities, accomplishments and initiatives.

#6 Strategic partnerships that enable the aims and objectives of the department’s academic agenda.

#7 A departmental Information Management System with up-to-date, state-of-the-art technology, processes and systems.

Strategic Plan: Mapping the Road We’re Travelling

The strategic plan is also a tool to assess how far the departmenthas travelled, if it has veered off course, whether the roads takenwere the right ones and if the department needs to revise itsdirections. In August 2008, the Department of Anesthesia releaseda progress report as a follow up to its strategic plan and brought its members together again to ensure they were on track to realizetheir collective vision and continue to help meet the health careneeds of Nova Scotians. The report and gathering of departmentmembers to assess progress are annual activities.


Patient CareDEPARTMENT OF ANESTHESIA

Improving the Quality and Quantity of Patient Care

Commencing in 2005, the Department of Anesthesia undertookthree initiatives to address the needs identified by the community,individual stakeholders and anesthesiologists. These initiaitvesinclude recruitment, wait time reduction and operating roomefficiency.

R e c r u i t i n g t h e b e s t a n d b r i g h t e s t l o c a l l y a n da b r o a d

Since 2005, the Department of Anesthesia has recruited 29anesthesiologists to its department:

• 11 of those recruits were Dalhousie residents who accepted staff anesthesiologist positions

Dr. Ron ChengDr. Janice ChisholmDr. Andrew DickiesonDr. Dennis DrapeauDr. Ronald GeorgeDr. Paula KolysherDr. Peter MacDougallDr. Andrew MilneDr. Ivan RapchukDr. Matthew SimmsDr. Ana Sjaus

• 10 are anesthesiologists who relocated here from university hospitals in Germany

Dr. Dietrich HenzlerDr. Axel JungerDr. Myron KwapiszDr. Christian LehmannDr. Konstantin LorenzDr. Silke OpitzDr. Michael SchmidtDr. Marcus SommerDr. Arnim VlattenDr. Tobias Witter

• 5 are anesthesiologists from other academic health centres in Canada

Dr. Colin AudainDr. Sally BirdDr. Ruth CovertDr. George KanellakosDr. Brian Norman

Patient careDepar tment of Anesthes ia Report on Per formance 2005-200814

• 3 are anesthesiologists from academic health centres in Ireland and Scotland

Dr. Prasad BolleddulaDr. Andrew FergusonDr. Andrew Jarvie

Our recruitment efforts have benefitted other departmentsof anesthesia in Nova Scotia as well. Five anesthesiologistshave been recruited to other district health authorities in theprovince.

Patient care Depar tment of Anesthes ia Report on Per formance 2005-2008 15

Improving the Quality and Quantity of Patient Care (cont’d)

D o i n g o u r p a r t t o r e d u c e t h e w a i t t i m e f o rs u r g e r y

• The Department of Anesthesia increased the number of orthopaedic surgeries being performed and decreased wait times by partnering with the Nova Scotia Department of Health,Dalhousie/Capital Health Department of Surgery, and Scotia Surgery (a private clinic).

• The Department of Anesthesia collaborated again with a community resource, CFB Halifax, to help expedite the performance of routine elective surgeries at Stadacona Base Hospital. This has enabled more complex surgeries to be performed at the QEII Health Sciences Centre.

• The Department of Anesthesia increased anesthesia resourcesat Hants Community Hospital – closer to home for many patients – to enable an additional 250 surgeries to be performed each year.

W o r k i n g b e t t e r t o i n c r e a s e t h e n u m b e r o fs u r g e r i e s a t Q E I I H e a l t h S c i e n c e s C e n t r e

• The Department of Anesthesia’s guarantee of subspecialist anesthesiologist availability has enabled Capital Health to more accurately schedule surgeries at the QEII Health Sciences Centre, resulting in better, more efficient use of operating theatres and other resources.

• The Department of Anesthesia’s new computerized program,designed to allocate appropriate anesthesia resources over extended periods, translates into patients receiving scheduled surgery dates sooner. Many patients now receive scheduled surgery dates six months in advance rather than only weeks prior to their surgery.

• The Department of Anesthesia’s creation of anesthesia coordinator positions has improved the response to emergency surgery and management of operating room resources.

Our Anesthesiologists


Ninety-six anesthesiologists belong to the DalhousieDepartment of Anesthesia – 59 at the QEII Health SciencesCentre and 22 at the IWK Health Centre in Halifax, N.S., and 15at the Saint John Regional Hospital in Saint John, N.B. Wecouldn’t include them all. Here we offer an introduction to justtwo of our dedicated team members:

L o n g - t i m e d e d i c a t e d a n e s t h e s i o l o g i s t s . . .

Dr. Ian Beauprie loves what he does. The anesthesiologist divideshis time between neuroanesthesia and the chronic pain clinic. Notwo days are ever the same.

Dr. Beauprie joined the Department of Anesthesia in 1994 aftercompleting his residency at Dalhousie and a clinical fellowship inchronic pain at Dartmouth College in New Hampshire.

Since then, Dr. Beauprie’s career has evolved and his love for hiswork has flourished. He now works as part of a team with Drs. IvarMendez and Rob Brownstone, world-renowned neurosurgeons,on some of the most delicate surgeries performed at the QEII Health Sciences Centre. He also has the privilege of helping to freepeople from the grip of chronic back pain through spinal cordstimulation, in which a wire is inserted close to the spinal cord toblock pain. His work in the chronic pain clinic has earned him theappreciation and respect of many patients and staff.

“I like the challenge, and often immediate gratification ofneuroanesthesia, but I also enjoy interacting with patients, getting to know them and to better understand their lives which is part of what I do at the clinic. This combination of work is ideal for me,” says Dr. Beauprie.

A n d n e w r e c r u i t s . . .

Dr. Ana Sjaus has big plans for her career – all of which includedelivering the absolute best patient care here in Halifax. Dr. Sjauscame to the Department of Anesthesia as a resident in 2002 afterearning her medical degree at the University of British Columbia. TheDalhousie residency program was her first choice. The native west-coaster says it has proven to be the right one.

Upon completing residency among the top of her class, Dr. Sjausjoined the department as a staff physician in 2007. She now hasher sights set on a fellowship in regional and obstetric anesthesia.The training program will provide her with a specialized skill set that she says could benefit many of the patients she sees.

The Department of Anesthesia’s culture – one of clinical excellencefostered by mentorship, a commitment to lifelong learning and anunderlying dedication to patients – has complemented Dr. Sjaus’desire to provide the best patient care. “I am often in awe of otherdepartment members’ clinical skills, which encourages me to learnmore and do better,” she says.

Meeting Patient Needs with a Range of Clinical Services


W o m e n ’ s & O b s t e t r i c A n e s t h e s i a

Women’s and Obstetric Anesthesia provides comprehensiveanesthesia services for maternal, breast health and non-oncologygynecology patients at the IWK Health Centre and the QEII HealthSciences Centre. This includes tertiary high-risk obstetric andneonatal referrals for the Maritime provinces.

The Women’s and Obstetric Anesthesia team provides labouranalgesia/anesthesia for an average of 4800 annual deliveries atthe IWK birth unit. Seventy per cent of these cases require epidural;28 per cent require Cesarean section.

Gynecology anesthesia is also a large part of the Women’s andObstetric Anesthesia mandate. The team provides anesthesiaservices for more than 1,500 gynecologic surgeries each year,including more than 200 emergency gynecologic surgeries.Further, the team provides anesthesia consultation for patients who require gynecology and obstetric preoperative assessment,approximately 1,000 cases annually.

