Hospitals & Divisions 2024

D E PA R T M E N T O F A N E S T H E S I O LO G Y, P H A R M A CO LO G Y & T H E R A P E U T I C S

ACADEMIC HOSPITALS SITES & CLINICAL DIVISIONS 2024

Department Faculty & Staff Numbers

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Full-time faculty - 26 Clinical Faculty - 568 Postdoctoral Research Fellows – 12 Research Associates – 6

CUPE 2950 Staff – 5 Non-Union Technicians/Research Assistants - 16 Management/Professional Staff – 18 Student Employees – 23

Clinical Fellows - 16 Residents – ANAE – 95 Residents – FPA – 5 Residents – Pain Medicine - 5 Medical Students – 327 Pharmacology Graduate Program – 24 students Pharmacology Undergraduate Program – 39 students / 47 with PCTH Co-op students included

Adjunct Professors – 11 Affiliate Professors – 9 Emeriti Faculty - 30 Honorary Professor - 1

Table of Contents BC Children’s Hospital

4

BC Women’s Hospital

18

Lions Gate Hospital

22

Royal Columbian & Eagle Ridge Hospital 24

Surrey Memorial Hospital 26 St’ Paul Hospital

30

Vancouver General Hospital

34

Victoria General Hospital

36

Clinical Divisions

38

Cardiovascular Anesthesia

40

Neuroanesthesia

44

Perioperative Medicine

46

Regional Anesthesia

50

Thoracic Anesthesia

52

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BC Children’s Hospital Dr. Simon Whyte Department Head The UBC Department of Pediatric Anesthesia (the Department), centred at BC Children’s Hospital (BCCH), has continued in its rôle as the home of paediatric academic and clinical anaesthesia, perioperative medicine, and pain medicine.

Executive Summary By the end of 2024, the Department comprised 29 permanent Staff pediatric anesthesiologists, three term Staff, three Fellows, and two Administrative Assistants. We also had two non-anesthesiologist permanent Pediatric Anesthesia Research Team members, 11 Anesthesia Assistants, one Coop Student and three Summer Students. Our Acute Pain Service was supported by two Nurse Practitioners and one Pain Nurse Intern. Please see Section 10 for details.

We began 2024 by continuing to hire and now have eight new colleagues, four of whom joined us this calendar year; the others will arrive throughout 2025. This represents a nearly 30% expansion in Department size over the last 4 years. As always, the lag between hiring & arrival is lengthy and, as anticipated, anesthesiologist availability has been the rate-limiting step to service expansion for most of 2024. This started to improve in the last quarter of the year & should continue to do so in 2025.

With growth come growing pains. Our office space was identified as insufficient at our last external review & with so many new colleagues, the situation was set to become untenable. In 2024 we were successful in negotiating some additional immediate capacity, and there will be further progress in 2025. Year-on-year growth in the

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UBC Anesthesia Residency program has created increasing challenges in facilitating access to experience and exposure for non-anesthesia specialties, let alone non-medical ones; meeting and prioritising these various non-anesthesia program requests will likely need broader UBC Anesthesia Dept. engagement in 2025, when further rationing decisions will likely become necessary.

As the sub-sections below detail, Department members have continued to be productive both clinically and academically, and there are many 2024 achievements to celebrate & be proud of. Among them: • Drs. Rory Blackler, Vicky Buswell, Ato Ocansey & Nancy Wang joined the Department as new Staff.

• Dr. Michelle Correia took over as our new Acute Pain Service Lead; Ms. Jennifer Dunlop joined the team as our second Nurse Practitioner.

• Dr. Katherine Bailey led a faculty of Dept members in hosting the 3rd Pacific Northwest Fellows Bootcamp.

• Drs. Bailey, Correll, Ridgway, Skelton & Whyte were invited speakers at national and international conferences.

• Drs. James Chen & Matthias Görges won the UBC APT Paper of the Year award.

• The Pediatric Anesthesia Research Team (PART) collectively published 17 papers.

• Dr. Simon Whyte was awarded a $250 000 Leadership Grant, to fund faculty development activity.

Clinical Care a) Education/Training Awards: The Sedation Practice and Implementation Subcommittee, which reports up to the Pain, Comfort and Sedation Steering Group, meets monthly to discuss challenges and new requests for sedation at BCCH; provides support, advice, and feedback to clinicians; and updates and develops polices to support site-wide sedation practices. Dr DibbFuller co-chairs this subcommittee.

BCCH has started to set up and support an outof-OR sedation service, the lack of which is a significant gap in service provision for a paediatric hospital. Updated Canadian Pediatric Society guidelines published in 2021, and the ChildKind accreditation process that BCCH underwent in 2022, have surfaced this large gap between demand and safe supply.

• We are working hard to support small pockets of mild to moderate sedation that is provided on the wards and clinic areas.

• We recently revised and established an out-of-OR Entonox policy.

• We are in the process of revising the sitewide sedation policy.

• We have developed multi-disciplinary formalised education sessions and a sedation course for different pediatric specialities. The first formal course for Staff Pediatricians is due to run early 2025.

• We ran a six-month pilot project of out-ofOR sedation in the outpatient clinics provided by self-selecting ED physicians. This was part of a QI initiative which has contributed data to support a business case proposal for ongoing funding.

b) Cardiac Anaesthesia (Dr. Louis Scheepers): • The past year has been one of challenges to secure post-operative ICU care due to staffing complexities.

• Despite these issues, our total number of surgeries decreased only slightly year over year (about 6%).

• Our outcome data consistently reports lower mortality and higher ICU bed turnovers compared to our reference group (VPN database analysis).

• The operative team has remained dedicated, stable in composition, and provides exemplary clinical care to all our patients.

• The cardiac surgical program has initiated a long-term plan to provide ventricular assist device implantation and post-operative care, and it is hoped that this program will be fully operational during this coming year. c) Neuroanaesthesia (Dr. Nigel Barker): • Service covers all paediatric neurosurgery: tumour resection, shunts, spinal cord detethering, epilepsy planning, and surgery employing sEEG robot and ECOG monitoring to guide resection.

• Craniosynostosis surgery is carried out jointly with plastic surgery. As a team we strive to keep blood loss and therefore subsequent transfusion, to a minimum in this population.

We recently audited this and have contributed our data to a multicentre registry.

• We have developed a full perioperative guideline, in combination with PICU, to enhance our care of Moya Moya patients, with the aim of reducing the incidence of stroke to almost zero.

• Two active audits are concerned with i) anaesthesia and conditions for ECOG 5

neuromonitoring during epilepsy focus resection; and ii) perioperative complications in the Moya Moya population.

• Many department members are involved in these procedures, to maintain good working relationships with neurosurgeons, and familiarity for on call work. A small subgroup exists to support the smaller volumes of ECOG and Moya Moya cases, to ensure consistency of care. d) Pain Services (Drs. Randa Ridgway & Michelle Correia): • Pain Care360 is a new and developing program at BCCH under the Department of Anesthesia. It encompasses pain care and sedation services, to improve comfort for children of BC and the Yukon.

• With substantial expansion within pain care services, we have welcomed two additional nurse practitioners (APS and CPS), an additional CPS physician (with another joining in 2025), and a CPS psychologist to the team.

We anticipate the impending arrival of an APS pharmacist.

• Sedation service development has included a new sedation team to support outpatient clinics to improve access to diagnostic and therapeutic modalities. Further expansion of sedation services is planned for

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2025.

• Education has been a key focus for the year with APS taking the lead on providing pediatric pain education to all residents and Fellows rotating through BCCH, of all specialties, which has been extremely well received.

• Ongoing pain research includes developing opioid stewardship strategies, involvement in POPSICLE, a multicentre, international, post-operative pain study in children, as well as applications for grant funding for pain in digital health. Pain Care 360 has supported UBC student flex projects and UBC residents’ involvement in quality improvement and research. Specific mention to two of our UBC anesthesia residents for excellent academic work with improving Pain Care: » Jessie Liu for her work in redeveloping Pediatric Pain & Sedation Management in Severe Burn Management Guideline which she recently presented at the Postgraduate assembly in New York.

» Jennifer Rowe for the development of the ERAS & Analgesia protocol for Minimally Invasive Pectus Excavatum Repair.

• Exciting plans for 2025 include the formation of a multidisciplinary perioperative clinic for the prevention of persistent pain, encompassing multiple strategies including mind-body techniques and other integrative approaches, which aims to improve the perioperative experience and recovery for children. e) Pre-Anaesthesia Clinic (Dr. Christa Morrison):

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Continued to work with the business and

innovation team to enhance our pre-operative preparation for children using virtual reality technologies.

• Partnered with Palliative Care for perioperative planning in children with complex care including direction/restriction on escalations of care/DNR orders.

• Collaborated with VGH to establish a pre-operative care pathway for all children undergoing procedures at VGH. • Working towards pregnancy screening for adolescent children.

• Collaborated with the orthopedic team to develop a pre-habilitation program to optimize anemia in children undergoing surgery.

• Working on improved care pathways for children with autism, and with other complex care needs, requiring multiple procedures under anaesthesia (see Section 4). (f ) Regional Anaesthesia (Dr. Kat Lanigan): The regional anaesthesia programme at BCCH has continued to grow in strength and volume during 2024.

• We have successfully continued our elastomeric programme for day case ACL surgeries as well as a variety of other lower and upper limb orthopaedic surgeries. These children are going home with regional catheter pumps instead of staying in the hospital for 2-3 nights. We have transitioned to a pharmacyprepared elastomeric pump with resultant

increased PACU efficiency.

• A grant proposal has been submitted for a digital platform for an at-home pain management pathway focusing on physical, psychological and pharmacological pain management prompted by a patient’s selfreported scores.

• We have completed a pilot of using our induction room for block placement in 2024 to aid in OR efficiency and possibly increase the numbers of patients getting access to the OR. This was an 8-day trial with 3 patients each day and was limited due to both nursing and anesthesiology staffing constraints. We hope to revisit variations around using this model in 2025 with the expansion of the anesthesiology department and increased nursing recruitment. What we have proven is that the induction room is a safe, wellresourced environment to do these blocks.

The next step is how we can reliably and efficiently resource this. With the planned introduction of our sedation service in 2025, we may be able to revisit different ways of improving efficiency with our regional anesthesia programme.

• In collaboration with our surgical colleagues, we have begun utilising regional blocks and cryoablation techniques for Nuss bar surgeries instead of the traditional thoracic epidural. We have done approximately 15 cases in the last year using this technique.

• Education: With the help of a leadership grant, department members are now encouraged and compensated to attend international regional anaesthesia courses to further their education. One of our department members attended a NYSORA course late in 2024. » ACU nurses now have a core group of nurses who are responsible for delivering the teaching and education on our elastomeric catheters to children and their parents going home.

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» Education has also continued outside the OR with sessions for our PICU colleagues, and ongoing education to ward nurses with revision of the regional education module. » There is also now an established regional anesthesia fellowship teaching programme consisting of structured didactic sessions and practical scanning sessions with tips and tricks to enable fellows to enhance their regional experience.

•

To come: CPAS has joined forces with

ESPA, APAGBI, RA UK and more recently SPANZA to create an online resource dedicated to pediatric regional anesthesia tips and tricks.

The Canadian representative from this is our regional lead, Dr Kat Lanigan. Extensive work has taken place in 2024 with writing the Plan A and B blocks. There are plans for this to go live on the CPAS website in early 2025 and an app hopefully in late 2025. » BCCH will be working towards joining the PRAN database in 2025. The database has been remodelled and taken over by Sick Kids in 2025 and we will be submitting our proposal to join in early 2025. We hope to use this resource to aid our local and international pediatric regional research. » With the advent of new staff over the past two years, we may re-run our inhouse regional anesthesia course course in 2025. g) Spine (Dr Andrew Morrison): • The Paediatric Anaesthesia Spine Team at BC Children’s Hospital provides a specialised, consistent, and coordinated approach to the provision of anaesthesia for our scoliosis patients, and education to the wider anesthesia community. Paediatric scoliosis aetiologies group into three broad categories: congenital, neuromuscular, and idiopathic. Affected children range from toddlers to young adults and often have associated complex medical 8

conditions. Our small, expert subgroup is able to focus on the individual requirements of each patient while delivering a high level of care specific to the requirements of scoliosis surgery.

• In 2024, the service provided expert care to around 200 patients for 250 surgeries per year - as many children require surgery over multiple days.

• Communication, understanding and interaction between care providers in the operating room is essential in complex and lengthy surgeries and these parameters have improved with the move to a smaller team, as have quality of care indicators.

• Together with our surgical, nursing, and technical colleagues, as part of the larger Paediatric Spine Team, we are actively involved in ongoing multidisciplinary education sessions to maintain, advance, and promote understanding of the challenges of these patients.

• We are represented at the Executive Board level of the North American Pediatric Spine Anesthesia (NAPSA) Collaborative & aim to begin contributing data to their multicentre registry in due course.

Quality of Care (Drs. Kat Lanigan & Brendan Smith) The Department’s Quality of Care portfolio is coled. Drs. Kat Lanigan & Brendan Smith coordinate QoC rounds (case reviews, approximately 8/ year); receive, review & respond to relevant PSLS reports; and represent the Dept. on other QoC Committees and Working Groups, including (but not limited to) Surgical Suites QoC; Child Health QoC; Surgical Suites Infection Prevention (SSIP); Pediatric National Surgical Quality Improvement Project (P-NSQIP); Pharmacy , Therapeutics & Nutrition; and Mortality Review.

