Department of Anesthesia McMaster University Report and Retrospective Summer 2002 Department of Anesthesia McMaster University Report and Retrospective Summer 2002 Edited by Kris Wilson-Yang and Mary Gahagan Hamilton, 2002 Department of Anesthesia, McMaster University,1200 Main Street West, Hamilton, ON, Canada. L8N 3Z5. Tel: 905-521-2100 x75166. Fax: 905-523-1224. www.fhs.mcmaster.ca/anesthesia/ Contents 1. Report from the Chair 4 2. Retrospective Hamilton Firsts 7 Anesthesia Archives 9 Interview with Don Catton 11 3. Research Basic Sciences 15 Clinical Research 17 Funded Research 18 Current Resident Research Projects 20 4. Education Undergraduate Curriculum 21 Post-graduate 24 Fellowship Training 27 Continuing Medical Education 30 5. Clinical Service Hamilton Health Sciences 33 St Joseph’s Healthcare 42 6. International Initiatives Problem-Based Learning 45 ISRA7 45 Nepal 46 Haiti 55 Ecuador and Jamaica 57 7. Publications 1997-2001 61 8. Faculty and Staff 76 McMaster University Department of Anesthesia Report and Retrospective June 2002 REPORT from the CHAIR REPORT FROM THE CHAIR It has been my privilege to sit as the Chair of McMaster University Department of Anesthesia during these difficult times. From this vantage point, the turmoil of amalgamation and health care restructuring, the issues surrounding the shortage of anesthesiologists, the consequent lobbying on behalf of highly-qualified foreign graduates, rising tuition costs and resulting changes in expectations of medical students, have been enriched by the opportunities provided to me to meet like-minded colleagues nationally and internationally. The future of the department will reflect our ability to adapt and to build on the growth that is demonstrated here in Report and Retrospective. We have made considerable progress in the fields of education and research. Our profile in undergraduate medical training continues to increase with the implementation of a compulsory anesthesia rotation. The new position of undergraduate co-ordinator has been created and funded by the department to deal in part with the challenges and opportunities attending this rotation. We continue to promote McMaster’s problem-based learning internationally. Post-graduate training thrives and our reputation in the field of evaluation has been strengthened through our initiatives in re-designing the Royal College Fellowship Examination and in other key areas of assessment evaluation. We continue to offer a highly regarded pain fellowship and are attracting an increasing number of highly qualified national and international candidates. The new Hamilton Health Sciences consolidated pain clinics will strengthen this fellowship experience. This clinical endeavour is a testament to the co-operation between Hamilton Health Sciences and McMaster University Faculty of Health Sciences. Our cardiac fellowship has expanded to include echo-cardiographic training facilities and consistently attracts exceptional candidates. The continuing medical education opportunity provided by our twice-yearly medical acupuncture workshops is unique in Canada. Both pure science and clinical research have been promoted by the winning of major grants from the Heart and Stroke Foundation of Ontario and from the Canadian Institute of Health Research. -4- www.fhs.mcmaster.ca/anesthesia McMaster University Department of Anesthesia Report and Retrospective June 2002 RETROSPECTIVE The University Department of Anesthesia has played a key role in the organization of several international and regional conferences. A yearly pleasure is the presentation of the CanAm conference at Niagara-on-the-Lake, of which our department is a co-founder with SUNY-Buffalo. The Hamilton Regional OPANA ( Ontario Peri-Anesthetic Nurses Association) conference, which connects nursing colleagues with current concerns in peri-operative anesthetic care was supported from its outset by our department in conjunction with the PACU nurses. The conference draws nurses from Southern Ontario and Upper New York State. The summer of 2001 saw the conclusion to the seventh session of the prestigious International Symposium on Resistant Arteries for which our department provided the entire and complete administrative support. It is a credit to the intelligence, dedication and skills of Bonnie Hugill, Mary Gahagan and Valerie