The Department of Anesthesia and Perioperative Medicine at the Victoria Hospital provides clinical service for vascular, thoracic, orthopaedic (trauma and spine), plastic (including craniofacial), ENT, urologic, oncologic, general surgical, robotic and pediatric (ENT, general, thoracic, urologic, neurosurgical and plastic) surgery. We also have a well-established palliative, acute and chronic pain service. In addition, we provide anesthetic services for ‘out-of-OR’ procedures such as endoscopy/colonoscopy, MRIs, CT scans, interventional radiology, diagnostic/therapeutic lumbar punctures, bone marrow aspirates, kidney biopsies, bronchoscopies and any other ‘out-of-OR’ procedures that might require sedation. Victoria Hospital also provides anesthesia services for all obstetrical patients in the City of London. The site’s emphasis is the clinical teaching of residents, medical students, fellows and allied health professionals. This includes the use of a well-established anesthesia simulator program.
The operating suites at Victoria Hospital have undergone major renovations and reconstruction.
We now have eighteen state of the art operating suites equipped with the latest anesthesia and surgical technological advances.
Anesthesia resources include a transesophageal echocardiography machine with 3D capabilities, two transthoracic echocardiography machines, multiple ultrasound machines for vascular access and for regional anesthesia and state of the art airway equipment. Furthermore, Victoria Hospital is increasing its ability to provide SSEP monitoring for complicated Adult and Pediatric patients.
Both thoracic and vascular subspecialties have flourished and remain popular as resident rotations and as fellowship training programs. Vascular surgery at Victoria Hospital has become a world leader in the endovascular management of thoracic aortic disease. Thoracic surgery has also become a world leader and boasts one of the largest series in Video Assisted Thoracic Surgical procedures. Several recent clinical research projects in these subspecialties have been completed, and others involving Video Assisted Thoracic Surgery (VATS) and pressure-limited one-lung ventilation are underway. With respect to vascular anesthesia, our preliminary results have shown that spinal oximetry detects decreases in spinal cord blood flow early, allowing for the early initiation of preventive treatment spinal cord protection strategies.
This pediatric division is under the guidance of Program Director, Dr. Mohamad Ahmad, with input from members of the Pediatric Anesthesia Subspecialty Group. We currently support three to four dedicated pediatric surgery operating rooms on a daily basis. In addition, we are increasing our involvement in ‘out-of-OR’ settings which include endoscopy/colonoscopy, MRIs, CT scans, interventional radiology, diagnostic/therapeutic lumbar punctures, bone marrow aspirates and any other procedure that is amenable to sedation. We have implemented a ‘Parental Presence at Induction’ Program in conjunction with the hospital’s ‘Child Life Program’ and have expanded paediatric preoperative assessment and postoperative pain management services. Perioperative Pain management, in paediatric patients, is offered in many forms including; PCA, epidurals, single-shot nerve blocks and/or indwelling regional block catheters. We have developed the first paediatric, multi-disciplinary chronic pain program in Southwestern Ontario.
Interested staff continue to participate in the nationwide telemedicine conferences hosted by the Hospital for Sick Children, Toronto, Ontario. Other educational activities in pediatrics include a monthly journal club in collaboration with McMaster University, Hamilton. We also have weekly pediatric rounds to discuss interesting cases and topics. Recently, we have established a multidisciplinary paediatric simulation academic program to deliver simulation-based crisis management training to anesthesia and paediatric residents and fellows, as well as to the nursing staff.
While in its early stages, Victoria Hospital is in the process of establishing a formal regional program for both pediatric and adult patients. We are exploring the creation of a multidisciplinary block room with state-of-the-art imaging and all of the necessary supporting equipment and staffing. We have developed patient information pamphlets explaining the role of paediatric regional anesthesia in pain management, postoperative care after regional anesthesia and on what to do if there are any concerns. We are also developing a paediatric home regional anesthesia program, where we can send paediatric patients home with continuous peripheral nerve blocks and have a system for regular follow up.
Dr. Sandra Katsiris, the Citywide Obstetrical Anesthesia Director, has successfully introduced a citywide standardized obstetrical anesthesia care approach including standardized epidural solutions, PCA, PCEA and postoperative pain management.
With the consolidation of all obstetrical services at Victoria Hospital in London, the volume of births in this level 3 unit has increased to over 6,000 deliveries per year.
The Simulation Program continues to thrive and expand under the guidance of Dr. Richard Cherry. The program delivers simulation-based crisis management training to anesthesia and critical care residents, as well as expanding the program to include more undergraduate medical students and surgical residents. Research collaboration is gaining momentum along with the general awareness and interest in healthcare simulation.
Dr. Ekta Khemani is a new hire for the Department of Anesthesia and Perioperative Medicine at LHSC whose mandate is to help further advance and improve our Quality Assurance program. After completing her Masters of Medical Sciences and residency in Toronto, Dr. Khemani completed a one year certificate in Quality Improvement and Patient Safety at the University of Calgary, where she won first prize for best quality improvement project. Dr. Khemani currently sits on the Victoria Hospital perioperative quality council and the Department of Anesthesia Quality Assurance committee. She is also the recipient of the mini fellowship award for Six Sigma in healthcare. Her current projects include a multidisciplinary quality improvement initiative in ERAS, examining quality indicators in anesthesia care, and developing a QI curriculum for residents and fellows.
Our Anesthesia Assistant program has been a great success and has been well received by all disciplines. It has allowed us to increase our ‘out-of-OR’ commitments for all procedures that require sedation. This has led to an increase in patient safety and satisfaction, more efficient use of resources allowing for an increased utilization of our services. The Anesthesia Assistant program has been beneficial for all, is well supported and continues to expand.
Our multi-disciplinary pain program is well established and continues to expand. We have two nurse practitioners that help with all aspects of pain including research and opioid addiction. A pain database has been developed for recording patient data, which are used for quality assurance and research purposes. Our interventional pain management program is well established and has expanded to include pediatric patients.