Other patient care activities include non-obstetric surgeryanesthesia for pregnant patients, obstetric anesthesia for pregnantpatients who are critically ill or have complicated health issues,acute pain anesthesia for women and resuscitation services forwomen at the IWK.

In 2008, the Women’s and Obstetric Anesthesia team wasinstrumental in establishing the breast health program at the IWK.The team provides anesthesia services for an average of 400 breastsurgeries annually.


Meeting Patient Needs with a Range of Clinical Services (cont’d)

P e d i a t r i c A n e s t h e s i a

The pediatric anesthesia team based at the IWK Health Centreprovides anesthesia care to more than 10,000 Maritime childrenand youth each year. While much of their expertise supports surgicalactivity, the team is active outside of the operating theatre wherecases can also be complex and require extended support.

As a group, the team possesses expertise in:

• pediatric regional anesthesia;

• neuroanesthesia;

• thoracic anesthesia;

• cardiovascular anesthesia; and

• anesthesia for transplant surgery.

The pediatric anesthesia team also provides anesthesia care forpremature and term newborn infants with a multitude of congenitalanomalies. Demand for the team’s expertise is increasing locally andregionally. The team is a specialized resource being the tertiary andquaternary referral centre for all pediatric specialty anesthesia in theMaritime provinces. Further, a subset of the team specializing incritical care provides all care in the IWK's pediatric intensive careunit.

The pediatric anesthesia team administers a range of programs andservices to respond to the varied needs of patients and theirfamilies:

• Cardiac program

• Pediatric pain service

• Pediatric pain network

• Preoperative assessments, telephone consults and chart reviews

• Trauma team

• Malignant hyperthermia consultation service and database

• Difficult airway consultation service and register

• Cardiac arrest response team

• EHS Lifeflight medical control

P e d i a t r i c P a i n S e r v i c e

Members of the pediatric anesthesia team work with children frombirth to adolescence at the IWK Health Centre to help ease theirpain. The team provides acute and chronic pain consultation andtreatment/management options to children and youth, and theirfamilies.

The average number of children and youth referred to the team foracute pain treatment and management stays relatively constant, atjust over 100 annually. Annual referrals for chronic pain consultationand management, however, are on the rise. In the last few years, thenumber has grown by about 30 each year.

In addition to the hundreds of face-to-face consultations withchildren and youth and their families each year, members of thepediatric pain team provide telephone support. The pain managementanesthesiologist on-call and clinical nurse specialist act as an easilyavailable resource team for children and youth, helping them to copewith, and to manage, their chronic pain.

Only three other centres in Canada (Vancouver, Toronto andMontreal) offer a comprehensive pediatric pain service. Members ofthe pediatric pain team often receive requests for consultation andclinical advice from hospitals and health centres across Canada andthe United States.



C h r o n i c P a i n S e r v i c e s

The Pain Management Unit is the nucleus of the Department of Anesthesia’s efforts to serve Nova Scotian adults living with chronic pain. At the clinic, the interdisciplinary pain manage-ment team supports hundreds of people each year with often verycomplex chronic pain. Led by Dr. Mary Lynch, a nationally andinternationally recognized expert in chronic pain, the team providesassessments, and treatment and management options. Demand fortheir services is growing.

Treatment options offered:

• medications • nerve blocks• acupuncture • trigger point injections• electromotive drug • transcutaneous electrical

administration nerve stimulation

In addition, the chronic pain team delivers a self-management program and helps patients connect to other therapies and supportsthat may be beneficial for ongoing pain management. These includetherapeutic exercise and relaxation therapy.

A c u t e P a i n S e r v i c e

Except in extraordinary cases, some level of pain follows surgery.Patients who experience extreme pain receive state-of-the-artpost-operative pain control from the Acute Pain Service.

The Acute Pain Service has steadily evolved since its beginning inthe late 1980s. While maintaining proven principles of acute painmanagement, the team has advanced its techniques based on thelatest scientific literature and ongoing clinical experience.

Now employing a combination of analgesia drugs, the Acute PainService team uses the most current and varied techniques forsurgical procedures. Instituting best practices for post-operativeanalgesia that offer the most effective pain control while lesseningadverse effects, the Acute Pain Service team practises localanesthetic-based peripheral nerve block techniques.

The team’s ongoing exploration of transverses abdominis plane(TAP) blocks for abdominal procedures includes catheter placementunder direct vision by the surgeon for single-shot and continuousinfusion of anesthesia drugs. As a substitute for epidural analgesia,the team recently introduced surgeon-placed continuous localanesthetic extrapleural catheter techniques for thoracotomies withgreat results. The technique is now being applied in some urologicaland vascular surgeries.

The potential for continuous peripheral nerve block for orthopaedicand plastic surgeries, and for patients to manage these blocks athome, is now within reach. Through ongoing learning, study andexperience, the Acute Pain Service team will continue to evolve andadvance its techniques to best support patients in pain.

About 30 per cent of Canadians suffer with chronic pain, whileall have experienced periodic, or acute, pain. The assessment,treatment and study of pain are major foci for the Departmentof Anesthesia.

Patient experience:

“The right regime of medications has taken a lot of my pain away–not all but certainly enough that I feel I can enjoy life withoutsuffering pain as a consequence. I am very grateful to Dr. Lynch,and have come to recognize that many people are working hardto bring an end to chronic pain.”

– Helen Tupper

With the growing demand forchronic pain assessment andtreatment, the Department ofAnesthesia is implementing in-novative ways to serve peopleliving with chronic pain.Dr. Peter MacDougall, withsupport from the Nova ScotiaDepartment of Health, began the Nova Scotia Chronic PainCollaborative Care Network in2008. The network aims toimprove the access to, andquality of, chronic pain assess-ment and treatment in NovaScotia. The network will be rolledout across the province by 2010.


T h o r a c i c A n e s t h e s i a

Anesthesia services for thoracic surgical procedures at the QEIIHealth Sciences Centre are provided by a subspecialist thoracicanesthesia group. Thoracic surgical procedures usually requiregeneral anesthesia and most thoracotomies require one lungventilation, also termed lung separation. The anesthesiologistperforms one lung ventilation by means of a double lumenendotracheal tube or a bronchial blocker that is positioned usingfibre optic bronchoscopic control. In 2008, 386 thoracotomies wereperformed at the QEII.

Thoracic surgery is often associated with significant post-operativepain. The thoracic anesthesia group at the QEII is currently in theforefront of a change in practice utilizing paravertebral peripheralneuroblockade in place of the routine use of epidural analgesia post-operatively. This major change in practice has resulted froma reported increase in the incidence of neurological complicationsassociated with epidural analgesia in non-obstetric patients, and aswell as reports of the efficacy and safety of paravertebral localanesthetic infusions.

In 2009, the thoracic anesthesia group will host a biannual seminarseries on Thoracic Anesthesia, as part of the Dalhousie AnesthesiaResidency Training Program. This series will include a four-hoursimulation workshop on lung separation. Department members alsoteach lung separation at simulation workshops throughout theUnited States.

A n e s t h e s i a f o r L i v e r, K i d n e y, a n d K i d n e yP a n c r e a s ( K P ) Tr a n s p l a n t a t i o n

Anesthesia services for liver transplantation at the QEII HealthSciences Centre are provided by a subspecialized group of tenanesthesiologists. Twenty-six liver transplants were performed atthe QEII in 2008.

Two liver transplant anesthesiologists are on call at any given timeas the procedure can be prolonged, can occur out of regular workhours, and requires complex anesthetic management. The donorliver must be transplanted within ten hours of retrieval if graftsurvival is to be optimized. The liver transplant anesthesia groupalso provides consult services for patients who are to be waitlistedfor transplant.

