SNACC Advanced Neuroanesthesia Classroom – Week 1

During week one, the trainee will acquire advanced knowledge of various neurovascular procedures. The trainee will:

Identify and manage the perioperative challenges encountered in open cerebrovascular procedures.
Consider and choose with deeper understanding various anesthetic management options
Identify complications and their management during perioperative period
Compare and contrast various invasive and non-invasive monitoring options in such cases

Cerebral aneurysm clipping: elective and emergent

Newsletter Education corner: Management of a ruptured cerebral aneurysms – decision making and dilemmas
Quiz
- Intraoperative aneurysm rupture: Neuroanesthesia Emergency Crisis Management (NECM)
Articles
- IHAST Trial: Mild intraoperative hypothermia during surgery for intracranial aneurysm (IHAST) (PMID: 15647576)
- ISAT Trial: Clipping vs. Coiling:
  - The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT) (PMID 25465111)
- Fellows’ and Residents’ Audio Corner
  - Anesthesia for Aneurysm Clipping Surgery (July 2018, Dr. Michael Todd)

Subarachnoid hemorrhage

Quizzes
- Subarachnoid Hemorrhage
- Complications of Subarachnoid Hemorrhage

Articles
- Critical care management of patients following subarachnoid hemorrhage: NCS Consensus Guidelines (PMID: 21773873)
- Stanlies D’Souza: Aneurysmal Subarachnoid Hemorrhage (PMID: 25272066)
Extraventricular Drain
- Fellows’ and Residents’ Audio Corner
  - Intraoperative Management of EVD (July 2022, Dr. Jack Buckley)
- Complications:
  - Vasospasm
    - Monitoring: Transcranial Doppler
      - Articles:
        Transcranial Doppler ultrasonography in anaesthesia and intensive care (PMID: 15220174)
      - Articles:
        Management of Vasospasm: Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. (PMID: 21285966)
        Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. (PMID: 17581487)
      - Fellows’ and Residents’ Audio Corner
        NeuroICU Management of Subarachnoid Hemorrhage (October 2018, Dr. Andrew Kofke)
      - Neurogenic stress cardiomyopathy
        Article:
        Brain-Heart Interactions: Cardiac Complications After Stroke (PMID: 28775014)

Intracranial open neurovascular procedures

Articles:
- Systematic Review: Extracranial-intracranial arterial bypass surgery for occlusive carotid artery disease. (PMID: 20166076)
- Anesthetic considerations for intraoperative management of cerebrovascular disease in neurovascular surgical procedures. (PMID: 17884703)

AVM resection

Moya moya

Carotid endarterectomy

Supplementary reading

Controversies in intraoperative aneurysm rupture management