In the previous issue of the SNACC Newsletter, I had the honour of interviewing Professor Martin Smith regarding his distinguished career, including his work as Editor-in-Chief of the Journal of Neurosurgical Anesthesiology between 2018 and December 2024. It is now my great pleasure to interview Dr. Alana Flexman, who has taken the helm as Editor-in-Chief of JNA as of January 2025.
Dr. Alana Flexman is a Clinical Associate Professor in the University of British Columbia Department of Anesthesiology, Pharmacology and Therapeutics, and an affiliated scientist with the Centre for Health Evaluation and Outcome Sciences at St. Paul’s Hospital in British Columbia. She completed fellowship training in neuroanesthesiology at the University of California San Francisco (UCSF). Dr. Flexman’s research focuses on both neuroanesthesia topics such as perioperative stroke and brain health, as well as on advancing equity, diversity and inclusion in medicine. Throughout her career, Dr. Flexman has held numerous leadership positions, including as SNACC President from 2022-2023 and as past Chair of the Neuroanesthesia Section of the Canadian Anesthesiologists’ Society. She has also contributed to the Editorial Boards of the Canadian Journal of Anesthesia and the Journal of Neurosurgical Anesthesiology. Dr. Flexman assumed the role of Editor-in-Chief of the JNA in January 2025.
1) How did you choose a career in neuroanesthesia? Was there a specific experience that inspired you to pursue this career?
I was always fascinated by the interactions between the brain and anesthesia. Our ability to modify and manipulate consciousness and perception is a fundamental aspect of anesthesia practice, yet remains relatively poorly understood in terms of immediate and delayed impact on the brain. The concurrent interactions between neurosurgical procedures and anesthesia is yet another fascinating layer of anesthesia practice and research. In short – I think this area of anesthesiology is mysterious and fascinating!
2) Who have been the most influential mentors in your career?
I think mentorship is an extremely important part of our careers. I have been fortunate to have many important mentors that have guided me over the years – both within and outside medicine. In neuroanesthesia, my important mentors have been Dr. Adrian Gelb and Dr. Pekka Talke, with whom I completed my neuroanesthesia fellowship at UCSF. Without these mentors, I believe I would not have had the opportunities in our community, nor the confidence to take those opportunities. As a mid-career academic anesthesiologist, I now make an intentional effort to mentor and support the next generation of anesthesiologists.
3) What is the best advice you have received in your career as a neuroanesthesiologist and researcher?
Someone once told me that in order to succeed at research, you need to get used to rejection. Although this takes getting used to, it’s inherently part of the process, and so it should be. Personally, I have experienced lots of rejection in my career, as well as successes. Critical review and continuous feedback ultimately makes you into a better scientist, researcher and writer. Being an editor involves quite a lot of rejection, which I know can be difficult for authors. I would encourage anyone who has this experience to understand that this is a normal part of the process, and does not mean you will not be successful. Consider the feedback, and try again.
4) What are you most looking forward to in your new role as Editor-in-Chief of the JNA?
I am truly honoured to have the opportunity to take on this important role. I am looking forward to many aspects of the job, including working with a stellar editorial board who are the foundation of the peer-review process as well as our current associate editors, Drs. Jeff Pasternak and Matt Whalin. I look forward to finding ways to support early career researchers and sustaining academic neuroanesthesiology for the future. I’m also interested in how we can advance the role of academic medical publishing in the face of new innovations and opportunities, such as artificial intelligence and new ways of information dissemination.
5) In your first JNA Editorial as the new Editor-in-Chief, you describe your vision for the future of the journal, which many of our readers will review with great interest.
• How will your experiences as an active researcher with a focus on perioperative brain health and past role as Associate Editor for the JNA and Canadian Journal of Anesthesia inform your work and priorities as Editor-in-Chief of the JNA?
I have been very fortunate to have had excellent mentorship in both research and editorial work from both the Canadian Journal of Anesthesia and at JNA. There is a steep learning curve to this process, and I am grateful for the patience of the experienced editors at these journals who answered my questions and provided guidance over the past several years. I have also learned a lot from my co-reviewers on manuscripts that I have reviewed – I always read with interest what the other reviewers have to say. As a result, I feel slightly (!) less daunted taking on the role of Editor-in-Chief for JNA, and I’m excited to be able to contribute to the progress of science in neuroanesthesiology. As for my research background, I feel I have a broad understanding of the widening scope of perioperative neuroscience, as our field has expanded beyond simply anesthesia for neurosurgical procedures. We have many outstanding researchers in our community who are contributing to our understanding of consciousness, mechanisms of anesthesia and neurologic outcomes after surgery. Neuroanesthesiologists truly have a footprint across all of anesthesia.
• You were also the 2022-2023 President of SNACC. What do you hope to see for the future relationship of SNACC and the JNA?
JNA and SNACC have a strong and mutually beneficial relationship, which is key part of our mission. During my time on the SNACC Board of Directors and Executive committee, I supported this relationship from the SNACC side, and now it’s a privilege to be able to continue this on the JNA side. As the official journal of SNACC, I see this relationship getting even stronger, through continuing our joint activities such as the podcasts, SNACC newsletter, and involvement at the SNACC Annual Meeting. JNA has also published SNACC’s abstracts, guidelines and other endorsed documents and provided these documents as open-access, which I consider to be an important component of our relationship. I very much look forward to working with SNACC’s leadership and members going forward, and value this relationship.
• In your Editorial, you reference the “consistent commitment to advancing equity in our subspecialty whenever possible.” Can you describe how the JNA has prioritized diversity, equity and inclusion, and what do you see as the next steps?
Equity is an important, yet complex and challenging goal, and an ongoing commitment and value. While it’s hard to say we will ever truly “get there”, we should always have these principles in mind to guide our strategy – in my opinion, it is good for science. The previous Editor-in-Chief of JNA Dr. Martin Smith made an intentional effort to diversify the Journal’s editorial board in terms of representation by geographic location, gender and expertise. I plan to carry on with his vision and continue to diversify our reviewer and author pool as much as possible. This will include regular evaluation and metrics to identify gaps, and keeping equity on the agenda.
6) Do you have any specific advice for new clinicians and researchers who are hoping to contribute to the Journal?
Absolutely – we enthusiastically welcome involvement from clinicians and researchers in the early stages of their career. If you are just starting out and would like to get involved in reviewing manuscripts for the journal, we can provide support and mentorship to learn the process. We also welcome submissions from early career neuroanesthesiologists, often this is best done with a more experienced mentor to learn the process. We also have various ways to support the Journal through our activities with SNACC, such as the newsletter updates, podcasts and social media. I appreciate this opportunity to engage with SNACC’s members – please feel free to reach out if you have any questions or would like to get involved further (aflexman@providencehealth.bc.ca).