All members of the Department of Anesthesia provide anesthesiaservices for the, on average, 85 kidney transplants performed everyyear at the QEII. Although less complex than anesthesia for livertransplantation, the kidney transplant recipient frequently hasmultiple health issues and requires expert anesthetic management.

Anesthesia services for kidney pancreas (KP) transplantation is alsoprovided by all members of the Department of Anesthesia. As thepancreas must be transplanted within ten hours, this procedure isperformed on an emergent basis as donor organs become available.Nine KP transplants were performed at the QEII in 2008.

Dr. Ron Cheng has been recruited to lead anesthesiatransplantation services at the QEII. Currently undertakingtransplantation anesthesia fellowship training in Los Angeles,Dr. Cheng’s arrival in 2009 will herald enhanced opportunities for research, education and clinical practice. Dr. Cheng will alsointroduce transesophageal echocardiography (a sophisticateddiagnostic tool that captures clear images of organs) to the QEII livertransplant team.




N e u r o a n e s t h e s i a

Few procedures are as complex as those that fall into theneurosurgical category. In the Maritime provinces, the largestvolume of neurosurgeries are performed at the QEII Health SciencesCentre in Halifax. A group of 11 anesthesiologists providesanesthesia services for these surgeries and other neuro-interventional procedures; 837 in 2008.

The most common neurosurgical cases needing anestheticmanagement are:

• intracranial tumours;

• aneurysms;

• head trauma; and

• spinal anomalies.

Most patients receive general anesthesia when undergoingneurosurgery. There is, however, an increasing need for patients to remain awake during some surgeries. These patients receivealternate forms of sedation and pain control. A core group ofneuroanesthesiologists most often provide the subspecializedanesthesia services for these surgeries.

On average, the neuroanesthesia team provides anesthesia servicesfor seven neurosurgeries each week. It also provides dedicatedneuroanesthesia services for neurosurgical emergencies 24/7.

The subspecialty has evolved and improved its practices to adapt to developments in neurosurgery and in anesthesia. With theaddition of an intraoperative MRI machine at the QEII, neuro-anesthesiologists ensure that the use of the technology does nothave a negative impact on patient safety.

Over the past seven years, the team has shifted its practice fromadministering anesthesia drugs via inhalation to administering moredrugs intravenously. The result is intraoperative anesthesia care thatis easier on vital organs and promotes a faster recovery.

C a r d i a c A n e s t h e s i a

Cardiac surgery is a complex field of medicine with significantmorbidity and mortality. Quality anesthesia care with specificattention to detail can greatly enhance patient safety and outcome.

The cardiac anesthesia team supports all cardiac surgeries at theQEII Health Sciences Centre. In 2008, 1,000 of those cases requiredcardiopulmonary bypass.

The cardiac anesthesia team provides anesthesia services for:

• cardiac surgeries requiring cardiopulmonary bypasssuch as:

• coronary artery bypass grafting (CABG)• aortic, mitral, pulmonic, and tricuspid valve replacement• heart transplants

• cardiac surgeries not requiring cardiopulmonary bypasssuch as:

• insertion of extracorporeal membrane oxygenators (ECMO) circuits

• cardiac tamponade• thoracoabdominal aneurysm repair

• surgeries required by patients with cardiac-related problemssuch as:

• open insertion and removal of intra-aortic balloon pumps (IABP)• amputations• variety of orthopaedic and general surgical procedures

• cardiac catheterization lab/electrophysiology labsuch as:

• percutaneous ASD and VSD closures• complex cardiac mapping and ablations• emergency cardioversions/defibrillations

• cardiac resynchronization and implantable devicessuch as:

• single and dual chamber pacemakers• insertion and testing of implantable automated

cardiodefibrillators• loop recorder insertion and removal

The cardiac anesthesia team also performs more than 950 transesophageal echocardiograms (TEEs) in operatingtheatres and critical care units each year. As well, the teamprovides primary care to patients in the critical care units at the QEII Health Sciences Centre.



The Regional Anesthesia Service now performs more than 150regional anesthesia* procedures, or blocks as they are typicallyknown, each month. In 2007, the team performed less than 100 per month. Regional blocks are a growing preference forpatients.

“Regional anesthesia provides patients with better options formanaging pain,” says Dr. Jennifer Szerb, Medical Director of theRegional Anesthesia Service, HI site. She and the regional anesthesiateam have shown that a regional block, in combination with otheranesthetic, lessens a patient’s recovery time. “It enables patients tobe more mobile and alert following surgery and delivers lasting paincontrol thus reducing the need for opioids such as morphine, whichoften cause negative side effects,” Dr. Szerb explains.

Aside from its direct benefit to patients, the use of regionalanesthesia also improves OR efficiency. With regional anesthesia, ittakes less time for a patient to be ready for surgery. By reducing OR prep time and recovery time, regional anesthesia has a two-pronged impact on OR efficiency.

E x p l o s i v e g r o w t h f o r t h e R e g i o n a lA n e s t h e s i a S e r v i c e

Regional anesthesia is used for pain management in select general,orthopaedic, plastic and vascular surgeries. Beginning in 2009,the service will help to reduce the wait for patients requiringarteriovenous fistula surgery – a procedure that enables people withrenal failure to continue with dialysis.

*Regional anesthesia is characterized by the loss of sensation in a specific

region of the body, caused by the injection of local anesthetic around a

peripheral nerve or the spinal cord.

R e g i o n a l B l o c k s

2000

1500

1000

500

2006-2007 2007-2008 2008-2009BLOCKS

0

• The regional block room, a designated space for regional blocks to be performed outside of the operating theatre,opened at the QEII Health Sciences Centre on April 1, 2008

• Though regional blocks were performed prior to 2006, the Department of Anesthesia officially began to record the number of regional blocks being performed annually in 2006

• The graph represents data collected up to February 15, 2009

Patient experience:

“I have had two experiences with the regional block service in the past two years, both involving orthopaedic surgery.Eighteen months ago I had a partial knee replacement andseven months ago I underwent shoulder arthroplasty. In bothcases, I had excellent pain control during and after theprocedures, was ready for early discharge and recoveredswiftly.”

– Dr. Helen Morrison



B l o o d M a n a g e m e n t

Patient experience:

“I can’t say enough about the Blood Management Program! Mywife and I received support from the service through her battlewith cancer and my heart surgery. In both instances, wereceived the information we needed to make the right decisionsfor us, and in a way that showed compassion and respect forour beliefs. I am very appreciative of the staff’s efforts to makeme feel more at ease and confident in the care I received. I can’tthank them enough.”

– David Wong

“I’m sure I wouldn’t be able to have my surgery without theBlood Management Program. The team, particularly Heather,worked side by side with me to elevate my iron stores to ahealthy level. The team was behind me every step of the way,going so far as to visit me before, during and after intensive irontreatments. They also ensured I had the information I needed totalk with the many physicians and healthcare providers I wasseeing so that everyone was on the same page with mytreatment.”

– Denise Mombourquette

Blood transfusions save lives but there is a downside to receivingblood and blood products. Bacterial infections, human error andnegative reactions can lead to serious transfusion-related problems.

One way to avoid some transfusions is to provide early screeningand treatment to patients undergoing major surgery who areconsidered anemic, and who are thus more likely to require atransfusion during surgery.

The Blood Management Program provides preoperative anemiascreening and treatment for major surgeries at the QEII HealthSciences Centre and the IWK Health Centre. Team members also counsel patients who do not wish to receive blood products and coordinate intraoperative surgical and anesthetic bloodmanagement techniques.

