Anesthesia — Core of Discipline

C15 Providing perioperative anesthetic management for patients undergoing vascular surgery

- This EPA focuses on preoperative assessment, investigation/optimization, informed consent, anesthetic management, invasive monitoring, appropriate analgesia and determination of postoperative disposition.
- This EPA includes: aortic surgery (surgery of the thoracic & abdominal aorta done without cardiopulmonary bypass, including, aneurysmal, occlusive, connective tissue disease, dissection/rupture & traumatic disease); peripheral vascular surgery (including invasive and non-invasive management of patients with occlusive & embolic etiologies) and carotid disease (including carotid stenting and endarterectomies).
- Anesthetic planning & management of vascular surgeries includes knowledge & management of aortic cross-clamping, renal protection, spinal cord protection, hemodynamic support, cerebral monitoring & appropriate use of blood, blood products, heparin and protamine.
- Technical skills associated with vascular surgery should be observed & incorporated into the anesthetic plan depending on the type of surgery being undertaken.

Form

F1: Observation

Milestones

• ME 1.3. Apply clinical knowledge of indications and specific surgical considerations for vascular surgery

• ME 2.2. Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management

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

• ME 2.4. Develop a plan to optimize the patient’s medical condition preoperatively.

• ME 3.1. Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches

• ME 1.3. Apply knowledge of transfusion principles, use of heparin, protamine and blood conservation strategies

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

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

• ME 3.4. Manage hemodynamics and complications during aortic surgery depending on the level of clamping on the aorta including hemodynamic instability, spinal ischemia, bleeding and renal dysfunction

• 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. Communicate effectively with physicians and other colleagues in the health care professions

• COL 1.2. Communicate effectively with the surgeon and other members of the team

• COL 3.2. Demonstrate safe handover of care, both verbal and written

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Type of procedure: aortic surgery; carotid surgery; peripheral vascular surgery
• Context of procedure: open surgery; radiological procedure
• Timing: elective; emergency
• Type of anesthetic: general; regional; combination; MAC
• Type of monitors (check all that apply): arterial line; central line; spinal cord protection; cerebral monitoring, lung isolation;
• Hemodynamic support & transfusion (check all that apply): vasopressors, inotropes, transfusion, cell salvage use, heparin use; protamine use
• Collect observations from a large breadth of training experiences with the expectations not all will be achieved, with a minimum of 6 observations of achievement