By: W Andrew Kofke MD, MBA, and David Highton, MBChB, FRCA, FFICM, FANZCA, PhD
The International Council for Perioperative Neuroscience Training (ICPNT) is like no other accreditation organization. The traditional model is reflected in Figure 1, wherein communication is solely between the training program and the accrediting organization. However, from its conception in 2018 ICPNT is designed to be more, i.e., provide for constructive communication between programs and ICPNT while also fostering communications and interactions between programs. ICPNT is developing into the nidus for an international educational network and very well may be the source of an international neuroanesthesia research network1. This is conceptually illustrated in Figure 1.
Figure 1: Facilitation of an intern program network by the ICPNT. Traditional (left) vs. ICPNT (right) network-driven communication pathway between an accrediting organization and accredited academic programs. Accredited institutions as of 2021 indicated. Figure from Rajan et al1 with permission.
From an educational perspective, the ICPNT network is facilitating approximately monthly webinars dealing with issues in perioperative neuroscience with varying formats, panels, lectures, research seminars, educational methods, and so on. This is conducted by the neuroanesthesia program relations committee chaired by Chanhung Lee from UCSF. The growth of ICPNT is such that other inter-program educational activities could be considered. For example, neuroanesthesia programs can share educational videos or allow for neuro-oriented lectures by their departments to be shared with other programs. Perhaps there could be a periodic ICPNT international grand rounds series fully covering the neuroanesthesia curriculum. These and other ideas are needed, as well as a willingness to contribute. This actually provides an opportunity for faculty and fellows from various places to deliver educational content to an international audience, generally considered a positive in promotions.
Many of us remember IHAST, perhaps the best-known neuroanesthesia research network. It was part of the research designed to assess the efficacy of induced hypothermia during aneurysm surgery2. It was NIH funded, which helped with its success, and was a remarkable demonstration of the potential, with committed leadership, for neuroanesthesia programs to collaborate in multi-institutional research conceived and overseen by anesthesiologists.
There are other generic clinical neuro research networks, such as Strokenet3, but without oversight or significant input by neuroanesthesioloigists, it can create potential issues in understanding the real perioperative neuroscience issues which need research attention and proper physiologic design.
With the development of ICPNT, we possibly have the administrative foundation for a research network, akin to IHAST, to promulgate conduct of perioperative neuroscience research. Thus far it has been used for surveys4. Future enterprising neuroanesthesia researchers may find this now nascent infrastructure to be a means to answer important questions in neuroanesthesia.
A recent ICPNT webinar (https://vimeo.com/814240321?iframe=true) reviewed the potential for collaborative international neuroanesthesia research centered around the ICPNT network. A functional model of increasing popularity is the trainee research network. This has the potential to deliver large multicenter projects while teaching research methods to neuroanesthesia trainees. Typically, large snapshot observational studies are most suited. However, multiple types of studies including RCTs can be delivered. Trainees collaborate across centers with a core project management team. This avoids several pitfalls of trainee research engagement, such as the length of time in rotations versus the time and expertise required for project set up. As a network, collaborative projects can be pitched, developed, funded, and delivered.
In the UK this approach has successfully delivered large national projects such as iHypE5 (describing intraoperative hypotension in older patients in the UK) and DALES6 (examining perioperative allergy documentation). Both of these sourced data from over 200 hospitals and involved hundreds of trainees. This had significant outputs with publication in high impact Anesthesia journals with all contributors acknowledged. This has been possible through the collaboration of regional trainee networks joined at the national level through the RAFT network (Research and Audit Federation of Trainees, Figure 2). See www.raftrainees.org for further information.
Figure 2: Trainee research networks in the United Kingdom making up the national network RAFT (Research and Audit Federation of Trainees). www.raftrainees.org
The scene is set for an international neuroanesthesia research network which can address educational or clinical perioperative neuroscience questions. ICPNT is the natural framework upon which to base this. We aim to deliver some projects of increasing complexity to evaluate the feasibility of this approach. Stay tuned for further updates and the opportunity to submit project ideas for development. Any inquiries can be directed to the authors or email@example.com.
- Rajan S, Bustillo M, Lee C, Kofke WA: Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward. Curr Anesthesiol Rep 2021; 11: 467-476
- Todd M, Hindman B, Clarke W, Torner J: Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 2005; 352 (2): 135-45
- Vahidy FS, Sozener CB, Meeks JR, Chhatbar PY, Ramos-Estebanez C, Ayodele M, Richards RJ, Sharma R, Wilbrand SM, Prabhakaran S, Bregman BS, Adams HP, Jr., Jordan LC, Liebeskind DS, Tirschwell D, Janis LS, Marshall RS, Kleindorfer D: National Institutes of Health StrokeNet Training Core. Stroke 2020; 51: 347-352
- Rajan S, Bebawy J, Avitsian R, Lee CZ, Rath G, Luoma A, Bilotta F, Pierce JT, Kofke WA: The Impact of the Global SARS-CoV-2 (COVID-19) Pandemic on Neuroanesthesiology Fellowship Programs Worldwide and the Potential Future Role for ICPNT Accreditation. J Neurosurg Anesthesiol 2021; 33: 82-86
- Wickham AJ, Highton DT, Clark S, Fallaha D, Wong DJN, Martin DS, Research t, Trainees* AFo: Treatment threshold for intra-operative hypotension in clinical practice—a prospective cohort study in older patients in the UK. Anaesthesia 2022; 77: 153-163
- Savic L, Thomas C, Fallaha D, Wilson M, Hopkins PM, Savic S, Clark SH: DALES, Drug Allergy Labels in Elective Surgical patients: a prospective multicentre cross-sectional study of incidence, risks, and attitudes in penicillin de-labelling strategies. British Journal of Anaesthesia 2020; 125: 962-969