Since its inception, the Blood Management Program has made greatstrides not only in clinical care, but also in education and research.It is a resource for Atlantic Canadian hospitals, educating staff,residents, nurses and other health professionals on the most current techniques in peri-operative blood management. A new fellowship program will put blood management education at the forefront in Canada. Further, the team plans to pursueaccreditation by the American Association of Blood Banks – a firstfor such a program in Canada.

G r o w i n g a n A t l a n t i c C a n a d i a n r e s o u r c e


Education


Teaching the Next Generation of Physicians

The introduction of an academic funding plan (AFP) for theDepartment of Anesthesia has improved the breadth and depth of alleducation activity, undergraduate and resident teaching, andcontinuing professional development.

• In 2008, the Department of Anesthesia established an Office of Education. The office is charged with coordinating and growing education opportunities for all members of the department. It was actioned as part of the Department of Anesthesia’s strategic plan.

• The number of physicians in the Department of Anesthesia who teach undergraduate medical students through the case orientedproblem-stimulated (COPS) curriculum rose from six in 2005 to 17 in 2008. The number of COPS teaching hours rose from 316to 738.

A n e s t h e s i a C O P S t e a c h i n g

• Teaching faculty in the department are recognized by medical students and residents each year through Teacher of the Year Awards. Recipients include:

Clinical Teacher of the Year

Dr. Orlando Hung, 2005Dr. Gord Whatley, 2006Dr. Fiona Roper, 2007Dr. Adam Law, 2008

Undergraduate Teacher of the Year

Dr. Ben Schelew, 2006Dr. Janice Chisholm, 2007Dr. Tobias Witter, 2008

• In 2008, the Department of Anesthesia received close to 190 applications from medical students in Canada, the United Statesand around the globe for its five residency positions. Of the five positions, one was reserved in 2007 and 2008 for an international medical graduate who would commit to practise in either Nova Scotia or New Brunswick upon graduation. The department plans to do the same in 2009. Programs such as this help communities in the Maritime provinces to attract and retain physicians.

Educat ionDepar tment of Anesthes ia Report on Per formance 2005-200826

Hours (x10)Tutors

Encouraging Lifelong Learning Inspiring Minds More Than EverBefore

Dr. Ben Schelew has taught undergraduate medical students andresidents for the last eight years. The anesthesiologist andundergraduate program director is an award-winning teacher whowas once one of only a handful of physicians in the Department of Anesthesia who taught undergraduate medical students.

The introduction of an academic funding plan in the Department of Anesthesia has encouraged more physicians to teachundergraduate medical students because of a compensationallowance for teaching and other academic activities. Somephysicians like Dr. Schelew, however, have dedicated much oftheir careers to teaching future doctors.

Recognized by medical students for breathing life into lifeless studymaterial and relating real experience to cases, Dr. Schelew says hisrole as a tutor and mentor is to encourage lifelong learning.

For his teaching excellence, he has received the Silver ShovelAward, which is the most prestigious undergraduate teaching awardin the Dalhousie Faculty of Medicine, and Teacher of the Year awards from residents and undergraduate students in the Department ofAnesthesia.

Dr. Kate Shields spends more time inspiring minds throughteaching than ever before, and loves every minute of it. She is an anesthesiologist with specialized training in critical care.

Whenever Dr. Shields is in the OR or in the intensive care unit, sheis teaching. She also presents formal lectures on critical care toresidents, works with them on cases, and delivers guest lectures inother departments.

Dr. Shields is passionate about what she does.

“Teaching keeps me up to date on the latest research and develop-ments – I want to be sure I’m delivering the best knowledge toresidents. This, of course, benefits patients as well,” she says.

Dr. Stuart Wright says Dr. Shields is the primary reason he chose anesthesia. “She recognized, much more so than I did, thatanesthesia was for me,” he says. “As a medical student I wasconsidering other disciplines when Dr. Shields suggested that Ishould pursue anesthesia.” Dr. Wright is now in his fourth year of the anesthesia residency program at Dalhousie.

“Dr. Shields provides medical students and residents with skills andknowledge then equips them to recognize the questions, findanswers and solve problems on their own,” notes Dr. Wright.

Educat ion Depar tment of Anesthes ia Report on Per formance 2005-2008 27

Educat ionDepar tment of Anesthes ia Report on Per formance 2005-200828

Dr. J. Bruce Smith Receives 2008Canadian Anesthesiologists’Society Clinical Teacher Award

Providing Excellent Opportunitiesat Home

Dr. Bruce Smith has connected with three generations of Canadiananesthesiologists through 20 years at McGill and ten atDalhousie. He is recognized for being knowledgeable andexperienced, with a unique, innate ability to clarify and simplifycomplex material. He has embraced the needs of medical studentsand residents whether strong, weak or vulnerable.

Almost all of the present anesthesia leaders at McGill Universitywere trained by Dr. Smith and that will soon be true for Dalhousie.

At McGill, his reputation is legend. As program director at Dalhousie,he was very involved as everyone’s advocate and facilitator.Dr. Smith is recognized and cherished for his generosity, toleranceand spirit.

Dr. Peter Coady didn’t think he would like anesthesia – that is until he got a real taste of it at Valley Regional Hospital in NovaScotia’s Annapolis Valley. “From then, I never looked back,”says Dr. Coady. He’s now a first-year Dalhousie anesthesia resident and a participant in Nova Scotia’s return of service program.

Dr. Coady spent his first two years as a medical student in the Dutch West Indies attending Saba University School of Medicine.His last two years were spent in clerkships at hospitals in Florida,Maryland and Nova Scotia. He had had enough of travelling and closeties to his roots were calling him home permanently when he appliedto the Dalhousie anesthesia residency program.

Considered an international medical graduate, when Dr. Coadyapplied to anesthesia, he applied to do so as part of Nova Scotia’s return of service program. Through the program, theprovincial government covers the cost of Dr. Coady’s residencytraining in exchange for a guarantee that he will work in a rural area of Nova Scotia upon graduation – one year of practice for each year of training. For its part, the Department of Anesthesiareserves one of its five residency positions each year for aninternational medical graduate who commits to practise in eitherNova Scotia or New Brunswick upon graduation.

1 “Problem” Rounds(27 hours)

2 Anesthesia in Challenging Environments (5 hours)

3 Glostavent Session (3 hours)

4 Maternity Anesthesia CRM (3 hours)

5 PGY2 Induction Airway Management (36 hours)

6 Thoracostomy/pericardio- centesis Workshop (24 hours)

7 Crichothyrotomy workshop (4 hours)

1

2

67

345

1 Anesthesia CRM Research Study (51 hours)

2 PGY2 Induction Airway Management (24 hours)

2

1

2008/2009

Educat ion Depar tment of Anesthes ia Report on Per formance 2005-2008 29

Providing Innovative Learning Opportunities: Atlantic Health Training & Simulation CentreFebruary 1, 2009, marked 10 years of providing innovative learningopportunities at the Atlantic Health Training & Simulation Centre.The Department of Anesthesia is one of the centre’s foundingpartners, having recognized early on the importance of experientiallearning for its residents and staff. The simulation centre was thefirst of its kind in Canada and boasts a reputation for innovationand leadership in training.

At the simulation centre, learners – residents, staff physicians,nurses, allied health professionals and paramedics – practisetechniques and enhance their critical thinking and interventionalskills. The centre’s simulators and innovative scenarios are itsstrength as a learning facility.

The simulators include sophisticated computer-based mannequins and part-task simulators. They can demonstrate clinical signs,physiological responses to medications, anesthetic and therapeuticgases and approximate tissue-plains for many clinical procedures.

