Director, Cerebrovascular and Endovascular Neurosurgery
Department of Neurological Surgery
Loma Linda University Health
11234 Anderson Street, Room 2562A, Loma Linda, CA 92354
EDUCATION AND TRAINING
Medical School: Kottayam Medical College, Mahatma Gandhi University, Kerala India
Internship: The Ohio State University Wexner Medical Center, General Surgery
Residency: The Ohio State University Wexner Medical Center, Neurosurgery
Fellowship: The Ohio State University Wexner Medical Center, Endovascular Neurosurgery
Fellowship: The Ohio State University Wexner Medical Center, Research Fellowship Skull Base Neurosurgery
Fellowship: University of Pittsburgh Medical Center, Gamma Knife Radiosurgery/ Research Fellowship
Awards & Recognition: Healing Hands Honoree. A grateful patient program honoring Loma Linda University Health physicians and staff.
Q 1. Do you think fellowship training in neuroanesthesia improves patient care?
Yes, I strongly believe so just from my personal experience. Spending a dedicated time specializing in neuroanesthesia makes these anesthesiologists experts in their field. They are always better prepared because of their expertise with different neurosurgical procedures. I often see them giving valuable input whether it is related to patient positioning or management of complex intracranial dynamics during complicated surgery or managing any unexpected complications. I can always rely on them for overall patient management while I focus on to my surgical field.
Q 2. What do you see as the value in a neuroanesthesia fellowship?
By spending a dedicated time in neuroanesthesia makes these anesthesiologists better prepared to manage various neurosurgical procedures which is a greatly evolving field. I don’t have to remind them what the blood pressure and hemodynamic goals are during various stages of a complex intracranial procedures, or how important it is to manage the coagulation profile during a bleeding spine or intracranial procedure. For example, you can’t let the platelets count to drop to 50 K like they do in general surgical procedures. How important it is to keep the patient immobile during an endovascular procedures like cerebral aneurysm coiling, importance of smooth and faster wakeup at the end of the procedure, is there a room to give more mannitol or hypertonic saline if patient’s osmolality is already close 320. I can recollect numerous scenarios where in the input from our neuroanesthesiologist turned out to be very valuable. When we encounter an unexpected scenario, their expertise always comes in handy to navigate through the situation smoothly as we have to work as a team. If I have a non-neuroanesthesia team, managing my patient, I have to remind them the goals of management at the beginning of the case and throughout during the surgery. Unfortunately, if things get arduous at the surgical field, I won’t be able to give them directions and worry about missing things.
Q 3. Does fellowship training factor into your hiring decisions?
Q 4. What career benefits do you see for a resident pursuing a neuroanesthesia fellowship?
This additional training in neuroanesthesia will put them at advantage than the general anesthesiologists. As they can take care of general surgical patients in addition to neuro patients. In many academic facilities, having a dedicated neuroanesthesia team is the goal and can only be achieved by hiring more anesthesiologists specialized in this field.
Q 5. Would you recommend anesthesia residents consider a neuroanesthesia fellowship?
Yes. I think demand for neuroanesthesiologists is going to increase as more and more neurosurgeons’ requests for specialized neuroanesthesia team to manage their patients. It is a fascinating field, and the anesthesiologists play a great role in the overall outcome of neurosurgical patients.
Q 6. What would you say to a resident who is considering a neuroanesthesia fellowship but is unsure if it’s worth it?
I would encourage them take an elective month and spend some time in neuroanesthesia and in neuro ICU.
Q 7. Any other thoughts you would like to share?
The anesthesiologists play a crucial role in all surgeries but even so while managing a complex awake craniotomy or some other major neurosurgical procedures and I think it is a very rewarding experience for any physician. As a surgeon, I would like to see a devoted neuroanesthesia team taking care of my patients.