Active Departmental QoC initiatives include:

• Project SPRUCE (Saving the Planet by RedUcing Carbon Emissions) is a multiinstitutional quality improvement project focused on reducing greenhouse gas emissions from inhaled anesthetics and N2O. The smart aim of the QI project is to reduce anesthesia GHG emissions from volatile anesthetics and N2O by 50% from baseline over 12 months, as measured by average kg CO2 equivalent/minute (kg CO2e/min) of anesthesia delivered in the hospital. BCCH joined the collaboration at the beginning of 2024. Baseline data showed that BCCH had an average of 0.02 kg CO2e/min of anesthesia delivered in the hospital, which was more than 10 times lower than any other participating centre! N2O was used in 14.3% of all cases and the average volume of N2O used per case was 1.73 litres. Reducing anesthesia GHG emissions from such a low baseline over 12 months was always going to be very challenging. Following education sessions on low flow anesthesia and volatile inductions, a nonsignificant reduction in average kg CO2e/min of anesthesia was measured, but a significant reduction of N2O use rate from 14.3% to 7.9%, as well as a reduction in average volume of N2O used per case, from 1.73 to 0.85 litres, was achieved. Future planned interventions to reduce GHG emissions from volatile agents and N2O include reducing default FGF on all anesthesia machines to 300ml/min and decommissioning of central N2O supply.

• Contribution to national (CANPANDA) and international (PeDI) paediatric difficult airway registries.

intraoperative thermoregulation.

• Local PeDI, PACU, POFU, antibiotic administration & intraoperative thermoregulation datasets all have associated live dashboards which all Department members can access in real time, to review overall and anonymised individual performance metrics.

• Home regional nerve catheter program, enabling children who were previously admitted for post-operative pain management to go home on day of surgery, with daily follow-up by the Acute Pain Service (APS) until catheter removal (at home). This programme is continuing with excellent feedback. There is a grant proposal for a digital platform which would be an athome pain management pathway focusing on physical, psychological and pharmacological pain management prompted by a patient’s selfreported scores.

• There are plans for a transitional pain clinic to start from April next year to identify patients at high risk of developing chronic pain.

Anesthesia plans to support this with one clinic day per week.

• Follow up of patients being discharged from APS still needing weaning support. PICU and pharmacy now collaborate to manage straightforward weans going to the ward, supporting the teams with personalised weaning plans. APS is still involved with more complex weans.

Please also see Section 4, REDI Considerations, below – many of these represent QoC activities & initiatives.

• Oversight of local registries, which capture patient-reported outcome metrics REDI Considerations (Dr. Natasha in recovery (PACU) and at 24 hours postBroemling) operatively (POFU).

The Department of Pediatric Anesthesia at BC

• Data contribution, to P-NSQIP and Children’s Hospital delivers individualized, traumaSSIP datasets, of timeliness of surgical informed and family-centred care supporting the antibiotic prophylaxis administration and province’s children and their caregivers.

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• Optimizing care of de-centered populations. Our department seeks to improve perioperative care for patients with severe behavioural complexity by actively engaging with patient strengths and with caregiver concerns through individualized care pathways, utilization of the Take a Sec tool for children on the Autism Spectrum, the provision of two Sensory Rooms to minimize behaviour escalation associated with a trip to the operating room and coordination with vocal Child Life departments. » A Car-to-OR pathway for children with severe behavioural complexity builds on team-based processes, including collaboration with PAC team, ACU nursing leads, and Relational Security Officers. » PAC reorganization maximizes opportunities for patients and families to meet with the anaesthesiologist who will care for them on the day of surgery, including in-person, telephone and virtual consults as suited to families’ needs & choices. » PAC-generated individualized care pathways for patients with anxiety, needle phobia, severe behavioural complexity etc., with respect to coordinating opportunistic investigations (blood draws, vaccination, bundling of procedures under one anesthetic (e.g. dental, ENT, ophthalmology)) and communicating family concerns to anaesthesiologists involved. » AIC “Anesthesiologist In-Charge” (AIC) position provides flexibility outside the time-constraints imposed by the OR slates for assessing patients and arranging sedative premedication.

•

• Practising cultural humility

» Rapid adoption of San’yas and ARRT (PHSA Anti-Indigenous Racism Response Training) courses by our dedicated physician group. » Our very diverse patient population is supported by an abundance 10

of translation technologies and a wellestablished history of openness to patient/caregiver requests. Patients are encouraged to bring comfort items and items of cultural significance into our operating rooms.

•

• Inclusive leadership

» Backing for an EDI Lead who assists with supporting respectful environments and comments on aspects of departmental research. » Backing for reformulation of our hiring process

Education a) Fellowship Program (Dr. Katherine Bailey): The clinical Fellowship program remains popular and strong, with qualified applicants far exceeding available positions. The Fellowship program continues to provide advanced paediatric anaesthesia clinical training, academic research and teaching opportunities for our Fellows.

• Program structure and recruitment: Calendar 2024 included the successful completion of our second academic year (July-June) with four Fellows, three of whom have subsequently been successfully recruited into faculty positions. At the start of the 2024-2025 academic year, three new Fellows joined our program (Drs. Coppell, MacDonald and Joubert; the fourth appointee had to withdraw at short notice). Funding for the fourth Fellowship position was thus available to provide second-year Fellowship positions, for up to three Fellows, up to three months each, to facilitate transition to faculty. Four Fellows have been successfully recruited for the 2025-2026 academic year.

• BCCH Program development: The focus of program development remains on increasing formal educational opportunities for Fellows such as a structured orientation process; an academic half-day with Fellowship-specific

content; a regional anaesthesia rotation; 10 days’ simulation experience and Fellow-level call. New educational opportunities added this year include Fellow participation in monthly multi-disciplinary simulations in PACU and a 3-day National Pediatric Transfusion Camp with Pediatric Anesthesia and Hematology fellows from across Canada.

• National collaboration: The Fellowship program actively promotes and advances pediatric anesthesia fellowship training within Canada, fostering cross-centre collaboration, and continues to successfully recruit both Canadian and International applicants. Fellows continue to participate in the long-standing tradition of CPAS Fellows telemedicine rounds three time per year, with BCCH being the host site for the Spring edition.

• International collaboration: The Fellowship program continues to foster international collaboration with regional children’s hospitals in Seattle and Portland. BCCH hosted the 3rd Annual Pacific Northwest Pediatric Anesthesia Fellows Bootcamp in September 2024. The evaluation and feedback from participating Fellows and international faculty was excellent.

The program looks forward to continuing to have our Fellows participate in PNW Bootcamp, which will be held in Oregon next year.

• National Curriculum development: In late 2022, the Canadian Pediatric Anesthesia Society (CPAS) Education Committee, co-led

by Dr. Bailey & her counterpart at the Hospital for Sick Kids in Toronto, successfully applied to the Royal College for Pediatric Anesthesia to become an Area of Focused Competency, thus making pediatric aesthesia the first RCaccredited subspecialty in anesthesia. Over the course of 2023, a Royal College working group was established with Dr. Bailey as Vice-Chair. In August 2024, the working group completed and submitted the Portfolio (Major Tasks, Standards of Assessment) and Competency Training Requirements (CTR) to the Royal College SSRC

for approval, which is expected in Spring 2025. The working group is currently drafting the Standards of Accreditation (AFC-SA) documents. Once these three components of the document suite are approved, individual Departments will be able to apply for accreditation of their Fellowship programs.

Dr. Bailey presented this update at the 2024 CPAS meeting in September 2024. b) Residency Program (Dr. Lynnie Correll): The BCCH Anesthesia Department has continued to increase its capacity and commitment to the education of the growing number of residents: • In the Fall of 2024, as requested by our Dept., the UBC Anesthesia Residency program purchased a subscription to Anesthesia Toolbox, which is a peer-reviewed and peersourced comprehensive set of educational materials aimed at providing high-quality standardized didactic and self-study materials for trainees.

• BCCH has begun a formal orientation process for residents at the start of each block, including providing a pre-rotation orientation packet, an orientation session, a “buddy shift” on the first day, a formal ACU orientation with nursing, and at least one “APS Day” for residents before they are on their first call shift to improve their familiarity and comfort with the systems at BCCH.

• For the first time in several years, we have three UBC Anesthesia residents planning to pursue pediatric anesthesia Fellowship training.

• Drs. Yvonne Csanyi-Fritz & Natasha Broemling continued to represent BCCH on the UBC CaRMS Committee; Dr. Zoë Brown continued her tenure as Residency Program Director. c) Undergraduate Program (Dr. Natasha

We continue to support and Broemling): accommodate UBC medical students rotating 11

through BC Children’s for a day of their mandatory anaesthesia rotation. Students continue to benefit from the flipped classroom approach proffered by the online modules; they are then able to appreciate the rapid changes in physiology attendant to paediatric anaesthesia. d) Outreach (Dr. Lynnie Correll): We continue to be the place for non-anaesthesiologist trainees to improve and refresh their pediatric airway and sedation management skills: • PICU, PCICU, NICU, Pediatric ED, and Pediatric Dental Fellows’ rotations have continued with formal structured orientation, goals and objectives. We continue to host Pediatric Residents as well as Paramedics through the provincial ITT program.

• We continue our partnership with the UBC CAMP program, the Provincial REAP program and have hosted 6 practising physicians from BC (2x ED, 4 x FPA) for week-long refreshers which have been appreciated and well received.

• We ran the annual Pediatric Anesthesia Update meeting in June 2024.

• Regular international outreach work continued in 2024, with Department members contributing to global health projects in Rwanda, Honduras, Ethiopia, The Gambia and Guatemala. e) Simulation (Dr. Chris Chin) : BCCH Anesthesia has an active program of simulation-based training including: • Managing Emergencies in Pediatric Anesthesia (MEPA). Pediatric anaesthesia simulation training course for UBC Anesthesia Residents, run since 2013. Since 2017, MEPA scenarios are run as a major part of the annual BCCH Pediatric Anesthesia Update meeting.

Since 2021 this course has been tailored and run for the Family Practice Anesthesia trainees.

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• Pediatric Advanced Life Support (PALS).

One-day PALS Provider course for anaesthetists and ‘skilled practitioners’ developed and first run by BCCH Anesthesia Simulation in 2015. This course is run several times a year for anaesthesia Residents and Staff across the Lower Mainland.

• Pediatric Airway Management (PAM).

One-day simulation-based course, initially developed for teaching anaesthesia Residents.

Following requests from other departments the course is now also run for the Pediatric Emergency and PICU Departments.

• Multidisciplinary Training. We have successfully collaborated with our perioperative nurse educators to include nurses on our MEPA and PAM simulation courses.

• In-situ Simulation. Since 2015, in collaboration with Pediatric Cardiology, we have instituted regular in-situ Cardiac Cath Lab multidisciplinary simulation sessions.

Feedback has been great, and several concrete teamwork changes have been implemented as a result.

Research (Drs. Lynnie Correll & Terri Skelton) The Pediatric Anesthesia Research Team (PART) is growing and evolving.: • PART hired a new full-time Research Assistant, Kate Mason, who joined us from Ottawa in September, bringing significant experience in survey- and interview-based clinical research.

• Significant numbers of projects, presentations, and publications in 2024. Of note, a number of these new projects were spearheaded by new PIs who had not engaged in much research before, highlighting an emphasis on creating an inclusive, supportive environment for all Department members with an interest in asking relevant clinical

questions.

• Department members were invited speakers at several prominent national and international (SPA, IARS, World Congress, CAS, CPAS, ASA) meetings in 2024.

• Conference contributions were strong with 33 presentations at meetings and conferences ranging from institutional to international, including the World Congress, IARS, CPAS, ASA, PGA and of course our own UBC APT Research Day. At these conferences, PART members received three ‘Best Of’ awards in their respective categories.

• The UBC APT Paper of the Year Award was a PART paper, featuring Drs. James Chen, Norbert Froese, Matthias Görges, Rebecca Munk, as well as longstanding PART members Andrew Poznikoff & Nick Westh.

• Multiple small grants were awarded (n=5) in the new CPOI E2i Podcast Grant competition in 2024.

• All four BCCH Research institute Evidence to Innovation Seed Grant submissions with PART PIs (Drs. Peters, Correll, Ridgway & Görges) were successful, along with a fifth that has multiple PART members as Co-Is. Additionally, Department members are awaiting verdicts on submissions for two Digital Health Lab grants, a CIHR grant & a grant from the Society for Pediatric Anesthesia.

• Please see Section 9 for a comprehensive list of peer-reviewed publications by Department members.

Faculty Development(Dr. Simon Whyte) Several initiatives progressed and/or came to fruition in 2024: • We were successful in our application to the BCCH Foundation for a $250 000 Leadership Grant. The application required

collaborative development with many Department members, and full Departmental support. The grant will provide one-time funding over three years for multiple Faculty development initiatives. In 2024 this has included training in the domains of healthcare leadership, pediatric regional anesthesia, and child-centric management of perioperative non-pharmacological anxiety.

• We continued with the BCCH Foundation to seek a philanthropic donation for a Hospital Chair in Pediatric Anesthesia. The Department’s research was featured in the Foundation’s biannual donor magazine, Shine.