Cannon that these conferences and meetings are successful and fulfilling. Dr David Morison’s work on the planning committee of the 2000 World Congress of Anesthesia in Montreal cannot go unmentioned. My tenure as chair has seen the retirement of four full professors: Dr David Morison, Dr Jay Forrest, Dr John Hewson and Dr Kari Smedstad. All were celebrated in McMaster style and photographic evidence is presented. We wish them all continued health and vibrancy. Report and Retrospective has been compiled from the reports of many clinical and full-time faculty and the editors and I thank all contributors. Especially illuminating is a transcript of reminiscences provided by Dr D.V. Catton, the first chair of the Department of Anesthesia at McMaster University. Drs Kari Smedstad, Norm Buckley, and Alez Dauphin have provided valuable and detailed accounts of practice-in-service in Nepal, Ecuador and Jamaica, and Haiti. It is hoped that this document provides a mirror of who we are and of the climate of change in which we work. —Homer Yang -5- www.fhs.mcmaster.ca/anesthesia McMaster University Department of Anesthesia Report and Retrospective June 2002 RETROSPECTIVE Hypnos (from Dr. John W. Sevegeringhaus, University of California) -6- www.fhs.mcmaster.ca/anesthesia McMaster University Department of Anesthesia Report and Retrospective June 2002 RETROSPECTIVE RETROSPECTIVE In preparation for the World Congress in Montreal 2000, all departments of anesthesia were asked to provide a brief historical summary of their local “firsts”. This is our submission. Canadian Firsts: Anesthesia in Hamilton Introduction The academic Department of Anesthesia was established in 1970 with the opening of McMaster University Medical Centre. Dr. D.V. Catton was the first professor and chair, taking the position in 1971. He held this post until 1980. Dr. Jay Forrest was the second chair from 1980 to 1990. Dr. David Morison was the department’s third chair from 1990 to 1997. The fourth and current chair is Dr. Homer Yang, 1997-present. The Faculty of Health Sciences, McMaster University has clinical campuses at the three of the four hospitals of the Hamilton Health Sciences corporation: McMaster Medical Centre, Henderson General Hospital and the Hamilton General Hospital (formerly the Civic Hospitals), and at St Joseph’s Hospital. These hospitals pre-date the establishment of the medical school. However, a residency training programme at the Civics, approved by the Royal College of Physicians and Surgeons, had been in existence for a number of years prior to the creation of the academic department. Since the establishment of the academic department, research directions have included: the pharmacology of anesthetics, physiology of smooth muscle-cells, respiratory physiology, pain management, obstetrical anesthesia, post-op nausea and vomiting, cardiovascular complications in non-cardiac surgery, resident training evaluation, and numerous clinical case studies. Canadian Firsts in Hamilton Anesthesia Pre-1970 In the late 1940s, Dr. Russell Fraser at St Joseph’s Hospital developed Westocaine, a -7- www.fhs.mcmaster.ca/anesthesia McMaster University Department of Anesthesia Report and Retrospective June 2002 RETROSPECTIVE procaine-based lighter-than-spinal-fluid anesthetic; this solution was used extensively in spinal anesthesia at that hospital. (This appears to be a very localized use which did not extend beyond St Joseph’s, according to Dr. Catton.) Dr. Frank Ruston, at the Hamilton General Hospital, extended the use of epidural techniques through the development of an infant epidural needle in the 1950s. He was able to demonstrate successful results on infants as young as one-day-old. [Canadian Anesthetists’ Society Journal, 1954, 1(1) 37- 44]. In the 1950s, Dr J.E. Marshall, and surgeon Dr Kenneth McKenzie, developed a new method of anesthesia for lobotomy, which consisted of a local block supplemented with sodium pentothal without intubation. The previous technique was to give deep general anesthetic with intubation. With the new method, patients were awake and conscious after surgery. A report of 300 successful cases was presented. (This is described by D. Catton and R. Stringer in their monograph The History of Anesthesia in Hamilton, 1977, self-published.