Ottawa Anesthesia Primer. Patrick Sullivan
of Ottawa
Marie-Jo Plamondon MDCM
Resident Anesthesia, University of Ottawa
Alim Punja MD
Resident Anesthesia, University of Ottawa
Nikhil Rastogi MD, FRCPC
Assistant Professor Anesthesia, University of Ottawa
Dennis Reid MD, FRCPC, FRCA
Professor Anesthesia, University of Ottawa
Andrew Roberts MD
Resident Anesthesia, University of Ottawa
Raylene Sauvé MD
Resident Anesthesia, University of Ottawa
Ahmed Soliman MD
Resident Anesthesia, University of Ottawa
Patrick Sullivan MD, FRCPC
Associate Professor Anesthesia, University of Ottawa
Melanie Toman MD
Resident Anesthesia, University of Ottawa
Kimberly Walton MD, PhD
Resident Anesthesia, University of Ottawa
Anna Wyand MD, FRCPC
Assistant Professor Anesthesia, University of Ottawa
Janet Young MD
Resident Anesthesia, University of Ottawa
Jordan Zacny MD
Resident Anesthesia, University of Ottawa
Forward
In the early 1990s, the University of Ottawa, Department of Anesthesiology published a textbook entitled Anesthesia for Medical Students. Its purpose was to provide a concise primary reference for students completing a two-week rotation in anesthesia. The nature of the specialty of anesthesiology makes it ideally suited as a means through which to impart the essential knowledge and skill set that all physicians should possess. In writing this text, the authors recognized that the majority of students would not be pursuing a career in anesthesiology. With this in mind, they identified learning objectives appropriate for students completing a rotation in anesthesia with a focus on the fundamental principles and skills, including preoperative assessment, securing intravenous access, airway management (mask ventilation and tracheal intubation), basic resuscitation skills, acute pain management, and safe use of local anesthetic agents.
Anesthesia for Medical Students was well received and soon became the primary anesthesia reference text for medical students across Canada. The concise straightforward approach to our specialty also made the text a popular choice for anesthesia, medical, and surgical residents, paramedics, respiratory therapists, nurses, and industry representatives.
In 2005, publication of the text ceased as there was need for significant revisions and updates. Encouragingly, demand for the text continued, and in 2011, our department embarked on a revision of the original text. It is renamed the Ottawa Anesthesia Primer, recognizing that the content is suitable for medical care providers practicing in a wide variety of roles.
We are particularly excited to offer an accompanying electronic version of the Ottawa Anesthesia Primer. The ePrimer is available as an iBook that can be purchased for use on an iPad by downloading a free apple application called ibooks. It is also available as a digitally encripted (DE) pdf for viewing on other electronic readers. The ePrimer offers URL links, video links, animated graphics and expanded case problem discussions. Selected URL addresses for additional resources are listed in the text.
I sincerely thank the anesthesia faculty and residents at the University of Ottawa who have volunteered their time to contribute to this project. Each chapter is the combined work of a resident in-training under the guidance of one of our anesthesiologists. I am also grateful to Perry Ng and Mariane Tremblay at the University of Ottawa; Perry for his expertise in graphic illustration and Mariane for her photographic know-how. Finally, I would like to thank Pamela Kartzali for her excellent editorial insight and assistance.
We are eager to direct the proceeds of this project towards the Canadian Anesthesiologists’ Society International Education Foundation (CAS IEF). The CAS has been a leader in supporting initiatives to improve anesthesia care in developing countries. Recent initiatives include supporting Dr. Enright’s Lifebox campaign (www.lifebox.org), a global organization providing pulse oximeters to operating rooms in Third World countries. Dr. Angela Enright was President of the World Federation of Societies of Anaesthesiologists (WFSA) from 2008 to 2012, and a past President of the Canadian Anesthesiologists’ Society (CAS). In 2010, she received the Order of Canada for her work with the Lifebox initiative. The CAS is currently leading an educational initiative called ‘SAFE’ to improve the delivery of obstetrical anesthesia care in Rwanda.
We hope you enjoy our Ottawa Anesthesia Primer and ePrimer.
Sincerely
Pat Sullivan MD
Chapter 1
Rotational Learning Objectives
Marc Doré MD, Nikhil Rastogi MD, Patrick Sullivan MD
The learning objectives in the Ottawa Anesthesia Primer are designed principally for the anesthesia rotation and are to be tailored to meet the needs of the student. Listed in the knowledge and skills section below are seven traditional objectives designed for medical students during their anesthesia rotation. Students studying in other disciplines may choose to tailor their goals to a limited number of objectives for their rotation. In addition to the general objectives presented here, key learning objectives are listed for the student in each chapter.
Specific attitudes, knowledge and skills are key elements for a successful rotation in anesthesia. With this in mind, students are encouraged to identify their specific goals and objectives and to discuss these with their supervisor and instructors near the beginning of their anesthesia rotation.
Attitude:
We hope the time students spend with us will stimulate a thirst for knowledge and understanding of the fascinating physiology and pharmacology that occurs in the patient undergoing surgery. Anesthesia is a somewhat unnatural if not magical state, and it is normal for students to feel technically challenged during their rotation as they acquire vascular access and airway management skills. Each student can expect to experience (as all doctors have) a humbling but hopefully rewarding technical learning curve. They should remain attentive to their technical challenges and their response to them, as well as the response of their patients and other medical personnel as they meet these challenges. We ask students not to cloud their eyes and senses by technical monitors, but rather, to open their eyes and senses to the overall care of the patient. We expect students to commit to excellence in the care and concern they provide for the well being of the patients and their families. We also insist on punctuality and honesty as a basis of good medicine.
The Royal CanMEDS Physician Competency Framework was created by the Royal College of Physicians and Surgeons of Canada as a competency-based resource to guide students through their individual development as a medical expert in their chosen field. The CanMEDS framework identifies and describes six roles of the medical expert (Fig.1.1): Professional, Scholar, Communicator,