• Over 90% of Department members completed or embarked upon San’yas Indigenous Cultural Safety training.

Foundation Liaison & Equipment (Dr. Prakash Krishnan) We have liaised with the BCCH Foundation (BCCHF) on several initiatives in 2024: •

Green initiatives » Started using 7 day use circuits with good uptake » We are trialling reusable SpO2 probes for carefully selected group of patients » We are also setting up a trial for reusable face masks

• New ultrasound machines have been delivered and are being used daily with a significant positive impact on vascular access and regional anesthesia capabilities.

• Fibreoptic bronchoscopes and video laryngoscopes have been procured and are being set up for daily use and difficulty airway carts.

• We are liaising with equipment leads of other Canadian pediatric anesthesia centres via social media (WhatsApp group chat).

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• We are currently trialling NIRS probes from three different companies in collaboration

with NICU and PICU to standardize the monitor across departments.

Publications featuring Department and PART Faculty (n=17) Publications are listed alphabetically, by surname of any Department member who was a listed author or co-author. Non-Dept authors aren’t included. The authors’ order in individual manuscripts may be different – please checks links for details of first, co-, senior authorship, etc..

Pediatric Anesthesia in North America.

Katherine Bailey, Simon Whyte

https://pubmed.ncbi.nlm.nih.gov/38462910/ Improving anesthesia resident wellness: a facilitated peer discussion group evaluated with a pre-/post-intervention survey.

Zoë Brown

Can Med Educ J. Accepted 16 Nov 2024.

Pediatric Pain Prediction Collaboration, Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-text Comments from a Postoperative Survey.

Natasha Broemling, Lynnie Correll, Heng Gan, Matthias Görges, Randa Ridgway

https://doi.org/10.2196/65198 Development and internal validation of time-to-event risk prediction models for major medical complications within 30 days after elective colectomy.

Matthias Görges

https://doi.org/10.1371/journal.pone.0314526 Impact of Digitally Enabled Peer Support Interventions on Diabetes Distress and Depressive Symptoms in People Living with Type 1 Diabetes: A Systematic Review.

Matthias Görges

https://doi.org/10.1007/s11892-024-01560-4 Evaluating a mental health support mobile app for adults with type 1 diabetes living in rural and remote communities: The REACHOUT pilot study.

Matthias Görges

http://dx.doi.org/10.1111/dme.15451 Caregiver and Youth Characteristics That Influence Trust in Digital Health Platforms in Pediatric Care: Mixed Methods Study.

Matthias Görges

http://dx.doi.org/10.2196/53657 Postsurgical Pain Risk Stratification to Enhance Pain Management Workflow in Adult Patients: Design, Implementation, and Pilot Evaluation.

Matthias Görges

https://doi.org/10.2196/54926 14

Anesthetic-sparing effect of dexmedetomidine during total intravenous anesthesia for children undergoing dental surgery: A randomized controlled trial.

Matthias Görges, Randa Ridgway, Simon Whyte

https://doi.org/10.1111/pan.14987 MyoActivation®, a Structured Assessment and Therapeutic Process for Adolescents With Myofascial Dysfunction and Chronic Low Back Pain: A Case Series.

Gillian Lauder

Cureus 16(8): e68029. doi:10.7759/cureus.68029 Intravenous lidocaine infusion therapy and intraoperative neurophysiological monitoring in adolescents undergoing idiopathic scoliosis correction: a retrospective study.

Gillian Lauder

https://doi.org/10.1111/pan.15019 Transfusion Camp Rwanda 2023: A train the trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education.

Teresa Skelton

https://onlinelibrary.wiley.com/doi/pdf/10.1111/vox.13611 The impact of a care bundle with an emphasis on hemodynamic assessment on the short-term outcomes in neonates with congenital diaphragmatic hernia.

Mike Traynor

https://www.nature.com/articles/s41372-023-01807-0 Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative.

Mike Traynor

https://fn.bmj.com/content/109/3/239 Lung-protective ventilation in the management of congenital diaphragmatic hernia.

Mike Traynor

http://dx.doi.org/10.1136/wjps-2024-000789 Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time.

Simon Whyte

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00040-3/ fulltext A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative.

Simon Whyte

https://onlinelibrary.wiley.com/doi/10.1111/pan.14895 15

Staff, 2024

a) Staff Anesthesiologists Dr. Katherine Bailey Dr. Michael Barker Dr. Nigel Barker Dr. Rory Blackler Dr. Natasha Broemling Dr. Zoë Brown Dr. Victoria Buswell Dr. Myles Cassidy Dr. James Chen Dr. Chris Chin Dr. Michelle Correia

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Dr. Lynnie Correll Dr. Yvonne Csanyi-Fritz Dr. Erica Dibb-Fuller Dr. Caitlin Gallagher Dr. Heng Gan Dr. Prakash Krishnan Dr. Katherine Lanigan Dr. Gillian Lauder Dr. Stephan Malherbe Dr. Andrew Morrison Dr. Christa Morrison

Dr. Ato Ocansey Dr. Cheryl Peters Dr. Randa Ridgway Dr. Louis Scheepers Dr. Teresa Skelton Dr. Brendan Smith Dr. Michael Traynor Dr. Nancy Wang Dr. Simon Whyte

b) Other Department Members Staff

Dr. Mark Ansermino (Scientific & Research) Dr. Norbert Froese (Locum) Dr. Rebecca Munk (Locum) Dr. Clayton Reichert (Locum) Dr. Eleanor Reimer (Locum)

Administrative Assistants

Ms. Yvonne Hardwicke Ms. Tanya Chan-Chiang

Fellows 2023/24

Dr. Rory Blackler Dr. Victoria Buswell Dr. Anna Ratcliffe Dr. Nancy Wang

Fellows 2024/25

Dr. Jonathan Coppel Dr. Danielle Joubert Dr. Jamie MacDonald

APS Nurse Practitioners

Ms. Kathleen Duddy Ms Jennifer Dunlop

Permanent PART Members and Staff

Dr. Matthias Görges (Dept Partner Member) Ms. Steffanie Fisher (PART Manager) Ms. Kate Mason (Research Assistant) Mr. Nick West (PART Assistant (contracted))

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BC Women’s Hospital

& Health Centre Dr. James Brown Department Head

Drs. Katie Seligman & Jonathan Collins Associate Department Heads

2024 has been a year of reflection and stabilitybuilding following a period of significant growth and change within the Hospital and APT Departments. This year, we welcomed two new staff members:

Department Highlights

•

Dr. Juliana Barrera: Joining us after

completing a Fellowship at BC Women’s, Dr. Barrera is undergoing additional formal training in research methodology. She will play a key role in supporting our Research and Fellowship programs, with particular interests in POCUS and Medical Education.

• Dr. Naima Kotadia:

With a joint appointment at VGH, Dr. Kotadia recently completed her Fellowship in San Diego. She will serve as a vital link between BC Women’s and VGH, and Obstetric and Neuroanesthesia.

We are also excited to announce the upcoming arrival of Dr. Amir Siddiqui, a former local resident currently completing his fellowship at Mount Sinai. Dr. Siddiqui will join us in July, bringing us to capacity for the foreseeable

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Thank you to Dr. Giselle Villar, who undertook the reapplication to The Society of Obstetric and Anesthesia and Perinatology (SOAP) Centre of Excellence designation. BC Women’s is one of two sites in Canada to hold this distinction reflecting that our systems, processes, and services meet the required stringent expert consensus criteria.

Thank you to Dr. Giselle Villar, who undertook the reapplication to The Society of Obstetric and Anesthesia and Perinatology (SOAP) Centre of Excellence designation. BC Women’s is one of two sites in Canada to hold this distinction reflecting that our systems, processes, and services meet the required stringent expert consensus criteria.

•

Dr. Ilana Sebbag (Deputy Research

•

Dr. Elise Hindle (Deputy

is actively establishing her Director) profile. research

to include laparotomies. These improvements support BC Women’s mandate to help reduce wait times for gynecology patients across the region.

Quality Director) is introducing an algorithm for Education and Training managing postpartum hemorrhage using • Dr. Paul Sahota (Residency Site CoordiROTEM—a first in Canada. Dr. Hindle has nator) in addition to hosting the most also spearheaded the development of lavish and best attended journal club, Paul individualized physician feedback on quality continues to enhance resident training at BC of care by leveraging CST data.

Women’s, adapting the program in response

to APT’s evolution and feedback from staff and • Dr. Katie Seligman (Quality and Safety residents. A special thank you to Dr. Ben Chen, Lead) has collaborated on a much-needed our inaugural Lead Resident, his hard work is initiative to identify and support women appreciated. with psychological birth trauma.

• Dr. Clare Burlinson (Fellowship Director) • Dr. Helen Parker has

successfully is further developing our program, fostering hosted a second provincial Obstetric connections with other obstetric anesthesia Anesthesia Update Day, combining teams across the province and country. This year, simulation and interactive lectures. Plans we welcomed our first local UBC graduate, Dr. are underway to extend this event to the Kresimir Ukalovic, into the fellowship program.

Kamloops simulation center next year, improving accessibility for community Looking Ahead colleagues.

As we move into 2025, our focus remains on

advancing our academic mandates: research, • Dr. Jonathan Collins (Medical Direc quality and safety, and medical education. tor Surgical Services) continues to lead the Additionally, we aim to build medical leadership growth of the gynecology program at BC capacity to support clinical practice improvements Women’s, introducing HAU monitoring for and service development initiatives. inpatients with OSA and expanding capacity

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Publications BC Women’s Anesthesia Chau A, Sebbag I, Sutherland E, Villar G. Obstetric hemorrhage risk assessment using the

maximum allowable blood loss calculation: are we on the right track?

Int J Obstet Anesth. 2024 Sep 24;61:104277. doi: 10.1016/j.ijoa.2024.104277. Epub ahead of print. PMID: 39342880.

Filteau L, Preston R, Seligman KM. A call to action-anesthesia assistants in Canada.

Can J Anaesth. 2024 Dec;71(12):1580-1585. English. doi: 10.1007/s12630-024-02813-2. Epub 2024 Sep 10. PMID: 39256301.

Dale-Gandar J, Chau A, MacDonell SY, Flexman AM. A survey of Canadian perioperative medicine practices regarding surveillance for myocardial injury after noncardiac surgery.

Can J Anaesth. 2024 Dec;71(12):1783-1785. doi: 10.1007/s12630-024-02850-x. Epub 2024 Oct 22. PMID: 39438401.

Barrera Ramirez J, Chen XX, Ludwig N, Singh IS, Sebbag I. Point-of-Care Ultrasonography

(POCUS) in obstetric anesthesia fellowship training: survey of North American programs.

Braz J Anesthesiol. 2024 Nov-Dec;74(6):844547. doi: 10.1016/j.bjane.2024.844547. Epub 2024 Aug 3. PMID: 39103016; PMCID: PMC11399787.

Querney J, Li Y, Li A, Singh SI, Jones PM, Dobrowlanski A, Symons Y, Sebbag I. Adult attachment style as a predictor for post-cesarean pain: a pilot study.

Int J Obstet Anesth. 2024 May;58:103977. doi: 10.1016/j.ijoa.2024.103977. Epub 2024 Jan 11. PMID: 38508962.

Ffrench-O’Carroll R, Saulnier L, Bhiladvala C, Albert A, Mayer U, Chau A. Quality of recovery and maternal satisfaction after caesarean delivery: a mixed-methods prospective cohort study.

Int J Obstet Anesth. 2024 Nov;60:104227. doi: 10.1016/j.ijoa.2024.104227. Epub 2024 Jun 20. PMID: 39018741.

Rai R, Wiseman JJ, Chau A, Wiseman SM. Readability and quality assessment of online patient education materials for spinal and epidural anesthesia.

Can J Anaesth. 2024 Aug;71(8):1092-1102. English. doi: 10.1007/s12630-024-02771-9. Epub 2024 May 21. PMID: 38773007.

Yamaguchi E, Ffrench O’Carroll R, Chau A, Preston R. Successful antepartum de-labelling of local anaesthetic allergy in a parturient with a self-reported allergy to amide and ester local anaesthetics. Int J Obstet Anesth. 2024 May;58:103978. doi: 10.1016/j.ijoa.2024.103978. Epub 2024 Jan 11. PMID: 38508964.

Dobson GR, Chau A. Special announcement: Guidelines to the Practice of Anesthesia-Revised Edition 2024. Can J Anaesth. 2024 Jan;71(1):1-7. English. doi: 10.1007/s12630-023-02667-0. Epub 2024 Jan 22. PMID: 38253967.

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Ismaiel N, Nguyen TP, Guo N, Carvalho B, Sultan P; study collaborators: Chau A, George R, Habib A, Palanisamy A, Weiniger C, Wong C . The evaluation of the performance of ChatGPT in the management of labor analgesia.

J Clin Anesth. 2024 Nov;98:111582. doi: 10.1016/j.jclinane.2024.111582. Epub 2024 Aug 20. PMID: 39167880.

Zimmo K, Ching-Johnson J, Jones PM, Singh SI, Dobrowlanski A, Symons YT, de Vrijer B, Sultan P, Carvalho B, Sebbag I. Quality of recovery after cesarean delivery in patients with Class III Obesity: a prospective observational cohort study.

Int J Obstet Anesth. 2024 Dec 12;61:104312. doi: 10.1016/j.ijoa.2024.104312. Epub ahead of print. PMID: 39700745.

