Featured Service: Vascular Anesthesia
According to Dr. Rae Allain, residents are an integral part of the Vascular Anesthesia Service.
"We try to really integrate the residents into what I look at as a very highly functioning team," Dr. Allain, the service's Team Leader, said.
The Vascular Anesthesia Service's mission is to:
- Provide excellent clinical care
- Educate residents in the core principles of caring for complex patients, most of whom have concurrent cardiac and/or pulmonary disease
- Integrate the residents into a highly functioning team environment
- Prepare residents for caring for emergency cases safely and expeditiously
"I hope another mission is to laugh and have fun as we do this, because the team can be a really fun place to work. I think we all get great satisfaction out of knowing we got a patient through what can be a very high-risk procedure," Dr. Allain said.
Vascular Anesthesia became a dedicated service under the leadership of DACCPM physician Dr. Ken Davison, who is now retired, Dr. Allain said.
Since then, Mass General has implemented several innovative vascular anesthesia techniques. For example, Dr. Davison collaborated with vascular surgeon Dr. Richard Cambria to develop a method of preventing paraplegia after aortic surgery.
"A significant number of patients who have aneurysms of the thoracic aorta wake up from the procedure and can't move their legs. [Drs. Cambria and Davison] knew that the spinal cord could tolerate lack of blood flow longer if they cooled it, so they came up with an idea from Ken to cool the spinal cord by using an epidural catheter," Dr. Allain said.
The method, called epidural cooling, was so successful that it became standard practice at Mass General and in other locations. Although newer techniques have been developed, Dr. Allain said Mass General is still known for the practice.
"I often get asked that at lectures or conferences: 'Oh, are you still doing epidural cooling?'", Dr. Allain said.
A typical day in the service can vary, Dr. Allain said. For residents, the day starts very early — around 6:30 am or earlier. A typical day in OR 32 starts with doing carotid endarterectomy, which is a surgery to prevent strokes, she said.
"That"s a pretty straightforward, medium-level case for the residents. It usually takes two and a half to three hours," she said.
Toward the end of the case, the resident is usually sent out by staff to get the next patient ready. Because it's common to follow a carotid procedure with a large aortic procedure, the resident puts in a large-volume IV and may either put in an epidural catheter or a spinal drain with the assistance of other vascular staff members and a critical care nurse, Dr. Allain said.
"All of these things involve a lot of needles and procedures, which the residents love," she said.
The cases can be complex and challenging for the residents, she said.
"Often I find the CA3s are completely humiliated halfway through the month," she said.
"They come into the service and they think they're on the top of their game, and they are. They're very good and very experienced, and then they encounter patients with anatomic challenges, which make them feel like they know nothing and they can do nothing."
However, the challenges are beneficial to the residents, because they learn to look for alternative solutions, she said.
"I think it's a great rotation to learn not just plan A, but B, C, and D. If your first plan doesn't work, what are you going to do? It also teaches them to be flexible. If things don't go as you had planned or wanted, then you have to be able to flex, which I think prepares them quite well for real life when they're out of here, as well as their board examinations," she said.
The Vascular Anesthesia Service core staff members include Drs. Hovig Chitilian, Aalok Agarwala, and Rodger White. Other members include Jonathan Charnin, Eric Pierce, Bill Benedetto, Scott Streckenbach, Brinda Kamdar, Cosmin Gauran, and Torin Shear. Newer members include Drs. Michael Andrawes, Todd Novak and James Williams.
The critical care nurses include Susan Aylouche, Valerie Buckley Farias, Laura Collier, Rosemary Daggett, Adrianne Diamond, Barbara Hill, Cindy Hoyer, Christine Angelini, Nancy Wyman, and Caterina Zanetti.
Pictured: Vascular Anesthesia Service founder Ken Davison.
Vascular Anesthesia Service
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