Anesthesia — Core of Discipline

C7A Providing peripartum anesthetic management for high-risk parturients-part A

- This EPA includes patient assessment, identification of contraindications to various modalities of labor analgesia or anesthesia, discussion of risks and benefits, informed patient consent, identification of required monitoring and execution of the management plan.
- This EPA includes all complex cases of labour analgesia and cesarean.
- This EPA does not include patients who are highly unstable or critically ill
- The observation of this EPA is divided into two parts: patient management and collaboration with the interprofessional team (multisource feedback)
- Relation with other EPAs: Initiating and leading resuscitation for unstable parturients is the focus of another EPA

Form

F1: Observation

Milestones

• ME 1.6. Adapt care as the patient’s clinical condition evolves

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, comorbidities and the second patient (fetus) in determining priorities to be addressed

• 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 2.4. Formulate and implement management plans that consider all of the patient’s health problems and context, in a timely manner, in collaboration with patients and their families and, when appropriate, the interprofessional team

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

• ME 3.4. Document procedures accurately

• 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 4.1. Establish plans for ongoing and postoperative care

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

• COM 1.4. Respond to patients’ non-verbal communication and use appropriate non- verbal behaviours to enhance communication with patients

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

• COM 3.1. Share information and explanations that are clear, accurate, and timely while checking for patient and family understanding

• COL 1.3. Communicate effectively with physicians and other colleagues in the health care professions

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

Context Variables

No context variables defined.

Requirements

• Direct or indirect observation by supervisor
• Use Form 1 or local alternative. Form collects information on:
• Pre
• existing comorbidity [select all that apply]: none; cardiac; obesity; other comorbidity
• Pregnancy related comorbidity [select all that apply]: none; hemorrhage; pre
• eclampsia; pre
• term; fetal distress; other comorbidity
• Urgent: yes/no
• Type of anesthesia: spinal; epidural; combined spinal/epidural; general; other anesthesia
• Collect observations from a large breadth of training experience with the expectations not all will be achieved, with a minimum of 10 observations of achievement
• At least one cesarean section under general anesthesia