Dobson G, Chau A, Denomme J, Frost S, Fuda G, Mc Donnell C, Milkovich R, Milne AD, Sparrow K, Subramani Y, Young C. Guidelines to the Practice of Anesthesia-Revised Edition 2024. Can J Anaesth. 2024 Jan;71(1):8-54. English. doi: 10.1007/s12630-023-02675-0. Epub 2024 Jan 22.

Erratum in: Can J Anaesth. 2024 May;71(5):685. doi: 10.1007/s12630-024-02752-y. PMID: 38253968.

Chau A, Markley JC. Re-attempting the procedure after an accidental dural puncture during

an epidural blood patch: is there a hole in the plan?

Int J Obstet Anesth. 2024 Feb;57:103953. doi: 10.1016/j.ijoa.2023.103953. Epub 2023 Nov 2. PMID: 37989614.

Taylor J, Collins J. Lumbar epidural analgesia in a nulliparous patient with a low thoracic spinal meningeal cyst and sacral Tarlov cysts: A case report.

Int J Obstet Anesth 2024. https://doi.org/10.1016/j.ijoa.2024.104306. [Article in press] Shippam W, Massey S, Clark K, Saulnier L, Chau A. Time to motor block regression after

neuraxial anaesthesia for caesarean delivery: a retrospective, cohort study.

Anaesthesia. 2024 Oct;79(10):1125-1127. doi: 10.1111/anae.16400. Epub 2024 Jul 29. PMID: 39073352.

Casellato JF, Balki M, Wang A, Ye XY, Downey K, Carvalho JCA. Differential sensory block during labour epidural analgesia: a prospective observational study to investigate the relationship of lower and upper sensory block levels to cold, pinprick, and light touch.

Can J Anaesth. 2024 Jun;71(6):802-807. English. doi: 10.1007/s12630-023-02638-5. Epub 2024 Jan 30. PMID: 38291174.

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Lions Gate Hospital Dr Magdalena Lipowska Department Head VCH Coastal Community of Care Lions Gate Hospital is part of the Coastal Community of Care of Vancouver Coastal Health (VCH CCOC) and provides acute, community and primary health services to more than 270,000 residents in rural and urban settings living on the North Shore, in the Sea-to-Sky Corridor, on the Sunshine Coast and in Powell River. Additionally, it is affiliated with, and provides service to, BC’s Central Coast, including Bella Bella and Bella Coola. As such, we are the tertiary referral centre for surgical patients from a wide catchment area. LGH currently has 268 beds. We have 10 ORs, including 8 Main ORS, a Case Room and a Closed Urology room, and 8.5 slates run daily, with 9.5 slates twice a week to accommodate expanded services in Therapeutic Endoscopy and Closed Urology, which were added in 2022.

It is the fourth busiest hospital in Vancouver and one of only five neurosurgery centres in B.C. The coming opening of our new Paul Myers Tower will further expand our services.

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In 2024, Dr Magda Lipowska continued on in her role of Department Head of Anesthesiology for the Coastal Community of Care. This year also saw the completion of Dr Clare Morrison’s tenure as Comedical Director for the Surgical Program for VCH CCOC, a role she has held since 2019. The Department of Anesthesia at LGH is greatly indebted to Dr Morrison for her many years of dedicated and exemplary leadership. She will be missed. We are lucky to have Dr Randy Hewgill assume the position of being the next Comedical Director of Surgical Program. In these roles, Dr. Lipowska and Dr. Hewgill will continue to work together to help with the perioperative program leadership. We will also continue to build relationships with our FPA anesthesia partners across the 3 Rural VCH Coastal Community of Care Surgical programs in Squamish, Sechelt, and qathet Hospital in Powell River. In mid 2024, Dr. Riley Senft completed his tenure as Deputy Department Head, and Dr Amelie Pelland has stepped into this role. Dr. Teresa Ripley continues

to be our Preadmission Clinic Medical Lead. Dr Connie Drewbrook is our Education Academic Site Director, continuing to provide guidance for the ever-increasing numbers of trainees coming through our LGH OR doors. Dr. John McAlpine serves in the role of Director of the Family Practice Anesthesia Program and Dr. Rob Fingland is the Local Site representative for the Family Practice Anesthesia Program. Due to our position as one of the hospitals in the VCH Coastal Community of Care, Lions Gate Hospital and its Anesthesia Department leadership maintain ties with the Family Practice Anesthesiologists at surgical programs across the other VCH Coastal Community of Care sites. Our site also provides opportunities for refresher days and extra training for currently practicing FPAs, as well as providing teaching for paramedic students and Anesthesia Assistant trainees.

In 2024, we continue to build on the development of an Anesthesia Department Quality Committee at LGH, spearheaded by Dr Cristin McRae, Dr Amelie Pelland, Dr Simon Burrows and Dr Clare Morrison. We are continuing to increase our focus on a more fulsome and systematic approach to delivering, assessing and improving quality of care at out site. In addition to monthly morning Educational Rounds, we are conducting regular Departmental Quality and Patient Safety rounds as well as multidisciplinary educational opportunities with other departments. Under the excellent guidance of Dr. Rob Fingland and Dr. Teresa Ripley, Anesthesiology at LGH also continues to run regular perioperative simulations for department members and perioperative staff.

Closed Urology/Therapeutic Endoscopy suite in our existing footprint. A new Perioperative Care Unit will modernize our preop and postop workflows and an accompanying inpatient tower will house new medical and surgical wards. The upcoming move to this new facility has taken a significant amount of planning and been the focus of much work the past year.

Staffing Changes: 2024 saw the addition of Dr. Alicia Ling to our Department.

The big focus at LGH in 2024 is gearing up for the opening of the new LGH Paul Myers Tower, our new Acute Care Facility on the LGH Campus.

This will house 8 new operating rooms, in addition to 2 legacy ORs, a Case Room and a

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Royal Columbian Hospital & Eagle Ridge Hospital Dr. Kenneth Ryan Regional Medical Director and Department Head The Department of Anesthesiology and Perioperative Medicine at Royal Columbian Hospital (RCH) provide anesthesia services at both RCH and Eagle Ridge Hospital (ERH). RCH along with Vancouver General Hospital, is one of two Level 1 trauma centres in the province and serves as the tertiary care referral centre for the Fraser Health Authority (FHA), with approximately 1.9 million people or 38% of British Columbia’s population, as well as patients from other regions. RCH, the oldest hospital in the province, is a general hospital providing a wide spectrum of surgical and medical services.

RCH is the highest volume cardiac centre in BC, and cares for an ever growing volume of trauma patients, as a result of its large population base, proximity to major transportation corridors, among other factors. Supporting this care is a robust critical care team, and an ECMO service for patients with severe heart or lung dysfunction.

RCH runs an orthopaedic trauma operating room 364 days per year. Additionally we have created a block room in the operating room, to facilitate the conduct and teaching of regional anesthesia for a variety of surgical patients. RCH is the regional neurosurgical referral centre for FHA, and sees a high volume of craniotomy, spine and neuro-interventional procedures annually.

RCH continues to have one of the best neonatal intensive care units in North America in terms of neonatal outcomes, and is the provincial centre of excellence for high-risk obstetrical care, specifically the management of complex invasive placenta conditions (eg. placenta accreta), cases that require ICU and/or cardiac care for expectant mothers, while also being 24

able to care for low birth weight, premature infants.

A multidisciplinary approach to this complex work, underlies the successes we see at our site.

Over 60% of the cases performed at RCH are classified as urgent/emergent. Over the last decade, NSQIP data has consistently ranked RCH surgical patients as having some of the the highest acuity amongst the hundreds of North American hospitals participating in the program including in 2023 when it received meritorious status for quality of care.

Royal Columbian Hospital and Eagle Ridge Hospital are core teaching sites for medical students and for anesthesia resident training. The residency program has expanded recently to 20 positions per year. As well, there is a new Fraser track for 32 3rd year medical students based primarily at our site, but involving other sites within the FHA. We also train anesthesia assistant (AA) students, and have a growing group of AA’s who are integral to the work we do. We expect RCH to continue to evolve as an important academic and learning centre for medical learners in the years to come.

RCH has a robust research and QI program, involving multiple ongoing clinical trials and projects, supported by a research coordinator, research assistants, and medical students. We have a dedicated team of committed clinician scientists who have been very productive in the past year. We are involved in at least 10 different clinical trials, the group have published a number of recent manuscripts, and there is more to come in 2025. We are proud of the work our research group has accomplished in this past year and look forward to it’s ongoing success.

Finally, RCH is undergoing a major redevelopment. Phase 1 which is completed, is the Mental Health and Substance Use Wellness Centre with a stand alone neuro stimulation suite where our group provides anesthesia care for electroconvulsive therapy. Phase 2, the 10 level Jim Pattision Acute Care Tower (JPACT), is under construction with a planned opening in late 2025 or early 2026. This includes an interventional platform with 17 operating rooms, 3 cardiac catheterization laboratories, and 5 interventional radiology suites. There will be a 3 bay block room, for regional anesthesia as part of the Interventional Platform. The obstetrical service will exist on its own floor with 2 obstetrical operating rooms. Phase 3 will renovate the existing hospital for future needs,

and to support the function of the JPACT. This new tower opening will coincide with the expansion of expanded subspecialty rotations for the residency program in FHA teaching sites.We expect to be able to access the JPACT building in May of 2025 to begin the process of making it operational by years end.

We have implemented tele tracking for patient flow, and anesthesia work stations for medication dispensing in the OR this past year as early implementation projects of redevelopment. We also launched Meditech Expanse in September, our new electronic medical record platform. This has been a challenging undertaking, and the department has done a remarkable job adapting to this new clinical tool.

Eagle Ridge Hospital (ERH), is a lower acuity community hospital in Port Moody, BC where our department also provides anesthesia care. There are six operating rooms, and a busy pre-admission clinic where care is offered for nearly 10,000 surgical cases a year, the majority of which are outpatient cases. This now includes a same day arthroplasty program, as well as minimally invasive major general surgery cases in selected patients. ERH is also where a majority of our paediatric patients are cared for. Residents from the training program now regularly rotate at ERH, as it offers an excellent teaching environment and volume for learners at all stages.

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Surrey Memorial Hospital

Dr. Alex Vesely, Dr. Maha Iyer (SMH), and Dr. Laila Karwa (JPOCSC) Co-Heads, Department of Anesthesiology, P a i n and Perioperative Medicine Surrey and SMH/JPOCSC Surrey is the fastest growing city in BC and is expected to surpass Vancouver to become the largest city within the next 5 years. Surrey Memorial Hospital is the second largest hospital in the province, now with almost 800 beds, and one of the busiest Emergency Departments in North America. The high birthrate is also reflected in the exploding number of deliveries at the site -- on pace for over 6000 next year.

SMH is a tertiary-teaching-community hospital that combines a high level of acuity, learners, and tertiary level infrastructure, supports and quality, with the fast pace and atmosphere more typical of the periphery.

The SMH OR currently runs 10 slates plus an elective/emergency swing room in our maternity unit, where we have 24x7 on-site dedicated Anesthesia coverage. We are a regional referral centre for high risk Obstetrics, Thoracics, and major Head and Neck. Our Pediatric surgery program is modest but still the primary one in the region, with 40-45% of children’s surgery in FHA. Other surgical services include Urology, Gynecology, General Surgery, Orthopedics (trauma, upper limb, foot and ankle, arthroplasty, spine), Plastics, ENT, Oral-Maxillofacial and Ophthalmology (retina/ glaucoma/cornea/cataract), and we provide care to higher comorbidity elective and emergency referrals from surrounding hospitals such as Delta and Peace Arch.

In 2024, the SMH Surgical Program was recognized for achieving meritorious outcomes for surgical patient care over the previous calendar year. SMH was in the top 10% (60 of 26

609 hospitals) in both the “All Cases” and “High Risk” categories – the only one of the 23 ACS NSQIP hospitals in BC to make either list.

https://www.facs.org/media-center/pressreleases/2024/acs-nsqip-recognizes-77-hospitalsfor-achieving-meritorious-outcomes-for-surgicalpatient-care/ The JPOCSC OR runs 5 slates daily, encompassing a wide variety of mostly higher turnover outpatient procedures in ASA 1-4 patients in Urology, Gynecology, Orthopedics, ENT, Plastics, and General Surgery, as well as AV fistulas and Pacemaker/ Defibrillators for the region. JPOCSC also hosts our multidisciplinary Chronic Pain Clinic, which logs over 25,000 patient encounters per year among all providers.

SMH Family Birthing Unit SMH is second in the province in deliveries, with roughly double the volume of the next largest sites, and continues to see annual increases of 5% or more: in 2024, deliveries rose from ~5200 to over 5800. SMH is also the only Tier 6 maternity unit in BC, meaning a wide variety of comorbidities. To create capacity for Surrey mothers in the coming years, SMH Tower 2 will be home to a brand new Birthing Unit roughly double the size of the current one, but this is at least 5 years away, therefore we also expect an interim expansion of the existing space in order to bridge the gap until the new facility opens.

We have recently started offering an elective OB Anesthesia rotation which allows residents to take advantage of the substantial Obstetrical volume and acuity and lower learner density at SMH.

