During week three,  the senior trainee will review the anesthetic management of the following procedures with an emphasis on choice of technique, monitoring, and approach to complications:

• Endovascular coiling of cerebral aneurysms and arteriovenous malformations
• Carotid stenting, trans-carotid revascularization
• Stroke management
• The trainee will also review the various monitoring modalities
  • Key aspects of raw and processed EEG and their clinical anesthetic applications and limitations
  • Clinical application and limitations of cerebral oximetry

Interventional Neurosurgery:

Aneurysm Coiling

• Fellows’ and Residents’ Audio Corner:
  • Anesthesia for Neuro-Interventional Procedures (April 2016, Adrian Gelb, MD)      
• Quiz:
  • Anesthesia for Neurointerventional Radiology
• PBLD:
  • Aneurysm Coiling in a Parturient with SAH

Vasospasm

• Article:
  • Balloon Catheter Technique for Dilatation of Constricted Cerebral Arteries After Aneurysmal SAH (PMID: 6234754)

AVM embolization

• Quiz:
  • Anesthesia for AV Malformations of the Brain
• Interactive case:
  • Case Presentation: Endovascular Embolization of Intracranial Dural AV Fistula Benign?

 Carotid Stenting

• Quiz:
  • Carotid Disease & Neuromonitoring
• Podcast:
  • Anesthetic Considerations for Carotid Endarterectomy (August 2016, Dr. Arthur Lam)
• PBLD:
  • Carotid Endarterectomy
• Article of the Month:
  • Long-term Outcomes After Stenting Versus Endarterectomy for Treatment of Symptomatic Carotid Stenosis: The International Carotid Stenting Study (ICSS) randomised trial (PMID: 25453443)

 Trans-Carotid Revascularization

• Article:
  • Anesthetic Considerations for Transcarotid Artery Revascularization: Experience and Review of Forty Cases From a Single Medical Center (PMID: 33505816)

Stroke Thrombectomy

• Quizzes:
  • Stroke
  • Acute Stroke
• Podcasts:
  • Interventional Neurosurgical Treatment of Stroke (January 2016, Babak S Jahromi, MD, PhD (Neurosurgery)
  • ICU Management of Stroke Patients (February 2020, Dr. Ugan Reddy)
• JNA Podcast:
  • General Anesthesia vs Conscious Sedation in Endovascular Thrombectomy for Stroke (January 2021, Dr. Vandse)

• Articles:
  • General Anesthesia or Conscious Sedation for Thrombectomy in Stroke Patients: An Updated Systematic Review and Meta-Analysis (PMID: 37268801)
  • General Anesthesia Versus Conscious Sedation in Endovascular Thrombectomy for Stroke: A Meta-Analysis of 4 Randomized Controlled Trials 2021 (PMID: 31567645)
  • Site of Occlusion May Influence Decision to Perform Thrombectomy Under General Anesthesia or Conscious Sedation 2021 (PMID: 31567854)
  • SNACC Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke During COVID19 Pandemic. 2020 (PMID: 32282614).
  • DEFUSE 3: Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. 2018 (PMID: 29364767)
  • DAWN: Thrombectomy 6 to 24 Hours After Stroke with a Mismatch between Deficit and Infarct 2018 (PMID: 29129157)
  • Blood Pressure guidance:
    • Article of the Month: Periprocedural Management of BP after Acute Ischemic Stroke
    • BEST-II RCT: BP Management after Endovascular Therapy for Acute Ischemic Stroke
    • Blood Pressure Thresholds and Neurologic Outcomes After Endovascular Therapy for Acute Ischemic Stroke An Analysis of Individual Patient Data From 3 Randomized Clinical Trials 2020 (PMID: 31985746)

Intraoperative EEG/Processed EEG

• ICE-TAP: International Consortium for EEG training of Anesthesia Practitioners
• Quiz:
  • EEG Monitoring in the Surgical Patient
•  Podcast:
  • Neuromonitoring for Intracranial Surgery (January 2018, Dr. Antoun Koht)
• Clinical Audio and Video Corner:
  • EEG Trajectories During Anesthetic Emergence and Postoperative Delirium in the PACU (December 2018, Dr. Paul Garcia)
•  Articles:
  • Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures (PMID: 26275092)
  • Article of the Month:  Monitoring Depth of Anesthesia Utilizing a Combination of Electroencephalographic and Standard Measures Commentary

Cerebral Oximetry 

• Quiz:
  • Cerebral Oximetry
• Article of the month:
  • The Effects of Systemic Oxygenation on Cerebral Oxygen Saturation and its Relationship to Mixed Venous Oxygen Saturation: A Prospective Observational Study Comparison of the INVOS and ForeSight Elite Cerebral Oximeters. (PMID: 29484605)

Supplementary Reading (SNACC Bibliography Collection)

• Cerebral Ischemia Articles (Neurophysiology → Cerebral Ischemia)
• AVM Articles (Neurosurgery → Arteriovenous Malformation)
• Carotid endarterectomy articles (Neurosurgery → Carotid endarterectomy)
• EEG Articles (Neuromonitoring → Electroencephalography) 
• Cerebral Oximetry Articles (Neuromonitoring → Cerebral oximetry)