Thoracic Anesthesia

(3-4 positions per year)

Clinical Curriculum

Surgical oncology procedures makes up the bulk of thoracic surgery at the Toronto General Hospital. Interventions for lung cancer vary from diagnostic procedures, minimally invasive resection (video assisted and robotic thoracic surgery) to major incision and resection. There is an active caseload of esophageal surgery, both resection and reconstruction for cancer and functional surgery for benign disease. As a referral center for major airway surgery, airway stenting, resection and reconstruction are frequent. Thymectomy is also routinely performed, both for malignancy and for the treatment of myasthenia gravis. A comprehensive approach to acute perioperative pain practice in thoracic surgery patients includes multimodal systemic analgesia, the use of truncal blocks and epidural placement.

There is emphasis for fellows to become proficient at the care of patients with end-stage lung disease undergoing high-risk surgery: lung transplantation (over 200 cases per year), pulmonary endartectomy (60-70 cases annually) and lung volume reduction (10-15 cases per year). The anesthesia department plays an active role in the assessment, selection and perioperative management of these cases. Thoracic anesthesia fellows gain extensive experience in a number of extracorporeal life supporting technologies. ECMO, both veno-venous and veno-arterial are used as a treatment for acute lung injury and hemodynamic failure respectively. Intra-operative ECMO support is common during lung transplant surgery, and less commonly used for bridge to transplant or bridge to recovery scenarios.

Call duties

At this time call is done from home for lung transplant and pulmonary endarterectomies, in a one in three to four rotation.

Education Curriculum

Weekly teaching sessions are held Tuesdays at 17:00 covering various and TGH practice specific topics. Echocardiography lectures and case discussion rounds are done Wednesdays and Thursdays at 17:00 and attendance and participation is encouraged. Monthly professor rounds are organized on Mondays at 17:00. Departmental rounds are scheduled for Friday mornings at 07:30.

Multidisciplinary meetings for discussion and selection of patients for lung transplant listing and pulmonary endarterectomy surgery are also weekly, and thoracic anesthesia fellows are welcome to participate.

Research

Participation in research and education is expected. Research is integrated into the fellowship with academic time provided to those involved in projects, with a goal of one non-clinical day per week up to a maximum of 40 days over a 12-month fellowship period. Frequently there are ongoing trials in which fellows may participate or they may embark on their own individual research projects. Recent study opportunities include transfusion management during ECMO supported lung transplantation, and coagulation profiles in pulmonary endarterectomy patients. Quality improvement and assurance projects are also an area of interest.

Participation and presentation in academic conferences is encouraged. Travel grants are available for presentations at eligible North American meetings.

Applications Requirement and Process

The fellowship is aimed at anesthesiologist in their early professional career. Interested applicants need to have successfully completed all the required anesthesia examinations, be registered with the official regulatory authorities and have at least 5 years of anesthesia training and experience at an academic centre. (1 of the 5 years may include a rotational year, also known as an internship, houseman year or medical officer year).

A current and valid ACLS certification is a requirement.

Applicants need to apply by using the online platform:

• The January 2024 application process has closed.
• The July 2024 application process has closed.
• If you are interested in applying for January 2025, please complete this online application form.

Shortlisted candidates will be contacted 12-18 months before the tentative start date for reference letters and to further the application. Please do not send any reference letters, until requested to do so.

Successful candidates will be notified about 9-15 months ahead of a potential start date. An interview might be required.

Direct inquiries to:

Dr. Adam Snyman
Coordinator, Fellowship Program 
Toronto General Hospital 
200 Elizabeth Street, EN3-438 
Toronto, ON Canada M5G 2C4 
adam.snyman@uhn.ca