Department Organization and Leadership The SMH/JPOCSC Department is a diverse and collegial group from across the lower mainland: our members are distributed from North Vancouver to Point Grey to White Rock to Maple Ridge. We maintain an egalitarian and generalist approach to our practice, on a fee-for-service basis.

Drs. Vesely and Iyer, and Dr. Karwa, continue in their Department Head roles at SMH and JPOCSC, respectively, but we have a number of staff that have completed additional leadership and PQI training, and as a department we aspire to a high level of engagement.

Membership

2024 was an expansion year, and as of December, the Department comprised 27.6 total FTE -- a net increase of 2.1 vs the same time last year -with 36 department members and 5 associate members (departed, casual or semi-retired members who maintain their relationship with the department). Looking ahead, we expect attrition replacement with stable total numbers through 2025, and further expansion in 2026.

2024 Additions: Dr. Josh Frohlich (Memorial University), Dr. Jiin Kim (UBC), Dr. Kamal Sidhu (UBC).

Resident and Medical Student Education Co-DSSLs Dr. Christine Graf and Dr. Mihaela van Idour are strongly committed to prioritizing optimal learning for Anesthesiology residents and medical students, as well as coordinating numerous other categories of learners such as RT, AA and paramedic students, off-service residents, and practicing physicians wanting to upgrade their skills.

Trainees rotating through SMH/JPOCSC enjoy a fertile learning environment with a diverse breadth of cases in a friendly atmosphere. Resident rotations currently include General Pool for R1-R5, subspecialty Regional and Thoracics blocks, and Transition to Practice, as well as elective OB. Teaching award winners last year include Dr. Graf and Dr. Aidan Lee.

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Selected Programs/Initiatives Chronic Pain: We have committed to revitalizing the link between the two hemispheres of our department and then to initiating programs to more seamlessly and holistically serve pain patients, wherever they may find themselves.

Significant infrastructure and human resource expansion have already begun and will continue for the next 2-3 years.

Regional Anesthesia: Our contract-supported Block Program, now in its 5th year of operation, continues to provide a valuable clinical service and popular educational experience in providing thoracic epidurals, upper and lower extremity, and truncal blocks to SMH surgical patients.

Last year, we added to our ultrasound fleet and moved into a new dedicated block room.

Simulation: Our in-house Surgical and Obstetric Hi-Fidelity Simulation Programs, led by Dr. Clara Gramberg, are now well-established as a valuable safety/quality and team building asset.

Anesthesia Assistants: Our AA program is over 20 years old, with numbers and deployment calibrated to ensure an efficient and sustainable practice for our group while providing value to the system.

Robotic Surgery: The Intuitive da Vinci has been selected to bolster our existing programs in Thoracics, major Head and Neck, Urology and General Surgery. To host our robotic surgeries, our OR6 is slated for a complete remodel this year, with program start now scheduled for spring 2026.

Preoperative Optimization: Led by Dr. Peter Gajecki, this project focuses on enhancing the care of patients undergoing esophagectomy and gastrectomy, and is showing decreased length of stay, morbidity and readmissions.

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Planetary health: In recent years, SMH has played host to a trial of anesthetic vapour recapture technology, and discontinued the use of Desflurane. We are in the process of decommissioning our nitrous oxide plumbing at JPOCSC and SMH. In 2024, we switched to coaxial silver nitrate anesthetic circuits in order to increase the duration between circuit replacement and reduce plastic waste. We are committed to try to find incremental changes to our equipment, supplies and practice patterns, in order to decrease environmental impacts and economic costs to our system.

Growth and Redevelopment In 2023, SMH experienced a boiling over of frustration for a number of reasons, in particular, hospitalist shortages, emergency department and ward congestion, maternity unit diversion, and dissatisfaction with the lack of certain capabilities.

An outpouring of publicity, advocacy, and pressure, involving a large number of physician groups and providers led to engagement with community leaders such as the Foundation, Mayor and Councilors, media, and ultimately the Ministry of Health. Our Department participated in a moderated forum at Surrey City Hall, and subsequently consultative meetings with former Minister of Health Adrian Dix at SMH, all of which ultimately resulted in commitments for much needed new and expanded services at SMH.

• Construction has now begun on 2 Cardiac Cath labs and 2 new Interventional Radiology suites in former administration space in the SMH Critical Care Tower, as well as a new freestanding outpatient dialysis building.

• A new SMH Tower 2 was announced in 2024 in order to address capacity in many areas. We were involved in the extensive Clinical Services Planning and Functional Planning meetings for both the Surgical and Maternity Programs, which have now been completed. Indicative Design plans are expected this spring but current thinking is that Tower 2 will more than double our surgical capacity and add a number of new services. The timeline for construction is eagerly anticipated, as this capacity is very much needed.

quality. An additional 3 ORs from within our existing footprint (2 at SMH, 1 at JPOCSC) are expected to come on line and to be fully operational by the end of 2026.

On the information technology side, we will be migrating both our EMR and AIMS platforms in 2025-26, and have begun preparing for this change.

Summary The next 5-10 years will be a period of significant growth for what is already one of the busiest surgery and maternity sites in the province, with all the opportunities and challenges that entails. SMH will remain a key educational site going forward.

In the meantime, the SMH Clinical operations team, Anesthesia heads and Surgeon heads have been working collaboratively to ensure renovation, reactivation, and optimization of all existing spaces. We have managed our growth sustainably, which has preserved staffing, working conditions and morale, allowing us to function with low closures, high efficiency and

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St. Paul’s Hospital Dr. James Kim Chair, Department of Anesthesiology The SPH Department of Anesthesiology had a busy year in 2024. St. Paul’s is a Clinical Medical Academic Centre in downtown Vancouver that is integral to the University of British Columbia Faculty Of Medicine. It is part of Providence Healthcare, which comprises St. Paul’s Hospital, and Mt. St. Joseph’s Hospital. The Department of Anesthesiology has demonstrated excellence in numerous aspects of Anesthesiology and perioperative care. Areas of clinical focus include Cardiac Anesthesia, Regional Anesthesia, Perioperative Medicine, and Interventional and Complex Pain. The Department of Medicine houses major initiatives in Respiratory, Cardiology, Gastroenterology, Geriatrics, Addictions, and Nephrology areas. The Department of Surgery aside from Cardiac sciences also has components including Urology, Otolaryngology, General, Gynecologic, Plastic, and Orthopedic surgery as well as Vascular surgery. Anesthesiology at St. Paul’s Hospital is a major Department comprising 57 anesthesiologists and up to 6 subspecialty fellows. The Department also delivers anesthetic services at Mt. St. Joseph’s hospital (a community hospital with special focus on retinal surgery and the Breast Centre) with 4 Operating Rooms and 4 Ophthalmology Procedure Rooms. .

Cardiac Anesthesia Group: The Cardiac Anesthesia Group is comprised of 15 members responsible for the intraoperative Trans-esophageal Echo Program, CSICU, Structural Heart and Open Heart and Transplant programs. Dr Anne Marie Madden is the Cardiac Anesthesia Lead. Dr Matt Klass leads the TEE group; Dr Matt Coley is the CSICU Lead; and Dr Simon Bruce is the anesthesia lead for structural heart program. Our successful Cardiac Anesthesia Fellowship program is lead by Dr. 30

Kevin Rondi and welcomes 2 Fellows each year. The Cardiac Anesthesia group also includes Drs. John Bowering, Bobby Lee, Aaron Doyle, Dmtry Mebel, Ron Ree, Raja Rajamohan, Jean Raubenheimer, Terri Sun. In 2024, the group concluded one multicentre trial and continue with 3 randomized clinical trials which should conclude in 2025.

Pain Group: The Pain Group has been very active: Dr. Jill Osborn is the Physician lead for SPH Complex Pain Program (6 members) as well as Interventional Pain with long standing member Dr. Clinton Wong. Dr Ainsley Sutherland leads the Acute Pain Team (9 members) as well as the Transitional Pain Clinic where she is joined by Dr. Kat Kojic. Dr. Sutherland was also named the interim VCH/PHC Physician Lead for Pain. The multidisciplinary Complex pain clinic provides services with outreach to many patients outside the lower mainland. The multidisciplinary Neuromodulation Program (Dr Jill Osborn and Dr. Vishal Varshney) includes two Neurosurgeons (Drs Ramesh Sahjpaul and Scott Paquette). Working together with the SPH Foundation, two initiatives were prioritized: The creation of an Endowed Chair in Pain Medicine (Dr. Vishal Varshney) and support for the Neuromodulation Program. In 2024, The Endowment is very close to completion ($2.5M) after a sizeable donation. This exciting milestone will occur in 2025 and bodes well for Pain education and research in the years to come.

Regional Anesthesia Group: The Regional Anesthesia Group is lead by Dr. Chris Prabhakar and has 14 members. They preform over 4500 regional blocks per year at 3 separate locations with dedicated block areas (two at SPH and one at MSJ). In 2024, Dr. Cole Wong completed his Regional Anesthesia Fellowship in New Zealand.

The SPH Regional Fellowship is very competitive and welcomes two Fellows/year. Dr Catharine Moores, Dr. Ayda Askari, Dr. Patrick Tawal were the Regional Fellows in 2024. Dr Steve Petrar is the overall department Fellowship program director and also transitioned Dr. Steven Wang as the Regional Fellowship program director.

The Regional Anesthesia Resident Rotation remains very popular.

Simulation Group:

Perioperative Medicine Group:

Research Group:

The Perioperative medicine group Physician Lead in Dr. Sui Yin McDonell who is also the UBC Perioperative Medicine Lead. The group continues to be innovative in terms of its team-based approach to perioperative care with residents, fellows and internal medicine staff. Two fellows are accepted every year. The core Perioperative members also include Drs. Charles Yu, Alana Flexman, Janny Ke, Hao Chen, Anton Chau, Vincent Frucci, and Tony Bhad. This group is also active in research and is part of 2 multicentered trials as well as a Supercluster group to examen continuous bedside monitoring in the acute care setting. Drs Janny Ke and Charles Yu are leading this multimilliondollar project. The weekly perioperative rounds continues to be offered to all UBC faculty and residents.

Dr. Alana Flexman continues as PHC Anesthesia Research program Director and Michael Smith Fellow. She is supported by Dr. Anton Chau, associate research director and Nicola Edwards, Research Manager. Drs Flexman and Schwarz welcomed Jaycee Farmer who entered the PhD program supported by the department. She was joined by 3 Co-Op students, Peter Mills, Brooke Evans, and Narjis Alhusseini, who worked on various research projects. There was a total of 29 articles

Simulation is a major focus of the department with Dr. Shannon Lockhart as the Co-physician lead for PHC Simulation. She is heavily involved with the UBC Simulation program is often joined by Drs Hao Chen, Heather Cadenhead, Kelli O’Reilly and Cole Wong. Dr Lockhart was successful in obtaining a large ($175,000) PHC Simulation Innovation grant to initiate this in a multidisciplinary fashion at PHC.

published in 2024.

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Highlights of 2024 include the following grants The Department of Anesthesia at St. Paul’s Hospital and awards and a large number of publications: will continue to develop as one of the larger

departments in Providence Health Care. New staff • Michael Smith Research BC $450,000 who are presently in subspecialty training include: (Dr. Alana Flexman).

• Co-Principal Investigator for CIHR Project Dr Heather Cadenhead, Cardiac Anesthesia Grant to develop evidence based guidance fellowship, Stanford University. and provide information for older people trying to make a decision to have surgery or Dr. Emily Chan, Pain Fellowship, University of Calnot. (Dr. Alana Flexman). gary.

• Dr. Alana Flexman was appointed SPH Leadership Activity: the next Editor-in-Chief of the Journal of Neurosurgical Anesthesiology.

• The PHC Anesthesia Leadership continues

to be active in the UBC system and abroad.

• SCA starter grant (second year of These are some of the highlights from this year’s funding) for Paravertebral Blockade for activity.

Recovery following Cardiac Surgery $50,000 • Stephan Schwarz, Editor-in-Chief, Cana(Dr. Terri Sun). dian Journal of Anesthesia, Director of the UBC • 2024 Carraresi Foundation: Early Career Clinician Investigator Award: Bilateral paravertebral blockade for improvement of quality of recovery following cardiac surgery: a randomized controlled trial (PVB PQOR Trial). Dr. Terri Sun.

• Dr. Ron Ree, Dr Alana Flexman, Dr. Terri Sun got an investigator-initiated grant from Eisai, Inc for pilot RCT “A Randomized Trial of Lemborexant for the Prevention of Delirium After Cardiac Surgery” (worth ~ $115,000).

• Participated in ongoing Multicenter RCTs: CODEX and Fit after Surgery.

• Ministry of Health Innovation Pathway Grant from the Ministry of Health: Mobile Interventional Pain Team: Portable Cryoneurolysis ($85,000; Dr. Michael Jew).

• Development of the Department of Anesthesiology Patient Advisory Council.

• Dr Alana Flexman is the inaugural Chair in Perioperative Brain Health. When fully funded, this endowment will be $2,000,000.

• Dr Vishal Varshney is the inaugural Chair in Pain Care. This $2,500,000 endowment is almost fully funded.

Hugill Anesthesia Research Centre.

• Anne Marie Madden, Co-Lead, UBC Division of Cardiac Anesthesiology.

