INTERNATIONAL NEUROANESTHESIA NEWS

Neuroanesthesiology in Qatar

Arunabha Karmakar, MBBS
Arunabha Karmakar, MBBS
Neeraj Kumar, MD
Neeraj Kumar, MD
Small Nation with Big Dreams

Arunabha Karmakar, MBBS
Fellow, Neuroanesthesia
Hamad Medical Corporation
Doha, Qatar

Neeraj Kumar, MD
Anesthesiology Residency Program Director
Senior Consultant, Hamad Medical Corporation
Assistant Professor, Weill Cornell Medicine
Doha, Qatar

Introduction

Qatar has often been described as a small nation with big dreams. While small in size, it boasts an ever-expanding international profile. Qatar has maintained its rich cultural heritage; being a modern nation with traditional flavors. The country is developing an increasing presence on the international stage. It has a rich supply of natural gas, as well as an award winning 5-star airline. Recently, Qatar has hosted a variety of international sporting events, and is due to hold the FIFA World Cup in 2022. There has been huge infrastructure development in the country over the last 15 years; not only in ambitious engineering projects, but also in the fields of education, leisure, tourism, and healthcare. The public health system, with large investments in buildings, equipment, education, and staff has achieved a ranking of 7th best in the world and the first in the Middle East by the 2018 Legatum Prosperity Index (Figure 1).

Dohah

Figure 1: Doha Skyline

Healthcare in Qatar

To cater to the healthcare needs of its people, Qatar grew a network of health centers and hospitals around the country, all staffed with very well-trained nurses and doctors who come from a wide variety of backgrounds. The popular government run health system known as the Hamad Medical Corporation (HMC), includes 12 specialized hospitals and is a completely not-for-profit organization. In addition, the country has many private hospitals.

Hamad Medical Corporation

The government run health system has become the major healthcare provider for the people of Qatar. HMC hospitals (Figures 2 & 3) are well known for their distinct architecture, world class infrastructure and highly qualified workforce. Hamad Medical Corporation is also the teaching hospital for the students of Weill Cornell Medical College - Qatar and Qatar University College of Medicine.

Figure 2: HMC Trauma and Emergency Center                   

Figure 3: HMC Hospitals

Moving Towards a World Class Healthcare System

In January 2016, HMC achieved the significant distinction of becoming the first healthcare system across the globe to have all of its hospitals accredited by the Joint Commission International (JCI) under the Academic Medical Center accreditation program. In November 2014, HMC’s Trauma System became the first international organization to be recognized by Accreditation Canada International’s Trauma Distinction Award. Hamad Medical Corporation has also received accreditation in American Nurses

Credentialing Center (ANCC), the College of American Pathologists (CAP) and the International Academy of Emergency Dispatch (IAED) for the Ambulance Service.

Neuroanesthesia at HMC

The neuromedical services at HMC, includes members from the departments of Neurology, Neuroradiology, Neurosurgery and Anesthesiology. Providing a multidisciplinary team, working together to deliver the best and most compassionate care for patients with neurological diseases. The neurocritical care service is shared by the Trauma, Medical, and Surgical Intensive Care Units. Neuroanesthesia services for adult patients are provided at Hamad General Hospital (HGH) operating rooms and interventional radiology rooms. (Figure 4 & 5) Pediatric procedures are treated at Sidra Medical and Research Centre.

Figure 4

Figure 4: A Busy Working Day in Neurosurgical OR

Hamad General Hospital

Figures 5: Hamad General Hospital

In the operating room, neuroanesthetic services are provided for routine and emergency procedures including traumatic intracranial and spine procedures. There are three state of the art hybrid operating rooms including an intra-operative MRI (Figure 6), angiography, and CT scan suites. Together, these high-tech environments, provide optimal operating facilities for the treatment of cerebral tumors, arterio-venous malformations (AVMs) and spine procedures.

