Anesthesia — Core of Discipline

C11 Providing perioperative anesthetic management incorporating a peripheral nerve block technique

- This EPA focuses on the management of all aspects of care including preoperative assessment, investigation/optimization if needed, appropriate patient selection, determination of surgical procedure compatibility, selection of anesthesia/analgesia technique, discussion of risks and benefits (informed consent), performance of the regional anesthetic technique and monitoring of the patient throughout the procedure.
- This EPA includes postoperative disposition and ensuring adequate follow-up.
- The assessment of this EPA includes review of the resident’s logbook

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of the pharmacology of local anesthetics with respect to mechanism of action, toxicity, kinetics and adjuvants, to the selection of appropriate pharmacologic agents

• ME 1.3. Apply knowledge of anatomy to regional anesthesia technique

• ME 2.2. Synthesize patient information to determine the most appropriate anesthetic management plan

• ME 2.2. Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan

• ME 3.1. Select the most appropriate regional anesthesia technique in the context of local guidelines, the patient, the procedure and the surgeon

• ME 3.2. Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy

• ME 3.4. Demonstrate effective procedure preparation, including gathering required equipment, and patient monitoring and positioning

• ME 3.4. Establish and implement a plan for post-anesthesia care

• ME 3.4. Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 3.4. Perform peripheral nerve block regional anesthesia and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• COM 1.2. Optimize the physical environment for patient comfort, privacy, engagement, and safety

• COM 5.1. Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

• COL 1.3. Engage in respectful shared decision-making with physician and other colleagues in the health care professions

• HA 1.2. Use information booklets, websites, and other communication technologies to improve patient understanding of the planned regional technique and post procedure care

• S 1.1. Use technology or personal documentation to record, monitor, and report on your procedural log

• P 2.2. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Location of block: upper limb; lower limb; trunk; other location
• Type of block: interscalenic; supra
• clavicular; infra
• clavicular; axillary; peripheral block; transversus abdominis plane block; sciatic nerve; femoral nerve; popliteal sciatic; ankle block; other block
• Collect observations from a large breadth of regional anesthesia experience with the expectations not all will be achieved, with a minimum of10 observations of achievement
• At least 3 upper limb
• At least 3 lower limb
• At least 1 trunk block