Vascular Anesthesia

Vascular Anesthesia

2 Blocks

Lead

Dr. Asad Mir Ghassemi

Welcome Message

Welcome to the amazing world of Vascular Anesthesiology. We hope that you will enjoy your time with us and that you will acquire the necessary knowledge to help you provide a safe anesthetic to some of the sickest patients you may ever encounter in your career. Our module lead is Dr. Marie-Jo Plamondon and our core members include Dr. Ashraf Fayad, Dr. Sukhjeewan Basran and our Vascular Fellow. Our group also is also represented by many other staff that have a particular interest in Vascular Anesthesiology. Please feel free to ask any of us any questions you may have during your rotations.

Core I will serve as your introduction to vascular anesthesiology but we are also hoping that we can start reviewing some of the Core II rotation objectives with you. Your daily assignment will depend on the OR booking and schedule so it is very likely that you will be exposed to an open AAA repair (for instance) even though the management of such a case is to be covered during Core II. Please see this as a learning opportunity and do not worry if the objectives of Core I and II overlap as we are anticipating this may happen given the nature of our profession.

Like all the subspecialties there is a lot to learn, and not all competencies/sub-competencies can be reviewed during the clinical working hours or in the learning cases, it will therefore be your responsibility to ensure that prior to the end of your residency training you cover them all.

EPAs & Milestones

  • Management of major vascular surgery
    • Demonstrates perioperative management of patient for peripheral vascular surgery
    • Demonstrates perioperative management of patient for carotid artery surgery
    • Demonstrates perioperative management of the patient undergoing aortic surgery
    • Demonstrates an understanding of CSF drainage aorta surgery
    • Demonstrate ability to obtain and interpret perioperative transesophageal echocardiography images for non-cardiac surgery
  • Management of vascular access perioperatively
    • Demonstrates central venous access via internal jugular and/or femoral vein using dynamic ultrasound technique
    • Demonstrates understanding of complications of central venous access
    • Demonstrates intra-arterial catheter via radial and/or femoral arteries for monitoring and sampling
    • Demonstrates intra-arterial catheter via brachial artery
    • Demonstrates central venous access via subclavian and femoral veins using dynamic ultrasound techniques

Academic Curriculum

Learning Cases

Core 1

  • Common Comorbidities Found in Patients with Vascular Disease
  • Management of Heparin Perioperatively
  • Management of Protamine Intraoperatively
  • Carotid Endarterectomy
  • Pulmonary Hypertension

Core 2

  • Aortic Cross-Clamping (X-clamping)
  • Prevention of Contrast-induced Nephropathy in Endovascular Procedures
  • Massive Haemorrhage, Transfusion and Usage of Blood Products
  • Spinal Cord Protection During Thoraco-Abdominal Aortic Aneurysm (TAAA) Surgery
  • Complications of Aortic Surgeries

Assessment Tools

  • Completed a minimum of 10 Vascular Anesthesia clinical days (per Core)
  • Submitted a Vascular Anesthesia case and staff assignment calendar for the rotation (20 Cases per Core)
  • Completed 5 Core 1 Vascular Anesthesia learning cases
  • Completed 5 Core 2 Vascular Anesthesia learning cases
  • Compliant with Resident Logbook
  • Submitted 10 Ottawa Vascular Anesthesia Checklist (OVAC) assessments (per Core)
  • Completed 5 Vascular Anesthesia regional blocks
  • Submitted the required number of CCATs (12 per Core)
  • Demonstrated evidence of self-learning
  • Achieved required grade on Core exam

Resources

  • Norris EJ. Anesthesia for vascular surgery (Chapter 69). In: Miller RD, Eriksson LI, Fleisher L, Wiener-Kronish JP, Cohen NH. Miller’s Anesthesia, 8th edition, Saunders – an imprint of Elsevier Inc. 2015.
  • Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery, Canadian Journal of Cardiology, January 2017, Vol 33, Issue 1, Pages 17-32
  • 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. Journal of the American College of Cardiology, September 2016, Volume 68, Issue 10, Pages 1082-1115
  • ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
  • Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery
  • Disease: Executive Summary. Journal of the American College of Cardiology. Vol 57, No. 8. 2011.
  • North American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Artery Study
  • Canadian Association of Radiologists, Consensus Guidelines for the Prevention of
  • Contrast induced Nephropathy, June 17, 2011
  • AHA Updated statement on the pharmacology and clinical use of heparin and lowmolecular- weight heparin, June 19 2001, Circulation
  • Kaplan JA, Lake CL, Murray MJ. Vascular Anesthesia, A Churchill Livingstone Title; 2 edition, March 15 2004
  • Cardiothoracic and Vascular Anesthesia Journals
  • ASE TEE updated guidelines
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