—Eds) Post-1970 The McMaster University Medical School was the first of its kind to develop problem-based learning. Members of the Department of Anesthesia, including Drs D.V. Catton and R Browne, were deeply involved in the development of problem-based learning for medical undergraduates in the earliest days of the school. In 1984, the first acupuncture clinic operating in an academic institution was started by Dr A Fargas-Babjak as part of a multi-disciplinary pain clinic at McMaster University. As an adjunct to this service, Dr Fargas-Babjak introduced methods of non-pharmacological pain management to residents and began the first Continuing Medical Education Programme in Acupuncture under the auspices of an academic institution in 1999. The use of TENS by nursing staff in labour pain management was introduced at McMaster by Dr Fargas-Babjak after some in-house research into routine usage and compliance in 1986: we believe that this application was a Canadian first. -8- www.fhs.mcmaster.ca/anesthesia McMaster University Department of Anesthesia Report and Retrospective June 2002 RETROSPECTIVE Dr J. Forrest has been involved in several large-scale multi-centre trials of isoflurane, with the involvement of centres in Canada, [CASJ, 1982: 29 S (S1-69)] the United States and in Europe. The involvement of McMaster’s Department of Biostatistics and Epidemiology in these trials was innovative in anesthesia research. In 1991 Dr Alez Dauphin at St Joseph’s Hospital began a medical outreach initiative in Port- au- Prince, Haiti, a Canadian first. It includes commitments to infrastructure refurbishment, maintenance of existing structures, and education. The educational stream is innovative in that it provides a bilateral exchange: with the assistance of the College of Physicians and Surgeons of Ontario in the provision of short-term educational licences, Haitian physicians and residents visit Canada for training. This initiative has been supported by the Ministry of Health, St Joseph’s and McMaster University and continues actively to this date. For his work, Dr Dauphin has received McMaster’s Sibley Award. In 1999, the Anaesthesia Residency Program introduced the "CLIC" program for its residents. "CLIC" stands for communication, leadership, influence and conflict resolution. The program is a 2-day workshop, adapted from the "Crew Resource Management" Course at Air Canada. It strives to teach professionals how to interact more effectively with coworkers. Drs. Steve Puchalski and Karen Raymer led the inaugural workshop with the assistance of Captain Jim Houvartis, from Air Canada. It was considered valuable enough to be included as a yearly event in the core curriculum for our residents, and is a Canadian first. Dr Alex Jadad, in 1999 became the first anaesthetist to be elected as a Top 40 under 40 for his work in informatics and epidemiology as a professor in the Department of Epidemiology and Biostatistics, cross-appointed to the Department of Anesthesia, McMaster University. —Kris Wilson-Yang Anesthesia Archives In the summer of 1999, Fred Lee, a new graduate in sociology, contacted anesthetists in Hamilton to collect reminiscences of and reflections on the development and growth of the practise of -9- www.fhs.mcmaster.ca/anesthesia McMaster University Department of Anesthesia Report and Retrospective June 2002 RETROSPECTIVE anesthesia in Hamilton. A series of set questions was sent out to thirty-nine members and several members were interviewed. Those interviewed were asked how they began their careers with the Department, to assess the growth of the Department they had witnessed over the years, and for anecdotes, personal views and highlights. Fred was graciously invited to visit several retired staff at their homes, occasions which were valuable and interesting. After reading through the interviews, one prominent common theme emerged: each member had a sincere passion for their work: in research, teaching, and clinical service. Thanks to Fred’s work, there is an archive of information from which an informed history of anesthesia’s development as a specialty, its culture, and its practise in the Hamilton hospitals can be constructed. It is hoped to expand the archive to include a complete listing of all our residents and fellows, our clinical trends and our progress in research. —Fred Lee, Bob Lee, and Kris Wilson-Yang -10- www.fhs.mcmaster.ca/anesthesia