•

Alana Flexman, Past-President, Society for

•

Su-Yin MacDonell, Head, UBC Division of

•

Cynthia Yarnold and Laine Bosma, Co-

•

Cynthia Yarnold, physician lead, New SPH

•

Jim Kim, CAS Vice-President, PHC Mem-

Neuroscience in Anesthesiology and Critical Care & Past-Chair, Neuroanesthesia Section, Canadian Anesthesiologists’ Society; incoming Editor-inChief, Journal of Neurosurgical Anesthesiology, UBC APT Vice-Chair REDI.

• Alana Flexman: Endowed Chair Perioperative Brain Health.

Perioperative Anesthesiology, Keynote Speaker Aukland City Symposium “At the Heart of the Matter: The cardiac patient for non-cardiac surgery”, Co-Chair Whistler Anesthesiology Summit organizing committee.

• Trina Montemurro, PHC physician group (PASS) lead for quality.

Chair, UBC Competency Committee.

Procedures Floor.

ber of PACT (perioperative anesthesia clinical trials group), UBC APT lead for Global Health, 32

UBC APT Executive Committee, UBC APT Head Selection Committee, CASIEF Board Member, Regional Head Department of Anesthesiology VCH/PHC, Co-Medical Lead VCH/PHC Surgical Program.

•

Vishal Varshney & Jill Osborn, Board Members-at-Large, Canadian Neuromodulation Society.

• Vishal Varshney: Endowed Chair in Pain Care.

•

Vishal Varshney: Physician Lead for

the Clinical Research and Support Building.

• Jill Osborn was featured as one of the three specialists interviewed in a Medical Post article titled, ‘Management of Sciatica: Three specialists provide advice on how to help patients with this common low back pain’ .

•

Lily Chiu started her MSc in Health Economics, Management and Policy at the London School of Economics.

• Hao Chen completed his Master of Healthcare Administration at Western Governors University.

•

Charles Yu started his MBA/Healthcare Administration, Rotman Scholl of Business, University of Toronto.

• Alana Flexman, Anton Chau, Tony Badh, Tim Jen, and Lacey Corbett, were

speakers at the CAS annual meeting in Victoria.

The Department continues to grow and expend under the APP contract which will be renegotiated in 2025 in preparation to the lead up to the new St Paul’s Hospital. In 2023, members celebrated the retirement of long-time member, Dr. Jim Prentice.

A major initiative in 2025 is the creation of a PHC • Dr. Charles Lo, Physician Lead for the Endowed Chair, innovation. This year in review New St Paul’s Redevelopment. will sadly be my last as my term as Chair of the Department will come to an end in 2025. I have no • Anton Chau, Board Member, Anaesthesia Journal. doubt that the department will continue to flourish

with a new leader at the helm. The past 10 years • Dmtry Mebel and Lily Chiu, Board have been an incredible journey which has seen the Member, BCAS. addition of 36 members to the department!

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VANCOUVER GENERAL/UBC HOSPITALS Dr. Jens Lohser, Department Head Dr. Jason Wilson, Associate Head, Human Resources Dr. Raymond Tang, Associate Head, Academic Dr. Jacqueline Trudeau, Associate Head, Clinical Activity: Our department covers surgical sites at both We have multiple novel and exciting initiatives VGH and UBC Hospital. On a daily basis we ongoing: operationalize 24 operating rooms plus 4-5 out or OR surgical sites including interventional • Our environmental stewardship group has radiology, cath lab, electrophysiology, uromoved Desflurane out of the operating room radiology, lithotripsy/ stone center and ECT at suites and has facilitated the decommissioning VGH, plus an additional 8 operating rooms at of our nitrous oxide manifold system throughout UBCH. the hospital.

Annually we provide anesthesia to approximately 15,000 surgical cases at VGH, 50% of which are urgent or emergent bookings. At UBCH we perform approximately 7,000 elective surgical procedures per year.

Transplantation has become a growing and increasingly normalized part of our work environment. In 2023 we performed an all time high of 77 lung transplants and 107 liver transplants.

In order to operate the 51-53 daily assignments, our department had expanded to 80 full-time staff by the end of 2023. We maintain a small temporary staff pool of 2-3 individuals for longitudinal assessment with intent to hire.

We maintain a locum arrangement with BCWH providing exposure to general anesthesia cases at UBCH for their staff.

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• Our regional group has embarked on a number of pain pathway initiatives in collaboration with surgical services. Our rib fracture pathway identifies trauma patients that will benefit from regional anesthesia for pain control and morbidity prevention. The goal is to utilize regional anesthesic techniques for analgesia to reduce opioid consumption and prevent the need for intubation and ICU admission. Our hip fracture pathway delivers regional anesthesia to patients prior to surgical fixation irrespective to their in-hospital location, in periop hold, the emergency department or on the orthopedic ward. This is an elderly and frail population that benefits from non-opioid analgesia for the prevention of delirium and other side effects.

• Our regional group has been instrumental in helping to decompress our post-anesthesia care unit. We have established dedicated OR slates

for regional only cases to enable bypass of stage 1 recovery.

• Our perioperative anaphylaxis clinic investigates perioperative events from our health authority and others in collaboration with Allergist Dr Ruiz. Workups include skin testing and, if required challenge testing in PACU.

• The PreAdmission Clinic has benefited from the full integration of Pharmacy in the clinic.

As well, pathways of Pre-Surgical Optimization continue to be developed for surgical patient benefit before their procedure. Optimization

New staff hires: Drs Hamish Bodnar and Vlad Kovalik joined our department after completion of their residency at UBC.

• We run a resident POCUS rotation supported by Cardiac Anesthesia and perioperative anesthesia staff members. Staff returns: Residents are exposed to a vast array Dr Kate Mittermaier re-joined the staff after her of ultrasound pathology in the cardiac Neuro-anesthesia fellowship in London, UK Dr surgery ICU, the intensive PACU and in the Naima Kotadia re-joined the staff after a combined preoperative arena. Neuro-anesthesia and Obstetric Anesthesia

fellowship at UC San Diego.

• Our perioperative group is responsible for the postoperative care of all non-cardiac Staff departures: patients going through PACU, facilitating Dr Rosie Earle unfortunately left our department for recovery and triage to ward or ICU for patients family reasons. after hepatobiliary, thoracic, vascular and major general surgery.

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Victoria General Hospital Dr. Desmond Sweeney Department Head The Victoria Anesthesia department continues to enjoy a wide breadth of clinical diversity in a tightly knit group that values high quality patient care, perioperative collegiality, and an environment that is supportive of future growth.

Clinical The Victoria Anesthesia department covers the Royal Jubilee and Victoria General hospitals.

Surgical coverage continues to expand in its diversity and includes trauma, cardiac, neurosurgery, thoracics, vascular, neonatal/ paediatric, and obstetrics, with widespread coverage excluding transplant. Non operating room anesthesia presence is increasing and includes perioperative medicine, interventional radiology, gastroenterology, paediatric pain and diagnostic services, burns and others.

Generous foundation donations have led to the introduction of the Da Vinci robot to start in February 2025 with urology, general surgery, gyne oncology and ENT surgery being at the lead of its initiation. Victoria has a thriving regional program, with a dedicated regional position,

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that includes paraveterbal blocks for breast surgery, peripheral nerve catheters for limb amputation pathways, and MIS cardiac surgery coverage. With a new contract, multiple other clinical and leadership positions will be opening and we are excited to see how this will add to iterative improvements in patient care. .

Education From an education perspective, we are working on increasing simulation training and morning staff-led teaching sessions. Tailoring the rotation to the specific resident’s needs is important to us, and residents continue to enjoy the high level of acuity Victoria offers, particularly in thoracics, general surgery, and vascular rooms. Teaching clinical excellence is highly valued and exemplified by staff such as Dr. Richard Alexander who won one of the prestigious UBC clinical faculty awards for teaching.

Research/Quality Improvement:

Staff changes:

Research and quality improvement are areas that have had an injection of enthusiasm from individuals such as new hire Dr. Garrett Barry, who received the CAS Su Ganapathy Regional Anesthesia Research Award for his regional anesthesia work. Quality improvement initiatives include work on maintaining up to date MOST status, improving perioperative staff rapport, TEVAR pathways, hemorrhage protocol and preop clinic optimization.

New hires in the department include Dr. Colin Edward Archer, Simon Adamson, Michael van der Westhuizen, Garrett Barry, Spencer Holowachuk and Martha Digiuseppe. Currently, there are 62 active members of the department.

We would like to extend our congratulations in retirement to Dr. Tom Ruta who has made numerous contributions to the department over the years including head of the department

Dr Gordon Wood has been very active contributing to several research papers. This includes“ Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation” NEJM, July 4, 2024, Vol.361 No.1. “Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage”, NEJM June 13, 2024, Vol 391 No.8, and “Effects of Losartan on Patients Hospitalized for Acute Covid-19: A Randomized Controlled Trial”, Clinical Infectious Diseases, Vol 79,Issue3, September 15, 2024 P 615-625.

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Clinical Divisions

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DEPARTMENT OF ANESTHESIOLOGY, PHARMACOLOGY & THERAPEUTICS 39

Cardiovascular Anesthesia Dr. Juliet Atherstone & Dr. Anne-Marie Madden Division Co-Heads UBC Anesthesia Residency and Fellowship Training UBC offers residents a 2 month rotation in cardiac anesthesia at one of the sites: Vancouver General (VGH), Royal Columbian (RCH), St. Paul’s Hospitals (SPH), Royal Jubilee Hospital (Victoria).

Residents can also pursue elective educational opportunities in cardiac anesthesia at Kelowna General Hospital. Fellowships are offered at the VGH, SPH, RCH and Victoria. Each of the sites have their own unique educational opportunities such as endovascular thoracic aortic aneurysm repair, mechanical assist devices, transplants, and transcatheter aortic, mitral, and tricuspid valve repair/replacements outside of the standard experience during such a rotation.

Residents also spend one month in the Cardiac Surgery ICU (CSICU) while fellows complete a 3 month rotation. Given the increasing complexity of cardiac surgery patients, this has resulted in an excellent learning experience in managing complex patients with a variety of mechanical assist devices such as ECMO and LVAD’s as well as challenging medical conditions historically seen in the ICU.

An additional one-month TEE/POCUS elective is also offered, focusing on both cardiac anesthesia and perioperative medicine. We have our fellows participate in regular echo education rounds.

Site Updates/Highlights: a) St-Paul’s Hospital Leadership Dr. Anne-Marie Madden is the Head of Cardiac Anesthesia. Dr. Matthew Coley is the directors of the SPH CSICU. Dr. Kevin Rondi is the SPH Cardiac Anesthesia Fellowship Director. Dr. Matthew Klas is the Director of Perioperative Echocardiography. Dr Terri Sun is the Cardiac Anesthesia research lead.

Human Resources Dr Shika Card has joined the SPH Cardiac Anesthesia group at Providence Health. She completed medical school at the University of British Columbia (UBC) and residency and cardiothoracic anesthesia fellowship at Massachusetts General Hospital, Boston, MA. She has a special interest in Quality Improvement and is currently completing Level 3 Advanced Physician Quality Improvement Training program at UBC. Awards and Grants Dr. Terri Sun, Clinical Assistant Professor, was awarded the 2024 Carraresi Foundation: Early Career Clinician Investigator Award for her study: Bilateral paravertebral blockade for improvement of quality of recovery following cardiac surgery: a randomized controlled trial (PVB PQOR Trial) Dr. Sun also received as second year of funding from the Society of Cardiovascular Anesthesiologists (SCA) Starter/ Diversity Grant.

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Publications: Sun T, Fan M, Peng D, Li L, Ree A, Flexman AM, Sutherland AM, Schwarz SKW, Jen TTH, Yarnold CH. Association of chronic poststernotomy pain and health-related quality of life: a prospective cohort study. CJA 2024 Feb 29.

Prabhakar, C., & Ree, R. M. (2024). Don’t just do something, stand there!.

Canadian Journal of Anesthesia 71(4), 563–564. https://doi.org/10.1007/s12630-024-02731-3 Sun, T., Yen, P., Peng, D., Besola, L., Chiu, W., Flexman, A., & Cheung, A. (2024). Right

ventricular function following sternotomy versus a less-invasive approach for left ventricular assist device implant: Retrospective cohort study.

Journal of Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1053/j.jvca.2024.04.044 Yen P, Sun T, Farmer J, Johnston D, Field T, Flexman AM. (Nov 2024) Perioperative Stroke Following Implantation of Left Ventricular Assist Device: A Retrospective Cohort Study.

Journal of Cardiothoracic and Vascular Anesthesia, epub ahead of print. b) Vancouver Acute Department of Anesthesia Leadership Dr. Sean McLean remains the Head of Cardiac Anesthesia with VADA and Dr. Darren Mullane is the Medical Director of the VGH CSICU. Dr. Julena Foglia is the VADA Cardiac Anesthesia Fellowship Director and Dr. Patrick Hecht remains the Director of Perioperative Echocardiography.

Human Resources Dr. Julia Cory was welcomed back from completing her Cardiothoracic Anesthesia Fellowship at The Alfred in Melbourne, Australia.

Dr. Kristen Kidson was also welcomed back to the department after completing her CV fellowship at Stanford University. Dr. Igor Brodkin left the Cardiac Division in 2024, leaving behind a legacy of excellent patient care, teaching and innovation.

Clinical Trials/Research • TRICS IV » Personnel: Darren Mullane, Juliet Atherstone, Joel Price.

