Anesthesia — Core of Discipline

C18 Providing perioperative anesthetic management for patients undergoing thoracic surgery

- This EPA includes preoperative assessment, investigation/optimization if needed, informed consent, anesthetic management, invasive monitoring if required and determination of postoperative disposition for patients undergoing thoracic surgery.
- This EPA focuses on strategies for lung isolation and lung protection as well as perioperative pain management strategies especially in the context of thoracotomy (e.g. epidural or paravertebral block)
- The observations of this EPA must include pulmonary resection surgery by thoracotomy or thoracoscopy, and preoperative assessment and anesthetic management of anterior mediastinal mass.
- Clear effective intraoperative communication with surgeons is an important part of this EPA

Form

F1: Observation

Milestones

• ME 1.1. Demonstrate commitment and accountability for patients in their care

• ME 1.3. Apply knowledge of anatomy to lung isolation technique

• ME 1.4. Perform appropriately-timed preoperative clinical assessments with recommendations that are well organized and properly documented in written and/or oral form

• ME 2.2. Select and interpret appropriate preoperative investigations based on the planned procedure and patient’s comorbidities

• 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 3.1. Integrate all sources of information to develop a plan for lung isolation and considers the risks and benefits of all approaches

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

• ME 3.4. Optimize the patient and surgical conditions throughout the procedure, anticipating, preventing and treating complications in relation with the specific procedure

• COM 1.5. Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

• COM 4.3. Obtain and document informed consent for the planned anesthetic management in a manner that engages the patients and their families using established principles of effective communication

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

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

• L 3.1. Assume a leadership role in managing complex cases in the OR

• HA 1.2. Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours

• S 3.4. Identify new evidence appropriate to their scope of professional practice through quality-appraised evidence-alerting services.

• P 2.1. Demonstrate a commitment to maintaining and enhancing competence

• 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
• Type of surgery: thoracotomy; thoracoscopy; other surgery
• Type of procedure: lung resection; pneumonectomy; esophagectomy; mediastinoscopy; surgery for anterior mediastinal mass; other procedure
• Timing: elective; emergency
• Technique for lung isolation: none; double lumen tube; bronchial block; other technique Collect observations from a large breadth of training experiences with the expectations not all will be achieved, with a minimum of 8 observations of achievement
• At least one lung resection
• At least one anterior mediastinal mass (can be completed by simulation or case discussion)