Anesthesia — Core of Discipline

C16 Providing perioperative anesthetic management for patients undergoing spinal procedures

- This EPA includes preoperative assessment, investigation/optimization if needed, informed consent, anesthetic management, invasive monitoring if required and determination of postoperative disposition
- This EPA includes scheduled or emergent procedures
- Preoperative assessment should be tailored to include baseline neurologic status and pain levels, if applicable
- This EPA also includes positioning considerations relevant for these procedures
- Clear communication with surgeons during all aspects of the perioperative period is fundamental

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of the clinical and biomedical sciences relevant to anesthesia for spinal diseases and injury, and neurological monitoring

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during preoperative evaluation and determination of timing for 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 and select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan

• 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 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. Manage perioperative fluid delivery including blood replacement strategies

• ME 3.4. Manage the airway of a patient with an unstable c-spine presenting for a surgical procedure

• ME 3.4. Document procedures accurately

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

• ME 5.2. Apply the principles of situational awareness to clinical practice

• COM 5.1. Adapt record keeping to the specific guidelines of anesthesiology and the clinical context

• COL 1.2. Interact effectively with surgeons during all aspects of the procedure

• COL 1.2. Work with the OR team effectively to ensure patient safety during prone positioning

• COL 3.2. Organize the handover of care to the most appropriate physician or health care professional

• L 4.2. Assume a leadership role in managing complex cases in the OR

• S 3.1. Generate focused questions that address practice uncertainty and knowledge gaps

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Type of surgery: lumbar surgery; thoracic surgery; cervical surgery; scoliosis surgery; unstable cervical spine surgery; other surgery
• Spinal cord injury: yes; no
• Neurologic monitoring: yes; no
• Timing: elective; emergency
• Collect observations from a large breadth of training experiences with the expectations no all will be achieved, with a minimum of 6 observations of achievement