Programs
The following programs are run under our department:
Odette Cancer Centre of Sunnybrook Health Sciences Centre is the second largest cancer centre in Ontario. Major cancer body sites include:
- GI (bowel, liver and pancreatic resections)
- Abdominal exenterations
- Urologic: Radical prostatectomies, cystectomy, pelvic exenteration, nephrectomies (open and hand-assisted laparoscopic)
- Head and neck
- Neurosurgical (brain and spine)
- Gynaecologic Oncology
- Breast
Approximately 800 cardiac surgery operations are performed each year at Sunnybrook campus. Approximately 75 per cent of the cardiac surgical cases are multiple coronary artery bypass grafting procedures. These include some "off-pump" operations. The remaining 25 per cent are either for cardiac valvular repair or replacement surgical procedures, adult congenital surgical procedures, proximal aorta surgical procedures, or for surgical procedures requiring a combination of the above. The cardiac surgical population at Sunnybrook Health Sciences Centre tends to be high-risk. Invasive monitoring is routinely used. Eleven anesthesiologists who have specialized in cardiac anesthesia provide anesthesia for these surgical procedures. A subgroup of these anesthesiologists is also trained in Transesophageal Echocardiography (TEE) and provides the necessary periopertive TEE.
One year cardiac anesthesiology fellowships are offered. In this fellowship aproximately 50% of time is spent devoted to cardiac anesthesia and 50 per cent to general anesthesia. Cardiac anesthesia training will initially be under direct supervision, on a one to one basis, with one of the cardiac anesthesiologists. This level of supervision will decrease as the fellow gains experience. The fellowship will include training in transesophageal echocardiograpy. Research opportunities also exist.
80% cases done under regional anesthesia
- Major Joint Arthroplasty - 2100/year(4200 by year 2008)
- Upper Extremity - 440
- Spine - 390
- Outpatient Sx - 2145
Exposure to:
- Upper extremity regional techniques
- Upper extremity nerve blocks for post op pain
- Lower extremity nerve blocks
- Lower extremity regional techniques
- Multimodal pain management - pain pathways
- Ambulatory procedures
- Blood conservation techniques
- DVT prophylaxis
The obstetrics suite of Sunnybrook HSC is currently located at 77 Grenville Street, inside Women's College Hospital. A new labour and delivery unit and neonatal inensive care unit is being built at at the Sunnybrook campus with expected date of completion in 2010. Currently there are approximately 4,000 deliveries per year, of which 20 per cent are high risk referrals.
The Obstetrical Anesthesia team provides consultation services to obstetrical patients on an inpatient and outpatient basis. Approximately 75 per cent of patients request epidural labour analgesia. In addition, an in-house anesthesiologist is available 24 hours a day, seven days a week to provide anesthetic services for obstetrical emergencies.
As part of the teaching programme in the Anesthesia Department of the University of Toronto, we teach final year medical students, residents in anesthesia and provide post-fellowship training in Obstetrical Anesthesia to qualified anesthesiologists.
- Medical students: Seminars: Pain relief in labour and local anesthesia. Medical students spend one day of their 2 week anesthesia rotation on the labour floor observing techniques in labour analgesia and anesthesia for caesarean section.
- Residents: Core lectures in obstetrical anesthesia are provided for PGY2 residents and include numerous topics in obstetrical anesthesia and neonatal resuscitation. A one month intensive experience in obstetrical anesthesia is available for senior residents.
- Fellows: A one year clinical, research and teaching experience is offered in Obstetrical Anesthesia to individuals who have completed Royal College training (or equivalent). Research experience includes clinical trials, systematic reviews and meta-analyses in obstetrical anesthesia.
Since the unit's official beginning in 1976, the Trauma Unit at Sunnybrook Health Sciences Centre is the largest trauma centre in Canada. Almost 1,200 multisystem trauma patients receive comprehensive care annually, starting from initial resuscitation in the, until discharge to the appropriate rehabilitation facility. Of these, 15-20 per cent are penetrating trauma, 75-80 per cent are blunt, and the remaining 5 per cent are burn patients. Burn patients are assessed by a separate team from the Ross Tilley Burn Unit.
