St. Joseph's Health Care | | University Hospital | | Victoria Hospital & Children's Hospital
By Dr. William Sischek, Site Chief
St. Joseph’s Health Care London (St. Joseph’s) continues to serve the population of Southwestern Ontario and beyond with a wide array of ambulatory and short-stay surgical procedures. St. Joseph’s is home to the recently named Roth McFarlane Hand and Upper Limb Centre, as well as the Ivey Eye Institute, and also supports minimally invasive surgery for urology, gynecology and general surgery.
The Department of Anesthesia and Perioperative Medicine is pleased with the growth of the Regional Anesthesia program at St. Joeseph’s as well as the integration of the newly formed Comprehensive Pain Management Program (CPMP). The CPMP is intended to coordinate the care of a diverse group of patients by bringing together the Acute Pain, Regional, Chronic Pain and Palliative Care pain groups. While the CPMP has a city wide presence, the new Royal College Chronic Pain fellowship, which is slated to begin summer 2014, will be sited primarily at St. Joseph’s and will form a significant component of training and work there.
As in the past two years, the ambulatory care programs have continued to evolve and are pushing the boundaries for short stay surgery. This past year saw the first of our 23 hour stay robotic, minimally invasive radical prostatectomy procedures. New and innovative surgical approaches to disease have mandated an equally assertive anesthetic management to help meet the ever changing needs of the surgical population. Our department strives to make patient care “goals” standards. With 11 700 surgical procedures in our operating rooms and over 4400 procedures in our cataract suites we have a wealth of opportunities to excel!
University Hospital | Parking, Maps & Directions
By Dr. Chris Harle, Site Chief
The University Hospital is a major quaternary referral center and teaching facility within the University of Western Ontario. We provide anesthesia for cardiac surgery, neurosurgery, general surgery, orthopedic surgery, sports medicine, plastic surgery, urological surgery and ear nose and throat surgery. We are a major transplantation center, and service cardiac transplantation, liver transplantation and kidney and pancreas transplantation. We are actively involved in the provision of anesthetic support for procedures in the interventional radiology suite, the cardiac catheter labs and the electrophysiology labs. We have a strong departmental presence in critical care with faculty members working in both the medical and surgical critical care unit as well as the cardiac surgery recovery unit. We provide ongoing support for a busy pre-admission clinic and we have a flourishing regional anesthesia program and acute pain service. We have a dedicated perioperative Trans Esophageal Echocardiography Service.
The Department of Anesthesia and Perioperative Medicine is actively involved in developing and supporting new and innovative surgical approaches to complex disease processes; in particular we are involved in implantable cardiac support programs, novel surgical approaches to aortic valve diseases as well as robotic surgery for cardiac, hepatobilliary, renal and head and neck surgery.
We have an active Neuro-surgical program and we provide anesthesia for innovative neurosurgical techniques including major epilepsy surgery as well as for device implants for patients with movement disorders and chronic pain.
At present, we have 16 fully operational operating rooms, and have excellent facilities for minimally invasive and robotic procedures. We have one of the first hybrid cardiac surgical facilities in Canada and have the first North American robotic arm neuro-angiography equipped operating room.
We train Residents and Fellows in Cardiac Anesthesia, Perioperative Trans Esophageal Echocardiography, Neuro-Anesthesia, Acute Pain Management, Regional Anesthesia, Airway Management and Liver Transplantation. We also train residents at all levels of training in general anesthesia both from within our own residency program and from other disciplines.
The University Hospital has embraced the Anesthesia Care Team model and are grateful for the support and assistance we receive from our Anesthesia Assistant colleagues who help us in the Operating Rooms, the Block Room and in our Out-of-Operating Room anesthesia locations enhancing patient care, safety and adding sustainability to our work patterns. We are pleased to welcome our fourth full time Anesthesia Assistant, and look forward to recruiting more.
The University Hospital site is the base for many ongoing and proposed research projects, and our Faculty are actively involved in a wide range of research projects including many prestigiously funded projects.
Victoria Hospital & Children's Hospital | Parking, Maps & Directions
By Dr. George Nicolaou, Site Chief
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. Our 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.
We also have a well-established 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 are undergoing major renovations and reconstruction. When completed there will be eighteen state of the art Operating Suites equipped with the latest anesthesia and surgical technological advances.
The Anesthesia office space continues to be modernized with updated computer equipment, as well as an up to date medical library, and a formal classroom/team room that utilizes ‘smart-board’ technology.
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. A previous project led to a change in the postoperative epidural analgesia solution utilized.
This pediatric division is under the guidance of Dr. Mohamad Ahmad, with program direction from members of the Pediatric Anesthesia Subspecialty Group.
It currently support three dedicated pediatric surgery operating rooms on a daily basis. In addition, this is 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 also implemented a ‘Parental Presence at Induction’ Program in conjunction with the hospital’s ‘Child Life Program’ and have expanded pediatric preoperative assessment and postoperative pain management services. Pain management in the ward for pediatric patients with epidurals is both offered and supported. We are also in the process of developing a pediatric, multi-disciplinary chronic pain program for residents. Interested staff continue to participate in the nationwide telemedicine conferences hosted by the Hospital for Sick Children, Toronto, ON.
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 in London at the Victoria Hospital, the volume of births in this level 3 unit is expected to increase to over 6,000 deliveries per year. This makes Victoria Hospital the second busiest obstetrical unit in the province.
The Simulation Program continues to thrive under the guidance of Dr. Richard Cherry. The program continues to deliver 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.
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 recruited two new nurse practitioners to help with all aspects of pain including research and opioid addiction. A pain database has been developed for recording patient data, which can be used for research purposes. Our interventional pain management program is well established and has expanded to include pediatric patients.