The simulation centre can be configured to resemble an operatingroom, a critical care unit or emergency department, or an out-of-hospital environment. It is equipped with all the appropriate medicalequipment and supplies. In addition, it employs video and audiorecording devices used to review and discuss learners’performance.

Dr. Adam Law, anesthesiologist and the centre’s Medical Director,notes that he and others ensure the simulation centre provideslearning opportunities that are as real as possible. “The simulationcentre is a tremendous resource for health professionals, replicatingclinical conditions while enabling repetitive practice so that learnersenhance both skill and confidence.”

For Department of Anesthesia members, the simulation centreprovides a range of learning opportunities from airway managementtechniques and interventions to critical care and emergencyscenarios. Over the last three years, department members haveincreased and broadened their use of the simulation centre. Forinstance, residents in the Department of Anesthesia now use thesimulation centre for “problem rounds.” On a weekly basis, residentsmeet to review particularly challenging cases and scenarios. Part ofthis study includes replicating the challenging case/scenario in thesimulation centre and practising clinical skills to manage the case.

2005/2006


ResearchDEPARTMENT OF ANESTHESIA

• Evidence of growing research capacity and activity within the Department of Anesthesia is seen in the increase in the scholarlyoutput such as peer reviewed articles which have increased four-fold, from 12 in 2005 to 40 in 2008.

• Fostering research and laying the foundation for a research-richdepartment, the Department of Anesthesia established the Officeof Research in 2008. The office facilitates a culture that promotes the achievement of research goals and excellence.

• The Office of Research worked with researchers in anesthesia to produce an accountability framework. This framework – a first of its kind among academic medical departments in Canada – reflects the department’s values of transparency and accountability, establishing clear standards and expectations against which research performance is measured and reported.

• Dr Ron George impacts the quality of maternal-child care at home and abroad.

• The Office of Research supports the department’s researchers,including Dr. Ron George and others such as:

• Dr. Mary Lynch, who was awarded more than $1.8M in funding by the Canada Foundation for Innovation, the Province of Nova Scotia and the Dalhousie Medical Research Foundation as principal investigator of the Canadian Pain Trials Network.

• Dr. Allen Finley, who received the department’s first award from the Teasdale Corti Global Health Research Initiative for more than $900K.

Building a Research-Rich Department to Improve Patient Care Here andAround the World

A vibrant and productive research environment is critical to creating new knowledge that advances the science andpractice of anesthesia. In the last three years, the Departmentof Anesthesia has incubated a vibrant research culture andgrown the capacity for high quality research.

• By 2008, the Department of Anesthesia had increased the number of dedicated researchers, that is anesthesiologists who receive funding from the department to participate in research activities for a predetermined amount of time in theirworkweek, to nine from three in 2005.

• These researchers primarily focus their research efforts in fiveareas:

• Chronic and acute pain• Airway management• Sepsis and inflammation• Organ protection and anesthetic action• Patterns of ventilation-induced lung injury

• Department of Anesthesia Research Funding:

ResearchDepar tment of Anesthes ia Report on Per formance 2005-200832

Moving Research from theBench to the Bedside

Many people hate needles and some can’t swallow medication.There are few other options. Much of Dr. Orlando Hung’s researchcareer has been dedicated to finding a better way to deliver drugs.

In 1992, Dr. Hung began to think that inhaling medication could be an option for the delivery of pain medication. That’s when theanesthesiologist and now Academic Director of Research started aresearch journey. What he and his collaborators have found sincethen is that inhalation as a drug delivery method has many benefitsand could dramatically change how people take medications.

“When medication is inhaled, it starts working very rapidly becausethe lungs absorb it quickly,” explains Dr. Hung. “We have also foundthat liposomes, tiny bubbles composed of the same material as cell membranes, can act as regulators for medication. They releaseadequate amounts into the system resulting in sustained pain relief.”

Dr. Hung took his idea from the bedside to the bench and back again which has included many studies in the lab, numerousmanufacturing practices and tests, and clinical trials. His work hasalso involved integral partnerships with industry – a step Dr. Hungsays is necessary to move research from ideas to practice.

Drug delivery methods are not Dr. Hung’s only focus. He is an activeclinician, researcher and leader in the Department of Anesthesia.Leading by example, Dr. Hung has authored more than 100publications, co-authored two books on airway management and isa well-known and respected teacher of airway managementtechniques. He is a mentor to department members, residents andstudents.

Research Depar tment of Anesthes ia Report on Per formance 2005-2008 33

D r . O r l a n d o H u n g ’ s r e s e a r c h j o u r n e y

Fostering Research ExcellenceNow and for the Future

Within a five-year span, Dr. Dolores McKeen completed heranesthesia residency, a combined obstetric anesthesia/researchfellowship and a master’s degree in clinical epidemiology. She is aresearch advocate and mentor to Dalhousie students and residents,acting as a research supervisor and teaching research methodology.Her own research endeavours include assessing the effectiveness of current treatments and practices in women’s and obstetricanesthesia.

For Dr. Erin MacQuarrie, a second-year anesthesia resident,Dr. McKeen has been a role model and mentor. With Dr. McKeen’sguidance, Dr. MacQuarrie undertook a project to examine patients’perceptions of care provided by residents.

“Dr. McKeen shows incredible commitment and enthusiasm towardher work, which is infectious,” says Dr. MacQuarrie. “I gained amuch better appreciation for the research process, but also learnedto look at things in all aspects of work and life a bit differently,perhaps with more curiosity, than I would have otherwise.”

Dr. McKeen is currently working on a national research methodologycourse for the Canadian Anesthesiologists’ Society that will betaught across Canada, extending her commitment to researchexcellence well beyond the Department of Anesthesia.

D r . D o l o r e s M c K e e n : R o l e m o d e l a n dm e n t o r


Bringing New Research andResearchers to Nova Scotia

Ninety per cent of people who are critically ill require mechanicalventilation and, as a result, are at risk for acute lung injury.Dr. Dietrich Henzler seeks ways to minimize or eliminate theadverse effects of mechanical ventilation on the lungs.

Dr. Henzler’s focus is two-fold: He and his collaborators are trying tofind out what ventilator settings reduce or eliminate damage to thelungs. They are also exploring the best physiological indicators uponwhich to base those settings.

Ventilator settings control the type and amount of breathing supportand are adjusted to each patient and circumstance. Exactly whenand how to adjust the settings to best minimize lung injury have not yet been well evaluated. “This is like driving a car in the winterwith frosted windows. You have control over steering and throttle butcan’t see the road limits or slope which should dictate how you aredriving,” notes Dr. Henzler.

“In the lab we study the physiological effects of different ventilatorsettings in animals. Every change in the settings has a physiologicalimpact,” he explains. “We hope the knowledge we’re gaining and thedata we’re gathering will give us the information we need to moveon to human clinical trials within 12 to 16 months.”

Dr. Henzler and his local team work with key collaborators in Italy,Germany and other parts of Canada. He began his research atAachen University Hospital in Germany where he worked beforejoining the Department of Anesthesia in 2007.

D r . D i e t r i c h H e n z l e r s t u d i e s v e n t i l a t i o n -a s s o c i a t e d l u n g i n j u r y

Focusing on the Safety & Efficacyof Drugs

Trying to define the impact of medications on healthcare would be as monumental as the impact itself. Drugs permeate medicine.They give patients hope, relief, and in some cases life. Much of Dr. Richard Hall’s research is devoted to testing the safety andefficacy of drugs.

