Neuroanesthesiology division members
The patient undergoing a neurosurgical procedure presents a unique challenge to the management of anesthesia. Craniotomies in the sitting position, or epilepsy surgeries in the awake patient are two examples of such challenges we face on a routine basis. Evoked potentials and electroencephalography are among the methods of monitoring central nervous system functions we employ. In addition, endovascular coiling of intracranial aneurysms and arteriovenous malformations, performed in the radiology suite, have become a frequently performed adjunct to our cases in the operating room.
A neurosurgical anesthesia rotation is offered to residents at each level of training (CA-1, CA-2, and CA-3). The CA-3 rotation is a senior resident rotation with emphasis on more advanced skills and more autonomy. During the rotation, residents provide anesthetic care for diverse neurosurgical cases, including removal of intracerebral tumors, arteriovenous malformations, and aneurysms, both open and endovascular. Because Strong Memorial Hospital is the region’s trauma center, residents gain experience in the anesthetic management of head trauma and in airway management of cervical spine injuries. The hospital is a leader in performing “awake” craniotomies for the surgical treatment of intractable epileptic seizures, and cares for most pediatric neurosurgical patients in the region.
Residents gain a complete understanding of the physiology and pharmacology of the brain, special considerations in neurosurgical patients (including monitoring and positioning), and safe anesthetic management for various neurovascular diseases. The resident will also become familiar with airway management of the unstable cervical spine. Techniques include the use of the flexible fiberoptic laryngoscope, GlideScope, VideoMac, and lightwand stylet. Residents learn through hands-on operating room experience and formal structured didactics. In addition to traditional topics in neuroanesthesia, advanced subjects such as brain protection and intraoperative monitoring of neural tissue integrity are taught. This approach provides a comprehensive experience allowing the graduate to provide quality anesthetic care to a wide variety of neurosurgical patients.