The Department of Anesthesiology and Pain Medicine at TOH comprises palliative care specialists, psychologists, addiction specialists,hyperbaric medicine specialists, pain nurses and other health careprofessionals. In the Pain Clinic, we collaborate with colleagues inPalliative Care, Emergency Medicine, Obstetrics and Gynecology,Physical Medicine and Rehabilitation, and Neurosurgery in theinterdisciplinary care of patients suffering with pain. Highlights of ourclinical practice profile include providing anesthesia for novelprocedures like robotic thoracic surgery, awake craniotomies andfunctional epilepsy neurosurgery. We run several innovative subspecialty programs including POCUS /TEE for non-cardiac surgery, Enhanced Recovery After Surgery (ERAS), and Virtual Recovery AfterSurgery (VRAS).We were one of the first institutions in Canada to offer an ambulatory nerve blockcatheter program and provide coverage of this service for all three campuses of The Ottawa Hospital,offering regional blocks for post-operative pain, trauma, ERAS, and complex pain pathologies.

Our Pre-Anesthesia Clinic (PAC), under the leadership of Dr. Amy Roeske is transforming how we assess patients and plan for surgery. Using Epic, we have expanded our ability to pre-screen patients and collect data. We have embarked on virtual care with great success, enabling some patients and families to avoid travel in advance of their procedures. Our Day Surgery Unit and PACU, with Dr. Gail Ryan as our lead, have transformed many of the policies regarding patient length of stay, discharge criteria and sedation administration. We are using Lean methodologies to focus on the patient experience while ensuring safe and efficient care.

In partnership with the hospital, we now have three Nurse Practitioners working closely with our department. Brenda Martelli, Amy Ford, and Michelle Foulkes support the APS, PAC and the Anesthesiologist-In-Charge (AIC). Additionally, we have a strong Anesthesia Assistant program under the leadership of Bonnie Kerr and supported by Dr. Gillian Ramsey. The AAs support patient care in the OR and are an integral part of our care team in Medical Imaging, Cardiac Surgery and Catheterization and off-site anesthesia.

We participate in wellness initiatives including the Peer Support Program at CHEO, with Dr. Kimmo Murto as our champion and our department supports the Equity, Diversity, and Inclusivity program at the DAPM which was created under the leadership of Dr. Darlene Weekes.

Dr. Phil Kruger is the medical lead for CHEO’s Cardiovascular Surgery and Cath Lab Morbidity and Mortality process as well as the lead for Pediatric Cardiac Anesthesia. He spearheads bimonthly quality of care discussions for all patients cared for in our program.

Our department has participated in international efforts to improve fasting guidelines for children before anesthesia and sedation. Dr. David Rosen represented Canada on this group and new guidelines have recently been published and adopted internationally and in Canada through the Canadian Pediatric Anesthesia Society. CHEO is also participating in an international study with the same team (led locally by Dr. Tinu Sandhu) looking at the incidence and factors surrounding aspiration during anesthesia.

We are active participants in NSQIP, the National Surgical Quality Improvement Program which collects data from international sites and allows us to benchmark indicators of quality for Anesthesia including prophylactic antibiotic management and intraoperative temperature control. We are also submitting data to the STS and PC4 databases for pediatric cardiac surgery and critical care.

Solutions for Patient Safety (SPS) is a collaborative of over 130 pediatric hospitals from across North America. These hospitals share the vision that no child will ever experience serious harm while we are trying to heal them. CHEO has been a member of this initiative for 6 years, enhancing safety throughout the organization.

Our department participates in local, national, and international research. Drs. Dylan Bould, Kimmo Murto and Christine Lamontagne have led and participated in research on education, workforce capacity-building, chronic pain, patient blood management and pediatric obstructive sleep apnea to name a few examples among many. A full account of our research activity is found in this Annual Report.

We are innovating the way we provide education for skills training to non-anesthesia learners. Under the leadership of Dr. Heather O’Reilly, we have developed a multidisciplinary skills training course to teach airway management to Pediatric Medicine residents. This course employs experts from Anesthesia, NICU, PICU and Pediatric EM and simulation to provide a broad experience to trainees. The inaugural course was met with great enthusiasm.

