Syllabus

Basic Education Goals 

By the end of the rotation(s) the resident should be able to demonstrate an understanding of the following concepts, clinical management strategies and underlying physiological and pharmacological principles:

1. lntraoperative emergencies in neuroanesthesia
2. Fluid management for craniotomies
3. Autoregulation in the cerebral circulation and anesthetic effects
4. lntracranial pressure: physiology, pharmacology, monitoring and management
5. Perioperative neurological examinations
6. Neurovascular anatomy
7. Neuroprotection: strategies and mechanisms
8. Mild hypothermia: technique and physiological implications
9. EEG and evoked potential monitoring
10. Anesthetic management of AVMs and aneurysms
11. Anesthetic management of the patient with elevated intracranial pressur
12. Anesthetic management for stereotactic surgery
13. Anesthetic management for patients with a seizure disorder
14. Special considerations for sitting craniotomies
15. Cardiovascular monitoring for craniotomies
16. Anesthetic considerations in Parkinson's disease
17. Positioning for craniotomies
18. lntracranial hemorrhage and vasospasm
19. mergence from anesthesia following craniotomies
20. Acute head injury
21. Anesthetic considerations for carotid endarterectomy.

Clinical Practice Objectives

1. Isointensive induction - ability to maintain MAP within 10% of OR entry levels throughout induction, intubation, line placement, and skeletal fixation
2. Respiration/ventilation - avoidance of hypercarbia with ability to maintain and control arterial CO2 at levels appropriate for current case requirements
3. Fluid management - limiting fluid input to less than 1000cc over total fluid losses while maintaining adequate tissue perfusion and urine output
4. Advanced intubation skills - demonstrate proficiency with advanced intubation techniques including awake and asleep fiberoptic laryngoscopy and trach light 
5. Subclavian central line placement - demonstrate proficiency in placing subclavian CVC, data interpretation and principles of managing complications
6. Long-line placement - demonstrating proficiency in placing antecubital CVC and ECG assisted catheter tip localization 
7. Induced hypothermia - understanding cooling and rewarming techniques as well as the physiology and anesthetic implications of mild hypothermia 
8. Air embolism - understand the techniques for detection and treatment of an air embolus 
9. Neurologic examination - demonstrate physical exam techniques appropriate for the pre and post-op neurosurgical patient
10. Patient position - ability to assess patient position for potential neuro or vascular complications