• FARES 2 » Personnel: Darren Mullane, Bevan Hughes, Sakara Hutspardol

•

•

TCDC study » Personnel: Julena Foglia, Darren Mullane, Joel Price, Raju Heran, Hilary Grocott .

AlbACS-1R » Personnel: Darren Mullane

Quality Improvement Projects • QI for Perioperative TEE » Personnel: Simone Schulein, Darren Mullane Sean McLean,Chris Durkin, Bevan Hughes, Cyrus McEachern, Patrick Hecht.

• Parasternal blocks for ERAS Cardiac Surgery » Personnel: David Olmstead, Sean McLean, Travis Schisler.

• TEVAR Temperature Management QI Project » Personnel: Jamie Head, Travis Schisler, Hilary Grocott, Darren Mullane.

• IPU Quality Initiative for TEVAR » Personnel: Darren Mullane, Jason Faulds, Joel Price.

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Publications for 2024 Development and Publication of Clinical Practice Parameters, Reviews, and Meta-analyses: A Report From the Society of Cardiovascular Anesthesiologists Presidential Task Force.

Kertai MD, Makkad B, Bollen BA, Grocott HP, Kachulis B, Boisen ML, Raphael J, Perry TE, Liu H, Grant MC, Gutsche J, Popescu WM, Hensley NB, Mazzeffi MA, Sniecinski RM, Teeter E, Pal N, Ngai JY, Mittnacht A, Augoustides YGT, Ibekwe SO, Martin AK, Rhee AJ, Walden RL, Glas K, Shaw AD, Shore-Lesserson L. Anesth Analg. 2024 Apr 1;138(4):878-892. doi: 10.1213/ANE.0000000000006619.

Epub 2024 Oct 3. PMID: 37788388 Cerebral Oximetry: An Imperfect But Still Valuable Brain Monitor.

Grocott HP. Ann Thorac Surg. 2024 Mar;117(3):633-634. doi: 10.1016/j.athoracsur.2023.09.041.

Epub 2023 Oct 10. PMID: 37820891 No abstract available.

Extracorporeal life support in trauma: Indications and techniques.

Lee A, Romano K, Tansley G, Al-Khaboori S, Thiara S, Garraway N, Finlayson G, Kanji HD, Isac G, Ta KL, Sidhu A, Carolan M, Triana E, Summers C, Joos E, Ball CG, Hameed SM. J Trauma Acute Care Surg. 2024 Jan 1;96(1):145-155. doi: 10.1097/TA.0000000000004043.

Epub 2023 Jun 29. PMID: 37822113 Characterizing the Relationship Between Arterial Carbon Dioxide Trajectory and Serial Brain Biomarkers with Central Nervous System Injury During Veno-Venous Extracorporeal Membrane Oxygenation: A Prospective Cohort Study.

Thiara S, Stukas S, Hoiland R, Wellington C, Tymko M, Isac G, Finlayson G, Kanji H, Romano K, Hirsch-Reinshagen V, Sekhon M, Griesdale D. Neurocrit Care. 2024 Aug;41(1):20-28. doi: 10.1007/s12028-023-01923-x.

Epub 2024 Feb 1. PMID: 38302643 Free PMC article.

Multidisciplinary Management of a Patient With Good Syndrome Postthymectomy for RedoSternotomy, Ascending Aortic Replacement, and Aortic Valve Repair.

Foglia J, Schuelein S, Ruiz JC, Kim JMS. J Cardiothorac Vasc Anesth. 2024 Apr;38(4):1055-1058. doi: 10.1053/j.jvca.2023.12.039.

Epub 2023 Dec 30.PMID: 38307739 No abstract available.

Aortic arch rupture in a patient with Marfan syndrome and previous aortic root repair: A stepwise approach to intraoperative catastrophe.

Jones T, Price J, McLean SR. Heliyon. 2024 Jan 28;10(3):e25235. doi: 10.1016/j.heliyon.2024.e25235.

eCollection 2024 Feb 15. PMID: 38322912 Free PMC article.

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Randomized trial of routine versus on-demand intraoperative extracorporeal membrane oxygenation in lung transplantation: A feasibility study.

Nasir BS, Weatherald J, Ramsay T, Cypel M, Donahoe L, Durkin C, Schisler T, Nagendran J, Liberman M, Landry C, Overbeek C, Moore A, Ferraro P. J Heart Lung Transplant. 2024 Jun;43(6):1005-1009. doi: 10.1016/j.healun.2024.02.1454.

Epub 2024 Feb 28. PMID: 38423414 Clinical Trial.

Transvenous catheter-directed embolectomy for pulmonary embolism.

McFadden E, Ronco JJ, Finlayson G, Hadjivassiliou A, Ho S, Klass D, Legiehn G, Machan L, Parhar D, Romano K, Thiara S. Can J Anaesth. 2024 Aug;71(8):1163-1164. doi: 10.1007/s12630-024-02797-z.

Epub 2024 Jul 10. PMID: 38987496 No abstract available.

The evolution and formalization of anesthesia assistant roles across Canada.

Yang H, Littleford J, Orser BA, Zaccagnini M, Umedaly H, Olsen M, Raazi M, LeDez K, Adam Law J, Giffin M, Foerster J, D’Souza B, Ali I, Dillane D, Christodoulou C, Buu N, Bryan R. Can J Anaesth. 2024 Dec;71(12):1627-1645. doi: 10.1007/s12630-024-02812-3.

Epub 2024 Sep 10. PMID: 39256302 English.

Fibreoptic or flexible bronchoscopy during bronchial blocker placement: time to stop perpetuating a bronchoscopic misnomer?

Grocott HP. Can J Anaesth. 2024 Nov;71(11):1569-1570. doi: 10.1007/s12630-024-02845-8.

Epub 2024 Oct 7. PMID: 39375284 No abstract available.

Role for Lumbar Cerebrospinal Fluid Drainage in High-risk Thoracic Endovascular Aortic Repair: A Narrative Review.

Shelton T, Gigax B, Aly AH, Choi K, Tili E, Orion K, Modarai B, Beck A, Grocott HP, Awad H. Anesthesiology. 2024 Dec 1;141(6):1175-1190. doi: 10.1097/ALN.0000000000005200.

PMID: 39530715 Review.

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Neuroanesthesia Dr. Alexandra Kisilevsky & Dr. William Rieley Division Co-Heads 2024 members: Dr Bali Dhaliwal Dr Cynthia Henderson Dr Henrik Huttunen Dr Sandy Kisilevsky Dr Naima Kotadia Dr Kelly Mason

Dr Jon McEwen Dr Amy Mitchell Dr Kate Mittermaier Dr William Rieley Dr Evan Shao Dr Jason Wilson

Division Member Updates: The neuro division was delighted to acquire three new members in 2024. Dr Amy Mitchell completed anesthesiology residency training in the East Midlands in the UK and subsequent neuroanesthesia fellowship at Vancouver General Hospital. She joined the neuro division immediately post-fellowship in July. Dr Kate Mittermaier completed a neuroanesthesia fellowship at the UCLH NHS foundation in the UK and returned to join the division in June 2024.

Last but not least, Dr Naima Kotadia completed a neuroanesthesia fellowship at the University of California San Diego (UCSD). Dr Kotadia returned to Vancouver and joined the neuro division in August. We welcome all three members to the division.

Resident Education: Dr Evan Shao remains in the role of Neuroanesthesia Resident Subspecialty Coordinator.

Senior UBC anesthesiology residents continue to have an 8 week VGH sub-specialty block which includes neuroanesthesiology, spine, and vascular surgery rotations. Residents spend 2-3 weeks in neuroanesthesiology at VGH. Exposure to neuroanesthesia also occurs at VGH on-call and at other teaching centres in BC including Royal Columbia Hospital, Victoria General hospital, and Lions Gate hospital.

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The neuroanesthesia resident journal club was hosted by Royal Columbian Hospital on October 21, 2024. The following two papers were presented for discussion: 1. Turgeon AF et al. 2024. Liberal or restrictive transfusion strategy in patients with traumatic brain injury. NEJM 391:722-735.

The HEMOTION trial was presented by Dr Ibrahim Sadiq

(R2) and supervised by Dr Alan Tung. In this multicentre RCT, the authors detected a trend towards improved GOS-E scores at 6 months in patients treated with a liberal transfusion (compared to a restrictive transfusion) strategy following moderatesevere traumatic brain injury. Although the primary outcome was not different between groups and further study is needed, consideration should be given to a more liberal transfusion strategy in acutely brain-injured patients compared to other critical care populations.

2. Sejdaya R et al. 2024. Cannabis use and inhalational anesthesia administration in older adults: A propensity-matched retrospective cohort study. Anesthesiology 141(5): 870-880.

This paper was presented by Dr Andrew Woodman (R2) and Dr Ola Lemanowicz (R2) and supervised

by Dr Edmond Li. Although cannabis use was found to be associated with a higher inhalational

MAC compared with non-users, multiple methodological weaknesses were highlighted including lack of quantitative depth of anesthetic measurements thus limiting the validity of the study result.

and will represent our fellowship at the SNACC webinar in January 2025. We will be invited to apply for re-accreditation in the coming months.

Dr Amy Mitchell successfully completed fellowship in June 2024. Dr Sian Myers, Australian-trained anesthesiologist, commenced the fellowship in July.

Fellowship Training: Dr Rieley continued in the position of the Neuroanesthesia Fellowship Program Director in 2024. The fellowship program retains its International Council of Perioperative Neuroscience Training (ICPNT) accreditation through 2025.

The Neuroanesthesia Fellowship Program at VGH was awarded 5 years of ICPNT accreditation in 2020. Since then we have successfully recruited a high quality fellow each year and have been compliant with regulations. Dr Rieley presented the progress of our program so far at the SNACC meeting in Dever Colorado in September 2024

Neuroanesthesia-Neurosurgical Rounds: Neuroanesthesia-neurosurgery combined rounds took place on December 12, 2024. A case of awareness under general anesthesia during neurosurgery was discussed. The clinical case scenario was presented

by Dr Alex Rebchuk (R5 neurosurgery) and a more generalized presentation on awareness under GA was given by Dr Sian Myers (neuroanesthesia fellow). An excellent discussion ensued and it was generally agreed that an increased frequency of rounds between departments should be carried out in future.

Presentations: Kisilevsky, AE. Awake Craniotomy: Tips & Tricks. SNACC Spring Symposium (virtual), April 2024.

Kotadia, N. In Shocking News: Neuromonitoring for the Anesthesiologist. UBC Resident Neuroanesthesia Academic Day, November 2024.

Rieley, WA. Perioperative Management of Patients with Spinal Cord Injury Undergoing NonCardiac Surgery. CAS Annual Meeting, Victoria BC, June 2024.

Myers, S. Neuroanesthesia Emergencies. UBC Resident Neuroanesthesia Academic Day November 2024.

Myers, S. Unintentional awareness under General Anesthesia. VGH Neuroanesthesia- Neurosurgical Critical Incident rounds, December 2024.

Publications: Metzner M, Mayson K, Schierbeck G, Wallace T. The implementation of preoperative optimization

in British Columbia: a quality improvement initiative. Can J Anaesth. 2024 Dec;71(12):1672-1684.

English. doi: 10.1007/s12630-024-02870-7. Epub 2024 Nov 19. PMID: 39562426.

Mitchell A & Flexman AM. Frailty: Implications for Neuroanesthesia. JNA 2024 Apr 1;36(2):95-

100. doi: 10.1097/ANA.0000000000000953. Epub 2024 Jan 17.

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Perioperative Medicine Dr. Su-Yin MacDonell Division Head Division Highlights: Since the Division’s inception, there has been a goal of fostering a culture of collaboration and education amongst hospitals and specialties.

This can be seen in the provincial perioperative rounds from St. Paul’s Hospital to the recent publication of the BC Surgical Prehabilitation Toolkit.

Dr. Lindi Thibodeau’s (Comox Valley Hospital) leadership on the Specialists Service Committee (DoBC) has resulted in the toolkit: BC Surgical Prehabilitation. The toolkit is anticipated to be published to the public in 2025 and serve as evidence of the collaborative nature of Perioperative Medicine with representation from multiple medical specialties including surgery, anesthesia, internal medicine, addictions, endocrinology, geriatrician, physiatry and family medicine. In addition to the specialties described

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there was representation from the multidisciplinary healthcare team members including dieticians, transitional pain and clinical nurse specialist, physiotherapy, pharmacy, NSQIP/research, and most importantly patient representation.

Ongoing education and review of contemporary perioperative literature is available via the website sphpom.com. This website was created by Dr. Kovacevic and has ongoing contribution from the residents going through their subspecialty rotation.

Dr. Amelie Pelland (Lions Gate Hospital) is the chair of the Perioperative Medicine section of CAS. She is helping coordinate the CAS meeting in St. John’s Newfoundland and working on creating a section research award whilst increasing visibility of the subspecialty both nationally and internationally.

Resident Education:

Multi-Disciplinary Rounds:

Given the recent expansion of the Anesthesia residency program and the addition of teaching sites; a Perioperative Medicine Anesthesia Training Committee has been created. This committee is composed of a chair, pertinent site representations and junior/senior residents. The committee recently created the perioperative rotation that is shared between two site: Vancouver General Hospital and St. Paul’s Hospital. Residents now spend 2 weeks in both sites and benefit from the strengths of both sites.