Each patient is assessed by a trauma team comprising a trauma team leader, and residents from anesthesia, orthopaedic and general surgery and two Emergency Room (ER) nurses. Anesthesiologists play a role in the care of these patients in the ER as trauma team leader, and the anesthesia resident is an integral part of the team for airway management and other aspects of resuscitation.
Trauma anesthesia is a significant part of the clinical anesthetic practice, as over 60 per cent of trauma patients have a minimum of one operating room visit. Much of the after hours on-call work is trauma related laparotomies, craniotomies and open fractures. A separate orthopedic trauma-fracture room was set up many years ago to deal with the high volume of orthopedic trauma fractures during the daytime elective list. Expertise has also been acquired in the area of anesthesia for cranio-facial reconstruction.
Postoperatively, the department continues to manage pain control for these patients on the Acute Pain Service utilizing Patient Controlled Analgesia, epidural and nerve block techniques. A small number of these patients may develop chronic pain problems and are referred to the department's Chronic Pain Clinic.
The Acute Pain Service
Dr. Imad Awad- Director.
The Acute Pain Service (APS) is an inter-professional team actively engaged in clinical practice, research, and education. Our mission is to generate and implement best practice regarding pain and symptom management, primarily for postoperative patients. We work in collaboration with the Chronic Pain Service, and the Palliative Care Consult Team (PCCT) to provide optimal pain management for our patients.
The APS is available for consultation to the SB community. Currently the APS cares for approximately 5500 patients annually (2700+ at the Bayview campus, and 2500+ at the Holland Centre). Like all programs and services, the APS must articulate a strategic focus that is in harmony with the mission, values and beliefs of SB, and feasible given its limited human and financial resources.
The APS has been in existence for ≥ 10 years in various manifestations. The main function of the APS is to provide pain and symptom (nausea/vomiting/pruritis) management to postoperative patients. The APS is currently comprised of 3.5 fulltime equivalent Nurse Practitioners and two Medical Directors, one for each of the Sunnybrook Campuses (Bayview site, and Holland Orthopaedic and Arthritic site). Staff Anesthesiologists, Fellows and Residents rotate through the APS daily / weekly.
The Chronic Pain Service
Dr. Gil Faclier - Director, Drs. Arsenio Avila and Michael Gofeld.
Sunnybrook Pain Management Clinic is a multimodal facility with specific interest in the chronic spinal pain and cancer pain.
We provide consultation and treatment using pharmaceutical and non-pharmaceutical modalities, such as massage, acupuncture, cognitive-behavioral therapy and mindfulness classes. However, our main clinical and research interest is in interventional pain management - the pursuit of an anatomical diagnosis for chronic pain with the view to implementing a target-specific treatment. Patient selection is a crucial step in interventional pain medicine. Following consultation with one of our physicians and a review of previous treatment and imaging tests, eligible patients are scheduled for different therapeutic or diagnostic minimally invasive procedures performed under X-ray or ultrasound guidance. As an example, the source of the chronic low back pain can be established using diagnostic local anesthetic blocks of potential pain generators.
Sunnybrook is the second largest cancer center in Ontario. As such we have developed an interventional program for those patients with pain resistant to all other therapies. We perform complex interventional pain procedures to ease cancer pain in collaboration with Palliative Care Consult Team. We are implementing cutting-edge technologies in radiofrequency devices and ultrasound navigation. So called “cooled radiofrequency” is a new physical modality which creates localized tissue destruction of a pain generator or malignant tumor without surgery. Ultrasound guidance is a new imaging application for pain treatment and we are one of a few centers in the world using it on a regular basis. This modality reduces radiation exposure to personnel and patients.
Research
1. Preclinical studies of biophysics and histology of radiofrequency ablation
2. Clinical studies of outcome, new techniques and applications in the interventional pain medicine
3. Interprofessional development of cancer pain management
Education
- The Pain Clinic runs a “hands on” course in Interventional Pain Management which was established in 2006 and received CME accreditation from the University of Toronto last year.
- Chronic Pain Fellowship Program of 12 months includes intensive clinical training and research opportunities. Our fellows work two days in the Pain Clinic, two days in operating room or Acute Pain Service and one day is allocated for research. We have multiple ongoing projects to offer and also original ideas are always welcome. Research and educational grants support scientific and educational pursuits of our staff and fellows.