During the pediatric viral surge in Nov 2022- Jan 2023 our department pivoted to assist our colleagues and patients. We ramped down surgery to allow us to be redeployed to work in the ED and on inpatient wards where the number and acuity of patients were overwhelming the capacity for care. Our nurses and AAs were deployed to critical care areas to provide direct patient care to support the 300% increase in critical care volume which was sustained over several months.

Our departmental family continues to grow. In the past year we welcomed Dr. Tinu Sandhu, and we will have Dr. Sarah Leir joining in the summer of 2023. Drs. Nicola Disma and Leila Mameli will join in the fall of 2023. Drs. Bill Splinter and Leslie Hall retired after many years of dedicated contribution to the care of children at CHEO. Drs Lesley Silver and Gopa Nair moved to Victoria and London respectively in support of family. We have recruited a new AA, Keith Marier, which brings our group to 9. On the administrative side, we welcomed Jesse Lussier to assist Jennifer Borup with the operational management of our department.

A large proportion of these procedures are not only of the highest risk and complexity but are cutting-edge and often undertaken as part of a collaborative and innovative interdisciplinary Heart Team model of care. For example, division members not only provide intraoperative TEE image guidance as members of the Structural Heart Team but also are involved in assessment and planning for these interventions at every stage. We have a unique model through which the twenty-seven bed Cardiac Surgery Intensive Care Unit (CSICU) is led by seven members of our Division who are also RCPSC certified Critical Care Medicine physicians. In addition to provision of complex postoperative surgical critical care, the CSICU physicians are the only providers of extracorporeal membrane oxygenation therapy for respiratory failure in the Eastern Ontario Health Region. The CSICU physicians will lead the newly formed UOHI critical care response team and are also full consulting partners in the UOHI heart transplant and code-shock teams. In the education realm, our division is an integral part of the University of Ottawa anesthesiology residency and Critical Care Medicine training programs and participates in Cardiology and Cardiac Surgical residency teaching. We have a long-standing and highly successful one-year cardiac anesthesia fellowship with a network of graduates providing cardiac care across the country. Finally, in the academic and research domains, we have led and continue to participate in multi-centred perioperative interventional trials in the cardiac surgical population. Our research efforts are in part supported through the newly created J Earl Wynands Chair in Cardiac Anesthesia Research named in honor of Dr Wynands MD, OC who was a world-renowned pioneer of Cardiac Anesthesia practice.

4. Family Birthing Centre

The department continues to play an important role in obstetric anaesthesia care, with a volume of around 3,000 deliveries this year, of which almost a third were by Caesarean section. Three-quarters of the patients who come to deliver at Montfort choose epidural analgesia. Dr. Tamara Henderson was involved in quality review as part of the perinatal sub-committee. With the help of pharmacy, we introduced additional analgesia options in the form of PCA IV fentanyl and remifentanil for a selected population of laboring patients.

5. Pre-admission clinic

The clinic continued to be held virtually until the beginning of December and then we started seeing patients in person again. We are delighted to welcome our colleagues in internal medicine who have set up a clinic dedicated to the pre-operative patients. We continue to optimize the pre-admission process with the involvement of LEAN.

6. Ambulatory Intervention Unit

The department continues to play a key role in the care of endoscopy patients by offering sedation services ten days a month. Patients and staff alike are very grateful and there is a growing demand for our presence. An agreement between the Montfort hospital and  OGI(Ottawa Gastrointestinal Institute) began in May 2022 to help address the waiting lists that during the pandemic. About half of our department's members are involved to help with sedation of those patients. This agreement has helped reduce waiting lists by over 1,200 patients.

7. Education

The department maintains its dedication to the education of french medical students and anesthesia residents and other specialties residents like internal medicine and emergency. . Dr. Des Rosiers won once again the education award for teacher of the year for medical students.

8. Research

The department began its participation in the TRACTION study of tranexamic acid.