St. Paul’s Hospital hosts a provincially broadcast monthly rounds on a topic within perioperative medicine. We have recently collaborated with the perioperative physicians in Winnipeg and included them as presenters and attendees.

There was also a multidisciplinary case review that occurred in November 2025 that shared the viewpoints of geriatrics, surgeons, anesthesia, internal medicine and PACU nursing on the management of high-risk surgical patients both pre, intra and post operatively.

St. Paul’s Hospital hosts two weeks of Perioperative Medicine academic days and we look forward to this year’s perioperative medicine academic days in March/April 2025 being led by Drs. Fruci and MacDonell.

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Research Report Ongoing: BuTT-OUT. Pilot RCT of remote intervention vs control for smoking cessation. RCH PI/Project lead: Dr. Susan Lee. Clinicaltrials.gov NCT04487548 CYP2D6 Pilot Study. Genetic survey of cytochrome P45 2D6. RCH PI/Project lead: Dr. Perseus Missirlis Functional Assessment for Surgery by a Timed Walk study. Multi-centered study. PHC PI/Project lead: Dr. Su-Yin MacDonell RCH PI/Project lead: Drs. Ed Li and Susan Lee The impact of enhanced postoperative continuous vitals monitoring for high-risk patients in-hospital and at home on days alive and at home after surgery within 30 days postoperatively: A pilot randomized controlled study. PHC PI/Project lead: Dr. Janny Ke, co-investigators Drs. Charles Yu and Su-Yin MacDonell.

Published: Dale-Gandar, J., Chau, A., MacDonell, SY., Flexman, AM. A survey of Canadian perioperative medicine practices regarding surveillance for myocardial injury after noncardiac surgery.

Can J Anesth/J Can Anesth (2024). https://doi.org/10.1007/s12630-024-02850-x Dobson G, Chau A, Denomme J, Frost S, Fuda G, Mc Donnell C, Milkovich R, Milne AD, Sparrow K, Subramani Y, Young C. Guidelines to the Practice of Anesthesia-Revised Edition 2024.

Can J Anaesth. 2024 Jan;71(1):8-54.

Dobson GR, Chau A. Special announcement: Guidelines to the Practice of Anesthesia-Revised Edition 2024.

Can J Anaesth. 2024 Jan;71(1):1-7.

Dönmez, A Eylül et al. Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries.

The Lancet Global Health, Volume 12, Issue 7, e1094 - e110. 3) Jerath, A., Satkunasivam, R., Kaneshwaran, K., Aminoltejari, K., Chang, A., MacDonell, D. S., Kealey, A., Ladowski, S., Sarmah, A., Flexman, A. M., Lorello, G. R., Nabecker, S., Coburn, N., Conn, L. G., Klaassen, Z., Ranganathan, S., Riveros, C., McCartney, C. J. L., Detsky, A. S., & Wallis, C. J. D. (2024).

Association between anesthesiologist sex and patients’ postoperative outcomes: A populationbased cohort study.

Annals of Surgery, 279(4), 569-574.

Ke JXC, Jen TTH, Schwarz SKW. Minimal intraoperative blood pressure threshold and postoperative outcomes.

Comment on Br J Anaesth 2023; 131: 823-31. Br J Anaesth. 2024 Feb;132(2):450-451.

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Ke JXC, Jen TTH, Gao S, Ngo L, Wu L, Flexman AM, Schwarz SWK, Brown CJ, Gorges M. (2024) Development and internal validation of time-to-event risk prediction models for major medical complications within 30 days after elective colectomy.

PLOS ONE 19(12): e0314526. https://doi.org/10.1371/journal.pone.0314526.

Ke, J.X.C., Dhakshina Murthy, A., George, R.B. et al. The effect of resampling techniques on the performances of machine learning clinical risk prediction models in the setting of severe class imbalance: development and internal validation in a retrospective cohort.

Discov Artif Intell 4, 91 (2024). https://doi.org/10.1007/s44163-024-00199-0.

Lorello, G. R., & Flexman, A. M. (2024). A matter of life and death: Physician gender and patient outcomes after surgery.

British Journal of Anaesthesia. https://doi.org/10.1016/j.bja.2024.06.002 McIsaac DI, Tandon P, Kidd G, et al. STRIVE pilot trial: a protocol for a multicentre pragmatic internal pilot randomised controlled trial of Structured TRaining to Improve fitness in a Virtual Environment (STRIVE) before surgery.

BMJ Open 2024;14:e093710. doi:10.1136/bmjopen-2024-09371 National Institute for Health and Care Research (NIHR) Global Health Research Unit on Global Surgery (2024). Global access to technologies to support safe and effective inguinal hernia surgery: prospective, international cohort study.

The British journal of surgery, 111(7), znae164. https://doi.org/10.1093/bjs/znae164 Nourouzpour, N., Jen, T. T. H., Bailey, J., Jobin, P. G., Sutherland, J. M., Ho, C., Prabhakar, C., & Ke, J. X. C. (2024). Association between anesthesia technique and death after hip fracture repair for patients with COVID-19.

Canadian Journal of Anesthesia, 71(3), 367-377.

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Regional Anesthesia Dr. Alexander Wong Division Head Clinical Report: In 2024, regional anesthesia has continued to play an important and major role in delivering high quality patient care at UBC-affiliated sites.

In addition to providing effective perioperative anesthesia and analgesia, regional anesthesia continues to help improve patient throughput in hospitals and reduce our climate footprint.

At Vancouver General Hospital (VGH), the Perioperative Anesthesia Intervention Service (PAIS) has continued to expand with an increasing need for regional anesthesia in the perioperative setting. A variety of upper limb, lower limb, and truncal blocks are performed regularly by the PAIS team. The hip fracture and rib fracture protocols have continued to provide improved analgesia and optimal care for these clinically vulnerable patient populations. The use of suprainguinal fascia iliaca, pericapsular nerve group (PENG), and serratus anterior plane blocks have been on the forefront of these patient care protocols. With ongoing plans for OR expansion at VGH, regional anesthesia will continue to play a key role in the perioperative setting.

Royal Columbian Hospital (RCH) has also continued to grow its regional anesthesia program. Along with RCH Lead resident (Dr. Blake Birnie), Dr. Stephen Heape has helped initiate a new regional anesthesia training site for residents. This represents an exciting addition to the residency program with excellent educational opportunities in a high volume centre.

St. Paul’s Hospital (SPH) have continued on with its well-established block room program with upper and lower limb blocks, in addition to paravertebral blocks for the breast program at 50

Mount St. Joseph’s Hospital (MSJ). Femoral nerve blocks are also being provided as part of hip fracture pain management at SPH. Regional anesthesia continues to be practiced with a diverse number of different blocks at other UBCaffiliated sites frequented by residents and trainees.

This includes, but is not limited to, Surrey Memorial Hospital, Burnaby Hospital, Lions Gate Hospital, and Victoria sites.

Academic Report: Training of Residents: With the significant growth in the size of the UBC residency program, regional anesthesia training is now distributed to multiple sites. Typically, each resident will spend 2 weeks at SPH and 4 weeks at either VGH or SMH in order to have a wide breadth of regional anesthesia experience. However, with RCH coming on board as a new training site, there is now the capacity to increase regional anesthesia training to 8 weeks in total. Residents will soon have the opportunity to train at 2 out of the 4 possible sites (RCH, SPH, SMH, and VGH), with 4 weeks at each site. This is a significant increase from the traditional 4 week rotation just a few years ago.

With representatives from the regional training sites, the Regional Anesthesia Training Committee continues to oversee these rotations to ensure high quality experience for both the residents and faculty.

The committee currently consists of Drs. Steven Lee (VGH), Lisa Li (SPH), Thomas Prasloski (SPH), Chris Prabhakar (SPH), Laine Bosma (SPH), Reza Faraji (BH), Stephen Heape (RCH), Zoe Brown (Program Director; BCCH), Kavin Bains (SMH), and Alex Wong (VGH). Special thanks to outgoing member, Dr. Tim Dickson (SMH), for helping get the training rotation at SMH up and running.

In May 2024, there was excellent resident turnout for the UBC Regional Anesthesia Academic Day Workshop. This was made possible with collaboration between the UBC Anesthesia Lead Residents and faculty from SPH, VGH, and Burnaby Hospital, who were able to teach a variety of clinically relevant nerve blocks on live models at multiple different stations.

Training of Fellows: SPH have continued on with their strong regional anesthesia fellowship program with a mixture of international and Canadian fellows. Dr. Ayda Askari started at SPH this year and will return to VGH on staff upon completion of her fellowship training. Dr. Dan Werry returned to VGH after

finishing his fellowship at Dalhousie and will be looking to incorporate some new ideas into our practice.

Conferences: The regional anesthesia workshops were once again organized by Drs. Chris Prabhakar and Peter Rose at the Whistler Anesthesia Summit (WAS) in February 2024. Dr. Prabhakar also organized workshops at the UBC CPD family practice anesthesia refresher course in November 2024. These were all well received by the attendees and there was a good turnout of instructors from various UBC-affiliated sites.

Research Report: UBC faculty have continued to work with the residents and fellows in performing high quality research and publishing articles in the area of regional anesthesia. The following are some of the recent publications: Corr LA, Froehlich K. External oblique intercostal catheters for liver transplantation surgery: a quality improvement project.

Can J Anaesth. 2024 Sep 24. doi: 10.1007/s12630-024-02840-z

Epub ahead of print. PMID: 39317831.

Kroeker J, Wess A, Yang Y, Al-Zeer B, Uppal H, Balmes P, Som R, Courval V, Lakha N, Brisson A, Sakai J, Garraway N, Tang R, Rose P, Joos E. Chest trauma clinical practice guideline protects against delirium in patients with rib fractures.

Trauma Surg Acute Care Open. 2024 Jun 5;9(1):e001323. doi: 10.1136/tsaco-2023-001323

PMID: 38860116; PMCID: PMC11163824.

Tang R, Chedgy ECP, So AI. Analgesic efficacy of rectus sheath catheter is non-inferior to thoracic

epidural catheter.

BJU Int. 2024 Aug;134(2):317. doi: 10.1111/bju.16408 Epub 2024 May 31. PMID: 38822552.

Nourouzpour N, Jen TTH, Bailey J, Jobin PG, Sutherland JM, Ho CM, Prabhakar C, Ke JXC.

Association between anesthesia technique and death after hip fracture repair for patients with COVID-19.

Can J Anesth/J Can Anesth 71, 367–377 (2024). https://doi.org/10.1007/s12630-023-02673-2 51

Thoracic Anesthesia Dr. Chris Durkin & Dr. Travis Schisler Division Co-Heads Membership: In 2024, there were 11 members in the Division of Thoracic Anesthesia at Vancouver Acute – Dr. Julia Cory, Dr. Chris Durkin, Dr Gord Finlayson, Dr Brett Fitzmaurice, Dr. Patrick Hecht, Dr Bevan Hughes, Dr Jens Lohser, Dr. Sean McLean, Dr. Sandy Pitfield, Dr. Kali Romano, and Dr. Travis Schisler.

Education: The UBC anesthesia residents complete a three-week rotation at Vancouver General Hospital where they gain experience primarily in anesthesia for video assisted and open lung resection surgery. Further exposure is gained at Surrey Memorial Hospital, Kelowna General Hospital and Victoria General Hospital. Emphasis is placed on the preoperative assessment for lung resection surgery and understanding bronchoscopic anatomy to inform lung isolation

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strategies and ultimately develop a plan that is safe, patient-centered and considers the risk and benefits of all approaches. Evidence based onelung ventilation strategies are discussed as are approaches to the less common scenarios of anterior mediastinal masses and pulmonary hemorrhage.

Residents also gain exposure to several different approaches to esophagectomy including MIS, Ivor Lewis and trans-hiatal. Opportunities are plenty to acquire skill in thoracic epidural, paravertebral catheter, and serratus anterior catheter placement.

The division remains engaged with leading the thoracic themed academic days as well as providing mentorship for a UBC wide thoracic journal club.

The expansion of the residency program has led to a new distributed thoracic anesthesia rotation that includes time at Vancouver General Hospital as well as additional weeks at either Kelowna, Victoria or Surrey.

Research: The division continues to remain active in both local and international research projects. Dr. Sean McLean has been the site lead for the recently reported international COP-AF trial looking at the prevention of perioperative atrial fibrillation in patients undergoing thoracic surgery. Dr. Schisler continues to contribute to the “Thoracic Year in Review” published annually in the Journal of Cardiothoracic and Vascular Anesthesia. Drs. Durkin and Schisler recently presented the results of a yearlong quality improvement project alongside thoracic surgery to discover best practices for pain management after VATS lobectomy surgery. In brief, in a cohort of over 150 patients they found that a single level

paravertebral catheter was a non-inferior pain modality to a thoracic epidural catheter with patients experiencing fewer side effects. These results have supported the creation of a new ERAS pathway at VGH for patients undergoing surgery for lung cancer.nerve blocks on live models at multiple different stations.

Lung Transplantation The lung transplant program continues to expand in frequency and complexity. In 2023, 66 double lung transplants were completed with excellent outcomes. We are on track for close to 50 double lung transplants in 2024.

Pediatric Anesthesia Included as part of the BC Children’s Hospital report Dr. Simon Whyte Division Head

Obstetric Anesthesia

Included as part of the BC Women’s Hospital report Dr. James Brown Division Head 53