
Alexander Papangelou, MD
Shobana Rajan, MD
Kamilla Esfahani, MD
Lauren Dunn, MD, PhD
Lauren Buhl, MD, PhD
Matthew Whalin, MD, PhD
Jane Easdown, MD, MHPE
Laurel Moore, MD
Shobana Rajan, MD
Arnoley S. Abcejo, MD
Basic Rotation Schedule
Basic - Key Neuro Topics
The Accreditation Council for Graduate Medical Education (ACGME) requires subspecialty training in Neuroanesthesiology during the anesthesiology residency program. Most academic programs require two months of Neuroanesthesiology, and similarly we have divided the core concepts of Neuroanesthesiology into basic and advanced one-month rotations. The goals of the basic rotation are to provide junior anesthesiology residents with focused exposure to the perioperative management of patients undergoing neurological surgery and to teach them the basic principles of neurophysiology pertinent to this care.
After completion of the rotation, the resident should be competent to administer anesthesia for common and relatively straightforward neurosurgical procedures.
Goals & Objectives and Milestones
In 2005, SNACC leadership created a task force to author rotation goals and objectives for the basic and advanced neuroanesthesia resident rotation. Rotation milestones were also drafted and published in JNA in 2019. Residents in their first month of neuroanesthesiology are expected to achieve a level 3 proficiency in the various milestones. These documents may be used to guide resident rotation development by program and rotation directors. They are attached here for reference.
Basic Neuroanesthesiology Rotation Goals and Objectives
Neuroanesthesiology Milestones
How to Use This Document
“Neuroanesthesia Classroom” links key rotation topics to resources on the SNACC website. Resources may be in many forms, including problem-based-learning discussions (PBLDs), neuroanesthesia quizzes, expert podcasts, interactive clinical cases and topic specific peer-reviewed articles. The manuscripts were chosen from a library of the most impactful papers in the subspecialty, which have been archived by members of the society.
These resources are not exhaustive, but serve as a stepping stone for further discussion and knowledge acquisition. These materials can be used to supplement and facilitate learning, but are not intended to replace a formal curriculum. SNACC strives to be a resource for both educators and learners.
Course Outline
A. Cerebral physiology and anesthetic effects
1. Cerebrospinal fluid: composition, production, flow pathway
2. CPP, CBF, CMRO2: autoregulation and anesthetic effects in normal state
3. Intracranial Pressure
a) Basics of ICP: physiological compensations
b) Signs and symptoms of elevated ICP
c) Medical management and monitoring, e.g. EVD placement
4. Cerebral ischemia and cerebral protection
B. Neuroanatomy
1. Brain and Spine (tracts, reflexes)
2. Pituitary gland
3. Blood supply (Circle of Willis, Dural Sinus)
C. CNS blood brain barrier and electrolyte management
1. BBB structure and function
2. Intravenous fluids
3. Hyperosmolar agents (HTS, Mannitol)
A. Craniotomy: concerns and complications
1. Delayed emergence
2. Reflexes (trigeminal, vagal, etc)
B. Hydrocephalus (CSF diversion)
1. Current guidelines
2. Glasgow Coma Scale
3. Physiological derangements
1. Endocrinopathies
2. Panhypopituitarism
A. Anesthesia for simple spine surgery
B. Analgesia for spine surgery
C. Blood conservation management
1. Spinal shock, neurogenic shock
2. Level specific complications
a) Airway protective reflexes
b) Autonomic hyperreflexia: symptoms and management
c) Unstable cervical spine: airway management
E. Neurophysiological monitoring
1. Indications for use
2. Anesthetic effects
A. Craniotomy for deep brain stimulator placement
B. TBI patient for non-neurological surgery
C. Coexisting disease and neuroanesthesia
1. Hepatic disease
2. Cardiac disease
3. Parkinson’s disease
4. Pregnancy
D. Neuroanesthesia during the COVID-19 Pandemic