SPECIAL INTEREST GROUP

Opening Minds and Eyes to Neuroanesthesiology

Shobana Rajan, MD
Marie Theard, MD

Shobana Rajan, MD

Marie Theard, MD

The Neuroanesthesia Education specialty interest group (SIG) was formed in 2016 to reach out to anesthesiology trainees in order to promote interest in this subspecialty. Cardiothoracic, critical care, pediatric anesthesia, regional and pain fellowship training are some of the top resident choices for training after residency completion, while neuroanesthesia ranks at the lowermost. According to the results of a survey conducted by the ASA in 2015, learn(ing) more, develop(ing) skills and desirability when looking for a job, are some reasons residents pursue these specialties. Why not neuroanesthesia? How can we best stimulate interest among our residents in this burgeoning field of neuroscience? As we each stop and consider for a moment the scope of possibilities in our field of neuroanesthesia, it is hard to imagine this apparent lack of interest on the part of our trainees in an area of study with so much potential for scientific discovery and clinical application. Filling this apparent gap in the awareness of this subspecialty and its offerings among trainees is the premise upon which this SIG group in the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) was formed.

Neuroanesthesia Education SIG meeting at the SNACC 44th Annual Meeting in Chicago, Illinois.

Research in neuroanesthetic care has provided us pharmacologic therapies and monitoring tools helpful in the safe perioperative management of our neurosurgical patients.  Anesthetic agents like dexmedetomidine has facilitated inclusion of patients for awake craniotomy who due to comorbidities like obstructive sleep apnea were previously not considered candidates for this beneficial procedure for glioma resection. Monitoring tools like brain tissue oxygen tension are useful in traumatic brain injury and transcranial doppler for managing vasospasm after aneurysm clipping in aSAH patients and have helped to positively impact neurological outcome. However, there are still many unresolved questions from how best to curtail postoperative cognitive dysfunction after a range of different surgeries, to the optimal anesthetic management for patients with acute ischemic stroke who require treatment in the interventional suite. Substantial strides made in neurosurgical care, like electrical stimulation of deep brain nuclei to treat Parkinson’s and laser interstitial laser therapy for brain tumors, are providing us opportunities to consider critical aspects of the anesthetic management which may impact neurological outcome in these patients.   

We, as members of SNACC, have an opportunity to inspire, educate and support anesthesia residents in a field which offers an opportunity for scientists and clinicians to answer questions. We predict this will lead to better surgical outcomes for our patients. SNACC is poised to remind our trainees of the opportunities for developing scientific expertise in these increasingly concerning neurologic dilemmas for use as consultants equipped with an understanding of potential preventive modalities and experimental designs for possible remedies.  

With the collective goal of generating more interest among residents in this dynamic field of science and with the support of our SNACC education committee and board of directors, this SIG was formed. Twenty interested SNACC members joined this group and since the fall of 2016, we have accomplished the following:

1. Earlier this year, each member of the committee reached out to directors of five anesthesia programs introducing this SIG and the educational resources available through SNACC for their trainees and fellows. We followed up recently with these programs in order to ensure that their trainees were able to access the SNACC App both here and abroad.

2. In February of this year, we conducted a survey in order to understand which factors determine resident interest in subspecialty training in general and to understand better perceived barriers curbing residents’ interest in neuroanesthesia subspecialty training. This survey also sought to gain information regarding interest in formal accreditation of neuroanesthesia fellowship programs. We presented the complete results of this survey at the program directors meeting at the IARS in Washington DC, May, 2017.

We surveyed residents, fellows and faculty through SNACC, Society of Academic Anesthesiologists, and Society of Education in Anesthesia and SIG members distributed the survey to their academic contacts as well. Most of the faculty, fellows and residents who responded to the survey felt that the neuroanesthestia fellowship should be accredited. While 75% of residents who responded were planning to complete a fellowship, their top choices were cardiac anesthesia, critical care, pediatrics and regional anesthesia. The reason for their top choice was the subspecialty was most interesting to them of all anesthesiology subspecialties. Among residents who responded (90% of whom were not SNACC members) some felt that the lack of a special skill acquired during neuroanesthesiology fellowships (such as transesophageal echocardiography with cardiovascular training and pain procedures during a pain fellowship) and the notion that residency training provides adequate preparation for the care of complex neurosurgical patients were reasons for the low volume of applicants to neuroanesthesia fellowship program. We look forward to sharing complete results of our survey at the upcoming SNACC meeting in Boston, Massachusetts.

Next steps planned for this SIG include:

1. Connecting anesthesiology residents to willing mentors of SNACC who will provide trainees information about our subspecialty, to help support interest in neuroanesthesia and help residents prepare for a future in neuroanesthesia by providing a clickable link on the SNACC website.

2. Developing a standardized neuroanesthesia curriculum which we hope will generate more interest amongst trainees in our specialty as well as elaborate on some of the complexities of this specialty which will require in depth tutelage to establish competency.

In conclusion, this is a young and growing committee consisting of members dedicated to improving awareness of our specialty in the next generation of physician scientists in anesthesiology. We think that there are “many miles to go” in this subspecialty interest group and we eagerly look forward to thoughts and ideas from more members who share our interest in “Opening minds and eyes to neuroanesthesiology.”

Reference:
Stein EJ, Mesrobian JR, Abouleish AE. The 2015 job Market for graduating anesthesiology residents. ASA monitor 2016;80(1):20-24.