Most recently, Dr. Hall completed a research study that examined theeffects of drugs, such as morphine, on people with head injuries. Heand his team found that, in people with head injuries, these drugscan pass through the blood-brain barrier and enter the brain. Thisunintended and potentially adverse effect does not occur in peoplefree of head injury. “We hope this study will lead to even greatervigilance and further examination of the effects of drugs on thispopulation,” says Dr. Hall.

Currently, Dr. Hall has clinical trials underway to study the potentialof two different types of drugs to slow down and/or treat sepsis. Fiftyper cent of people who develop severe sepsis will die and thoughmore than 50 drugs have been tested to date, only one is being usedto effectively treat the life-threatening condition.

The anesthesiologist is also an integral member of the Canada-wideCritical Care Research Network. Dr. Hall is a co-investigator in amulti-centre clinical trial of the safety and efficacy of new drugs toaddress blood clots in older adults. The study, which began in 2007,involves about 15 academic health centres across Canada and morethan 2,000 participants.

In a second project as part of the network, Dr. Hall is examiningcurrent processes used across Canada to obtain consent frompatients in critical care units. The results of the qualitative study areexpected to help standardize a process for obtaining consent andmake it easier to conduct clinical research in critical care settings.

D r . R i c h a r d H a l l e x a m i n e s t h e e f f e c t s o fm e d i c a t i o n


Bringing New Research and Researchers to Nova Scotia (cont’d.)

More than 50 per cent of people who develop severe sepsis die from the condition. Severe sepsis occurs when immune response toan infection goes into overdrive, triggering widespread inflammationand microscopic clots in blood vessels throughout the body.Consequently the body begins to shut down and vital organs fail.

People in hospital and/or people who have undergone surgery are atincreased risk of developing sepsis, which stems from an infectionsomewhere in the body.

Through his research, Dr. Christian Lehmann seeks to identifyearly signs of sepsis and to facilitate early diagnosis and treatment.He is an anesthesiologist with specialized training in critical carewho, in his clinical work, has seen the devastating effects of sepsis.

In preclinical studies, Dr. Lehmann and his team use intravitalmicroscopy to visualize and examine the microcirculatory system,vessels of the blood and lymphatic system. “We’re aiming to identifychanges in white blood cells and the speed of red blood cellsthrough the capillaries,” says Dr. Lehmann. “These markers may bethe earliest indicators of sepsis.”

Since January 2007, Dr. Lehmann has been leading a researchprogram at Dalhousie University while also maintaining a program atErnst Moritz Arndt University Greifswald in Germany. He will join theDepartment of Anesthesia on a full time basis in 2009.

About 75 per cent of elderly people experience neural cognitivedecline following cardiac surgery. Following orthopaedic surgery, theoccurrence is slightly less, at 50 per cent. Both percentages areoverwhelmingly high.

Through his research efforts, Dr. Michael Schmidt aims to helpreduce or eliminate neural cognitive decline following major surgery.He is most interested in determining the ideal drugs for anesthesia– drugs that have little or no adverse effects or that actually protectpatients’ organs, including the brain, from adverse effects.

Specifically, Dr. Schmidt and his team explore four interrelatedareas:

• Methods to protect organs, including the brain, from the adverse effects of anesthesia, particularly in cardiac surgery.

• The creation of models to investigate inflammation in the brain and subsequently a connection between brain inflammation during surgery and neural cognitive decline following surgery.

• Whether and/or how organs could be pre-conditioned prior to transplantation to improve outcomes.

• The most efficient and cost-effective methods of delivering gases known to have neuroprotective properties.

Dr. Schmidt joined the Department of Anesthesia in 2007. Hiscollaborators now include some of the most prominent researchersat Dalhousie. “I chose to come here because of the researchinfrastructure, and the collaborative and cooperative environment.There isn’t a better place for me to grow my research,” says Dr. Schmidt.

T h e e a r l i e r t h e b e t t e r : D r . C h r i s t i a nL e h m a n n s e e k s t o i d e n t i f y t h e e a r l i e s ts i g n s o f s e p s i s

D r . M i c h a e l S c h m i d t w a n t s t o h e l pe l i m i n a t e n e u r a l c o g n i t i v e d e c l i n ef o l l o w i n g s u r g e r y


Chronic Pain Research: Making Our Mark on Canada and the World

• Dr. Mary Lynch, a nationally and internationally recognized pain management expert, leads the chronic pain research team. Dr. Lynch’s research interests include the development of new agents for the treatment of neuropathic pain,integrative care in chronic pain management, development of wait-time benchmarks and strategies for service delivery.Dr. Lynch is founding director of the Canadian Consortium for the Investigation of Cannabinoids and principal investigator of the Canadian Pain Trials Network.

• In 2007, the chronic pain research team, led by Dr. Lynch,opened a clinical trials suite as a result of receiving more than$1.8M in funding from the Canada Foundation for Innovation,the Province of Nova Scotia and the Dalhousie Medical Research Foundation. The research suite provides specially configured space to conduct clinical trials and other research studies designed to discover the most effective treatments for chronic pain.

• In addition, Dr. Lynch is exploring complementary therapies in the treatment of chronic pain. She and Dr. Jana Sawynok,Dalhousie Department of Pharmacology, recently completed a study that showed a form of qigong relieves pain and other symptoms of fibromyalgia. Further, Dr. Lynch is in the midst of her first qualitative research study on the effect of art on pain with the Inspirational Artists Research Project.

• With support from the Nova Scotia Health Research Foundation, Dr. Ron George, together with Drs. Dolores McKeen and Ashraf Habib (Duke University), are testing the effectiveness of a new medication to manage acute pain following abdominal hysterectomy. Aggressive management of the acute pain may reduce the risk of complications following surgery and limit the development of chronic pain.

• Dr. Peter MacDougall, with support from the Province of Nova Scotia, established the Nova Scotia Chronic Pain Collaborative Care Network to improve the availability and quality of chronic pain care and treatment in Nova Scotia.Dr. MacDougall and his team are currently studying the effect of its introduction on patients, family physicians and other primary care providers.

Helen Tupper is a participant in the Inspirational ArtistsResearch Project.


Local Study and Knowledge of Pediatric Pain Improves Care andTreatment of Children in Thailand

In 2007, a team led by Dr. Allen Finley, pediatric anesthesiologist,received more than $900K through the Teasdale-Corti Global Health Research Initiative to improve pediatric pain management inThailand.

Dr. Finley is working with Dr. Somboon Thienthong, professor ofanesthesiology at Khon Kaen University in Thailand, to develop apediatric pain management program with standardized approachesto ensure the best possible pain prevention and treatment forchildren. Concurrently, the process of disseminating information andchanging practice is being studied.

The project includes co-investigators in nursing, anesthesiology,pediatrics and computer science from Dalhousie and Khon KaenUniversity. The team’s work has translated into ongoing improvedcare and treatment.

The Global Health Research Initiative, a partnership between theCanadian Institutes of Health Research, the Canadian InternationalDevelopment Agency, Health Canada and the InternationalDevelopment Research Centre, awards grants to projects that pairCanadian health researchers with counterparts in the developingworld.

D r . A l l e n F i n l e y r e c o g n i z e d f o r w o r kt o e n d c h i l d r e n ’ s p a i n

The American Pain Society (APS) honoured Dr. Allen Finleyin 2008 for his global efforts to end children’s pain. The societypresented Dr. Finley with the Jeffrey Lawson Award forAdvocacy in Children’s Pain Relief at its annual meeting in May.

Established in 1996, this honour is bestowed upon only oneexceptional individual each year.

