Dr. George Nicolaou (Director)

The academic Thoracic and Vascular Anesthesia Program located at Victoria Hospital, is an extremely busy program covering all types of complex elective and emergency cases, with the exception of lung transplantation.

Vascular surgery operates five times a week and Thoracic surgery three times a week. Our TEE Program is well developed with formal teaching and rounds. We have monthly Multidisciplinary, Morbidity and Mortality Rounds with our surgical colleagues.

The majority of vascular and thoracic patients coming through our institution have multiple co-existing diseases including cardiorespiratory compromise. These patients have an extensive preoperative evaluation by anesthesia and/or internal medicine, cardiology and respirology. We have developed a multidisciplinary perioperative high-risk clinic for optimization and follow up of these patients. The Thoracic and Vascular surgical programs have their own postoperative step-down monitored units.

Thoracic

The robotic and video-assisted thoracic surgical programs are well developed at our institution and currently account for 80% of cases, the remainder being open thoracotomies or investigative procedures. On average, per year, we perform 300 lobectomies and 80 esophagectomies.

Vascular

The Vascular Division of Surgery at Victoria Hospital has and continues to be a pioneer in endovascular stenting of abdominal and thoracic aneurysms, and claims one of the largest series in North America. Ruptured abdominal and thoracic aneurysms that have favorable anatomy are also repaired by the endovascular route at our institution. The thoraco-abdominal aneurysm program is well developed and these aneurysms are now generally repaired using fenestrated stents. The thoraco-abdominal aneurysms that cannot be repaired using stents, are repaired utilizing partial left heart bypass. On average, per year, we perform 150 open abdominal aneurysms, 50 endovascular thoracic, and 100 abdominal endovascular stents.

TEE is specifically available for management of thoracic aneurysm stenting and for adjunctive management of the vascular patient with associated cardiac disease. While not every anesthetist involved in Vascular Anesthesia is experienced in TEE, there is usually an anesthetist experienced in TEE, available for guidance.

Residents

Our residency program includes two four-week blocks of subspecialty training in vascular and thoracic anesthesia. Educational objectives are clearly outlined and monitored through daily assessments. Reading material is provided and they are encouraged to partake in ongoing clinical research. At the beginning and end of their rotations, the residents have an MCQ examination to assess improvement during their rotation. An oral examination is also administered at the end of the rotation.