The best possible quality of care is delivered by a highly trained team of neurosurgeons, anesthesiologists, nurses, technologists and neuro-intervention physicians, to these critical patients requiring such demanding procedures. There is a team of specialized neuroanesthesiologists providing anesthesia for complex elective services surgeries. Out of hours emergent cases, in and outside the OR, are managed by a combination of the neuroanesthesiologists and general anesthesiology team, according to protocols and guidelines designed by the neuro-anesthesia team. All anesthesiology services are consultant led with academic programs for both residents and fellows. In spite of catering for only a small population of 2.7 million, the scope of work ranges from simple to complex procedures. Cases include intracranial aneurysms, AV malformations, carotid endarterectomies, posterior fossa surgery in the sitting position, endoscopic ventricular procedures and vascular procedures such as Moya-Moya disease. On average, the operating suite at HGH provides anesthesia for more than 200 elective and 225 emergency craniotomies annually. In addition, the neurosurgical team perform on average, 110 emergency and 125 elective spine procedures annually. Recently neurophysiologists have joined the intra-operative team to provide services for advanced real-time intra-operative neurological monitoring.

Figure 6: Intraoperative MRI

Interventional Neuroradiology

Interventional Neuroradiology provides a 24-hour service for emergency stroke management, elective aneurysm coiling, and AVM embolization. For thrombectomy, the anesthetic department provides anesthesia services round the clock, while many other procedures are performed on elective basis. Neuroanesthetic services are actively involved in caring for patients in the neurointervention suite. In 2018, our busy neuro-intervention suite performed more than 175 diagnostic cerebral and spinal angiograms, in addition to about 250 therapeutic interventional procedures.

Sidra Medicine

Sidra medicine is a recently opened specialized Women’s and Children’s hospital that carries out an average of 150 pediatric neurosurgical cases, including Intraoperative Magnetic Resonance Imaging Systems (IMRIS), endoscopic craniosynostoses and neonatal neurosurgical procedures. There are dedicated pediatric anesthesiologists who provide care at Sidra Medical and Research Centre (Figure 7).

Figure 7: Sidra Medicine

Neurointensive Care

Neurointensive care is provided by three separate units. For trauma patients, there is a dedicated trauma ICU (TICU), which takes care of all trauma victims including patients with traumatic brain injury and patients with spinal injuries. Postoperative care of non-traumatic surgical patients is provided in the surgical intensive care unit (SICU). Medical cases, including decompressive craniectomy and stroke patients, continue their treatment in the Medical Intensive Care Unit (MICU). Less critical medical patients are managed by the neurology team, and there is a state of the art dedicated stroke unit.

Residency and Fellowship

The Anesthesia Residency Program lasts for five years, including one Clinical Base Year (CBY) and is proud to be ACGME-I accredited. The anesthesiology residents rotate for two blocks in neuroanesthesia in their 2nd and 3rd year. They have fixed goals and objectives for each rotation and learn with progressive responsibility. In addition to exposure to complex neurosurgical cases, residents learn and practice, total intravenous anesthesia (TIVA), target control infusion (TCI) and awake-tracheal-intubations during the residency. Residents have four full days of didactic neuro-anesthesia teaching every year (Figure 8), which includes basic and advanced topics moderated by neuro-anesthesiologists. Problem based learning sessions and an end of rotation examination, in addition to other workplace-based assessments, are carried out. The neuroanesthesia fellowship program, like other post-graduate fellowship programs, begins after completion of the residency program and lasts for another three years.

During their fellowship, fellows receive advanced training in the management of of neuroanesthesia cases, as well as increased experience neuroanesthesia cases, as well as increased experience with general cases.

Teaching Activity

Figure 8: Teaching Activity in Progress

The Department of Anesthesiology, Perioperative Medicine and Critical Care is committed to continuous medical education. An ACGME-I retreat is held for new trainees and faculty members twice a year, to update them about the ACGME-I program. Residents have regular dedicated didactic sessions, in addition to morning rounds, morbidity and mortality specialty rounds and trainee presentations.

The Itqan Clinical Simulation and Innovation Center

The Itqan Clinical Simulation and Innovation Center (Figure 9) is a newly constructed state of the art clinical simulation center. Occupying around 12,000 square meters of space, it is one of the largest such facilities in the world. The center contains an animal operating suite, skill stations and advanced training mannequins. The facility allows trainees, as well as trained physicians, to practice specific diagnostic and therapeutic skills and interventions in a simulated controlled environment.

Simulation Center

Figure 9: Simulation Center

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