Neuroanesthesia

Goals and Objectives

CA 2 Level

GOALS AND PRIMARY AREA OF KNOWLEDGE

As part of the consolidation of neuroanesthesia subspecialty concepts, the resident in the second month will have become familiar with the basic elements of neuroanesthesia management during the first month. Advanced Training in Neuroanesthesia in the second month will include steady advancement to more difficult and complex anesthetic problems, including care of seriously ill neurosurgical patients. At this level, neuroanesthesiawill include an enhanced experience in an understanding of the anatomy, pharmacology, physiology, pathophysiology, and specialized issues related to the administration of anesthetics to neurosurgical patients.

ACGME Core Competencies

Demonstrate mastery of all core competencies outlined for the first month.

COGNITIVE OBJECTIVES

1.Demonstrate mastery of knowledge of all cognitive objectives expected of a first month with little or no staff assistance

2.Demonstrate mastery of knowledge of normal brain physiology; functional and special monitoring

3.Demonstrate mastery of knowledge of cerebral and spinal cord blood flow

4.Demonstrate mastery of knowledge of brain oxygen consumption, metabolism, and cerebral ischemia

5.Demonstrate mastery of knowledge of regional ischemia and global ischemia

6.Demonstrate mastery of knowledge cerebrospinal fluid mechanics

7.Demonstrate mastery of knowledge of the Anesthetic effects on CSF physiology and intracranial pressure

8.Demonstrate mastery of knowledge of ICP monitoring and interpretation of intracranial compliance, elastance, relationships

  1. Demonstrate mastery of knowledge relating to severe neurologic injury to include:

a)Primary and secondary injury

b)Edema formation

c)Vasospasm and delayed neuronal necrosis

d)Multisystem effects of head injury

e)Spinal cord injury acute and chronic changes

f)Altered consciousness and coma

g)Brain protection, preservation and resuscitation

SKILL OBJECTIVES

1.Demonstrate all the “skill objectives” expected of the first month trainee

2.Induce cerebral “protective” measures and manipulate hemodynamics based on neurophysiological monitoring

3.Balance the anesthetic technique to accommodate neurophysiological monitoring

4.Demonstrate the ability to manage neuroanesthetic complications, prepare anesthetic plans for complex neurosurgical patients including those involving sophisticated, neurological monitoring or techniques such as deep hypothermic arrest for aneurysm clipping

5.Manage the anesthetic care of the complex and difficult neurosurgical patient which may range from an infant with a brain tumor to complex AV malformation

6.Manage anesthesia for neuroradiologic procedures in remote location anesthetic

7.Manage anesthesia for supratentorial lesions to include rationale and positioning

8.Demonstrate appropriate management for severe head injury to include interpretation and therapy for ICP monitoring techniques

9.Demonstrate appropriate management for posterior fossa procedures in the prone and sitting position

  1. Demonstrate the ability to use:

a)precordial Doppler monitoring

b)right heart catheter (air aspiration)

11.Demonstrate anesthesia management for neurovascular procedures (neuroradiology, aneurysm and endarterectomy)

12Demonstrate appropriate implementation and interpretation of neurophysiologic monitoring: EEG, SSEP, BAER, MEP

REQUIRED READING

Week 1Newfield Chapters 6 (Head trauma), 7 (Supratentorial tumors), and 8 (Posterior fossa), total of 42 pages including references.

Week 2Newfield Chapters 9 (Intracranial aneurysms), 10 (Cerebral ischemia), and 11 (Neuroendocrine tumors), total of 54 pages including references.

Week 3Newfield Chapters 4 (Cerebral protection), 12 (Epilepsy and epilepsy surgery, etc.), and 16A (Interventional neuroradiology), total of 55 pages including references.

Week 4Selected reading of faculty publications.

Additional reading: Residents are encouraged to seek additional materials about specific cases. More detailed references can be identified through the SNACC Internet Web site and other anesthesia related Web sites. There are several resources (textbooks/journals) also available at the department library.

EVALUATION

Final evaluation will be based upon clinical performance with a written evaluation

Rev. 7/2009

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