Funding Support


A s e l e c t i o n o f s o m e o f t h e D e p a r t m e n t o f A n e s t h e s i a ’ s r e s e a r c h f u n d i n g , 2 0 0 5 – 2 0 0 8 :

Canada Foundation for Innovation, Nova Scotia Research andInnovation Trust, Dalhousie University Department ofAnesthesia$416,351Lehmann, C. (Principal Investigator)Project: Innovations in microcirculatory sepsis research –mechanisms of new anti-inflammatory strategies in the intestinalmicrocirculation2008-2009

Canada Foundation for Innovation, Province of Nova Scotia,Dalhousie Medical Research Foundation$1,877,446Lynch, M. (Principal Investigator)Project: Canadian Pain Trials Network2005-2007

Canadian Anesthesiologists’ Society(David S. Sheridan Canadian Research Award)$10,000MacDougall, P. (Principal Investigator)Project: Nova Scotia Chronic Pain Collaborative Care Network pilotproject2007

Canadian Institutes of Health Research $11,375Hall, R. (Co-Investigator)Project: Morphine handling and responses in patients with braintrauma2005-2006

Canadian Institutes of Health Research$84,454Hall, R. (Site Investigator)Project: The PROphylaxis for thromboembolism in critical care trial(PROTECT study)2006-2009

Canadian Institutes of Health Research$28,579Lynch, M. (Site Investigator)Project: Stop Pain Project: Evaluation of human and economicburden of chronic pain2005-2007

Canadian Institutes of Health Research$112,416Finley, G.A. (Co-Investigator)Project: Psychological pain management techniques for childrenwith intellectual disabilities2007-2009

Canadian Institutes of Health Research$1,379,952Finley, G.A. (Co-Investigator)Project: Translating research on pain in children (TROPIC)2008-2012

Canadian Institutes of Health Research$21,298Finley, G.A. (Principal Investigator)Project: Collaborative program for children’s pain management inBrazil2008

Canadian Institutes of Health Research, Hospital for SickChildren$194,467Finley, G.A. (Site Investigator)Project: Team grant in children’s pain, common database2005-2010

Canadian Institutes of Health Research$138,583Lynch, M. (Site Investigator)Project: Cannabis for the management of pain, assessment ofsafety study (COMPASS) 2005-2008

Capital District Health Authority (Capital Health ResearchFund)$27,843MacDougall, P. (Principal Investigator)Milne, D. (Co-Investigator)George, R. (Co-Investigator)McKeen, D. (Co-Investigator)Project: Effects of Pregabalin on pain following breast cancersurgery2007

Funding Support (Cont’d)


Dalhousie Medical Research Foundation$31,632Lehmann, C. (Principal Investigator)Project: Receptor modulation in experimental sepsis2008

Dalhousie University (Clinical Research Scholar Award)$405,000Henzler, D. (Principal Investigator)Project: Prevention of ventilator-associated injury in lungs(PREVAIL)2007-2012

Dalhousie University (Faculty of Medicine Intramural Grant)$19,600Lehmann, C. (Principal Investigator)Project: Receptor modulation in experimental sepsis2007

Dalhousie University (Faculty of Medicine Intramural Grant)$19,465Henzler, D. (Principal Investigator)Project: Effects of experimental lung injury on hemodynamics, gasexchange and activation of inflammation2007

IWK Health Centre (Recruitment and Establishment Grant)$96,000George, R. (Principal Investigator)Project: Women’s and obstetric analgesia2008-2010

Nova Scotia Department of Health$50,000MacDougall, P. (Principal Investigator)Project: Nova Scotia Chronic Pain Collaborative Care Network pilotproject2008

Nova Scotia Health Research Foundation$115,269George, R. (Principal Investigator)McKeen, D. (Co-Investigator)Lynch, M. (Co-Investigator)Project: Clinical trial of Pregabalin for postoperative pain in womenundergoing abdominal hysterectomy2008-2011

Nova Scotia Lung Association$14,375Henzler, D. (Principal Investigator)Project: Pressure-volume curves in partial ventilatory support2008

Shriners Hospitals for Children$229,674Finley, G.A. (Co-Investigator)Project: Botox injection in alleviating postoperative pain andimproving quality of life2006-2007

Teasdale-Corti Global Health Research Partnership$981,900Finley, G.A. (Principal Investigator)Project: Pediatric pain management in rural and urban Thailand2006-2011



I n d u s t r y F u n d i n g

AstraZeneca$108,755Lynch, M. (Site Investigator)Project: A real life prospective observational study, multicentrestudy of health outcomes in the treatment of painful diabeticneuropathy and post-traumatic neuralgia in the context of routineclinical care2005-2008

Bayer (Canada) Inc.$134,795Hall, R. (Site Investigator)Project: Effect of Aprotinin on transfusion requirements and bloodloss in hip replacement surgery2005-2006

Boeringer$37,000Murphy, M. (Principal Investigator)Project: Ipratropium versus Ventolin2007

Coeur Metrics Inc.$19,900Hall, R. (Principal Investigator)Project: Measurement of cardiac output using ballistocardiography2005

Coeur Metrics Inc.$30,000Hall, R. (Principal Investigator)Project: Mathematical model of cardiac function and motion2008

Draeger Medical Canada$65,000Henzler, D. (Principal Investigator)Project: Prevention of ventilation associated injury in lungs2007

Draeger Medical Canada$10,000Henzler, D. (Principal Investigator)Project: Models of lung injury2007

Eisai Medical Research Inc.$245,791Hall, R. (Site Investigator)Project: Clinical trial of Eritoran Tetrasodium2006-2009

GlaxoSmithKline$45,000Hung, O. (Principal Investigator)Project: Prevention of postoperative nausea and vomiting 2005-2006

GlaxoSmithKline$103,000McKeen, D. (Principal Investigator)Project: The safety, efficacy, and pharmacokinetics of the OralNeurokinin-1 Receptor Antagonist, GW679769, when administeredwith Intravenous Ondansetron Hydrochloride for the prevention ofpost-operative nausea and vomiting and post-discharge nauseaand vomiting2005



GlaxoSmithKline$44,700Hall, R. (Primary Investigator)Project: Treatment of severe sepsis in adults2005-2007

GlaxoSmithKline$28,384Hung, O. (Principal Investigator)Project: Prevention of postoperative nausea and vomiting in womenat high risk for emesis2006

GW Pharmaceuticals$25,825Lynch, M. (Site Investigator)MacDougall, P. (Co-Site Investigator)Project: Clinical trial of Sativex for peripheral neuropathic pain2006

J&J PRD – Janssen Ortho Inc.$30,000Chisholm, K. (Principal Investigator)Hung, O. (Principal Investigator)Project: Treatment of acute pain following total hip replacementsurgery2007

Lilly Canada$150,549Hall, R. (Site Investigator)Project: Treatment of Drotrecogin Alfa in patients with severesepsis and multiple organ dysfunction2007-2009

NeurogesX Pharmaceuticals$35,000Lynch, M. (Site Investigator)MacDougall, P. (Co-Site Investigator)Project: A multicentre randomized double blind controlled study oftopical high-dose capsaicin in post herpetic neuralgia2006-2009

Nova Nordisk Canada $53,674Hall, R. (Co-Investigator)Project: Efficacy and safety of activated recombinant factor VII inseverly injured trauma patients2006-2008

Purdue$27,851Lynch, M. (Site Investigator)Project: A randomized controlled trial of extended releaseTramadol in the treatment of post herpetic neuralgia2007

Tanox$19,016Hall, R. (Principal Investigator)Project: Effects of TNX-832 in patients with acute lung injuryand/or acute respiratory distress syndrome2005-2006

Valeant Canada$132,869Lynch, M. (Primary Investigator)Project: Canadian Consortium for the Investigation of Cannabinoids2005-2009


Stewardship


StewardshipDepar tment of Anesthes ia Report on Per formance 2005-200844

A First in North America

What do you call a course, started by one of the smallest anesthesiadepartments in Canada, that’s a first in North America and one ofonly three of its kind in the world?

“It’s a bit of a coup!” says Dr. Tom Coonan, founder of GlobalOutreach: Anesthesia in Challenging Environments. Modelled aftercourses in Oxford, England, and Hobart, Tasmania – the onlycourses dedicated specifically to preparing anesthesiologists formissions to developing countries – the Halifax course draws uponglobal outreach experts to share their knowledge of deliveringanesthesia care in difficult circumstances.

The course was first held in June 2008. Participants, who camefrom Canada and the United States, learned how to fix equipmentdesigned for difficult environments and how to manage surgerywithout reliable electricity or necessary medications. They alsoexamined intangibles like trusting your gut, handling crises andknowing when to step back.

Many participants describe the course as intense and very valuableand an overwhelming majority rated it as excellent. In their feedbackon the event, one participant wrote “It was a challenging andvaluable time – intellectually, philosophically and personally – and a lot of fun too. A good deal was exchanged about the philosophy of aid, and how we can best be helpful in a sustainable way. It was an invaluable exchange of ideas.”

Anesthesia in Challenging Environments was made possible bysupport from the Department of Anesthesia, the CanadianAnesthesiologists’ Society International Education Foundation,corporate sponsors and course faculty, and guidance from theOxford and Hobart organizers and the World Federation of Societiesof Anaesthesiologists.

A sample of participants’ comments:

“The quality of the visiting faculty was outstanding. All thepresentations were great. Well organized and clearly presented. Avery inspiring experience!”

“An excellent, inspiring course! This is just what theanesthesiologists of Canada need! Thank you!”

“The content seems quite comprehensive and suitable for partici-pants just starting or thinking about being involved in this type of work”

“This was a fantastic course, I loved it and feel very inspired”

G l o b a l O u t r e a c h : A n e s t h e s i a i nC h a l l e n g i n g E n v i r o n m e n t s

I n t e r n a t i o n a l O u t r e a c h P r o g r a m :O n t h e m a p a s a l e a d e r i n a n e s t h e s i ao u t r e a c h

In 2008, the Department of Anesthesia launched a formalprogram to improve anesthesia and perioperative care globally.The International Outreach Program aims to build sharedknowledge, provide education and training, build capacity forservice delivery, and engage in research and evaluation. Theprogram is in the early stages of establishing relationships andbuilding collaborations around the world – including those thatwere instrumental in instituting the Global Outreach: Anesthesiain Challenging Environments course in Halifax. Thedepartmental program supported two department members toundertake a mission to Rwanda in November 2008 and willsend another two department members to the region in early2009.

Building Healthcare Leaders inGhana to Improve Women’s andNewborn Health

Extending Our Teaching Efforts toRwanda

In September 2008, Dr. Ron George visited Ghana on his secondmission to the West African country. This trip was part of hiscontinued support of Kybele, an organization that aims to improvechildbirth conditions around the world, and a follow-up to a firstmission about a year earlier.

In June 2007, Dr. George travelled to Accra, Ghana’s capital city, aspart of a Kybele mission. While there, he and a group of healthcareprofessionals helped to identify and build healthcare leaders throughtraining and education. The group also lobbied for appropriate healthservices for women and newborns. During the most recent mission,Dr. George and the Kybele team evaluated – and found – successmarkers such as changes in obstetrical practice and procedures.

Dr. George, Dr. Yemi Olufolabi (Duke University), and Dr. EmmanuelYeboah (University of Saskatchewan) also spent part of this latestmission evaluating the potential expansion of the Kybele-Ghanamission to the interior region of the country.

Dr. George hopes to continue the success of Kybele in Ghana andlead a Kybele team back to Sunyani Regional Hospital in 2009.

In November 2008, Drs. Patricia Livingston and GenevieveMcKinnon spent a month in Rwanda as volunteer teachers,sharing their knowledge and skills with anesthesia residents and nurses. The two travelled to Rwanda as part of the CanadianAnesthesiologists’ Society International Education Fund program,and are the first department members to visit the country throughthe Department of Anesthesia’s International Outreach Program.

Drs. Livingston and McKinnon were inspired to undertake themission after participating in the Global Outreach: Anesthesia inChallenging Environments course held in Halifax in June 2008.The mission proved to be an eye-opening experience whetherconsidering Rwanda’s incredibly beautiful scenery or contrasts inhospital conditions.

In just their second day in Kigali, Rwanda’s capital city,Drs. Livingston and McKinnon met with residents at CentreHospitalier de Kigali (CHK), Kigali’s main hospital, and developed acomprehensive teaching plan for the month. Their goals were toenhance the residents’ knowledge of pain management, airway and preoperative assessment. The teaching at CHK took place with very modest equipment in mostly poor conditions amidst heavyconstruction in many parts of the hospital. None of this, however,overshadowed the enthusiasm or appreciation of the residents.

“We found the residents to be gentle, warm and very welcoming.They had excellent ideas as to how they would like to be taught andwhat they wanted to learn,” says Dr. Livingston.

Drs. Livingston and McKinnon provided formal lectures, smallinteractive group sessions, and practical hands-on airway sessionsto residents and nurses in King Faisal Hospital Kigali and CentreHospitalier de Butare as well as CHK.

Stewardship Depar tment of Anesthes ia Report on Per formance 2005-2008 45

Ensuring High Quality Anesthesia Care for All Nova Scotians

StewardshipDepar tment of Anesthes ia Report on Per formance 2005-200846

Residents across Nova Scotia should benefit from the robustacademic health sciences community of Halifax. This is the premiseupon which Dr. Emerson Moffitt initiated the AnaestheticServices Program Encompassing Nova Scotia (ASPENS) in1986. He wanted to ensure all Nova Scotians had access to high-quality anesthesia care employing the best practices based on thelatest scientific evidence.

Through a rejuvenated ASPENS, the Department of Anesthesiasupports anesthesiologists in hospitals and health centres acrossthe province to provide safe, high-quality anesthesia care. Itsmandate includes advocacy, education, specialty consultation andhospital-based service reviews.

ASPENS coordinator Dr. Des Writer, an anesthesiologist with more than 30 years’ experience and expertise, carries forwardthe ASPENS mandate. He often points out, however, the role ofall anesthesiologists across Nova Scotia. “We can only ensure thebest patient care across the board by working together,” says Dr. Writer. “Building relationships and collaborations among theanesthesia community in Nova Scotia is essential.”

Reflecting ASPENS’ province-wide reach, Dr. Writer is supported bythe ASPENS advisory committee. Its members stem from regionalhospitals, Doctors Nova Scotia, the Nova Scotia Department ofHealth and Capital Health.

Specifically, ASPENS:

• provides advice, as requested, regarding anesthetics and anesthesia equipment;

• coordinates anesthesia education;

• promotes quality assurance programs;

• provides urgent telephone consultation; and

• conducts quality assurance reviews of anesthesia services across Nova Scotia.

Patient care is at the centre of the ASPENS mandate. TheDepartment of Anesthesia, through ASPENS, reaches beyond itsteaching hospitals and health centres to ensure residents acrossNova Scotia have access to safe, high quality anesthesia care.

Atlantic Health Sciences CorporationCorporation des sciences de la santé de l’Atlantique

Documents

REPORT ON PERFORMANCE 2005 - 2008