NEUROANESTHESIA
GOALS AND OBJECTIVES
CA 2 Level
GOALS AND PRIMARY AREA OF KNOWLEDGE
As part of the consolidation of neuroanesthesia subspecialty concepts, the resident in the second
month will have become familiar with the basic elements of neuroanesthesia management during
the first month. Advanced Training in Neuroanesthesia in the second month will include steady
advancement to more difficult and complex anesthetic problems, including care of seriously ill
neurosurgical patients. At this level, neuroanesthesia will include an enhanced experience in an
understanding of the anatomy, pharmacology, physiology, pathophysiology, and specialized
issues related to the administration of anesthetics to neurosurgical patients.
ACGME CORE COMPETENCIES
Demonstrate mastery of all core competencies outlined for the first month.
COGNITIVE OBJECTIVES
1.
Demonstrate mastery of knowledge of all cognitive objectives expected of a first month
with little or no staff assistance
2.
Demonstrate mastery of knowledge of normal brain physiology; functional and special
monitoring
3.
Demonstrate mastery of knowledge of cerebral and spinal cord blood flow
4.
Demonstrate mastery of knowledge of brain oxygen consumption, metabolism, and
cerebral ischemia
5.
Demonstrate mastery of knowledge of regional ischemia and global ischemia
6.
Demonstrate mastery of knowledge cerebrospinal fluid mechanics
7.
Demonstrate mastery of knowledge of the Anesthetic effects on CSF physiology and
intracranial pressure
8.
Demonstrate mastery of knowledge of ICP monitoring and interpretation of intracranial
compliance, elastance, relationships
9.
Demonstrate mastery of knowledge relating to severe neurologic injury to include:
a)
b)
Primary and secondary injury
Edema formation
c)
d)
e)
f)
g)
Vasospasm and delayed neuronal necrosis
Multi-system effects of head injury
Spinal cord injury - acute and chronic changes
Altered consciousness and coma
Brain protection, preservation and resuscitation
SKILL OBJECTIVES
1.
Demonstrate all the “skill objectives” expected of the first month trainee
2.
Induce cerebral “protective” measures and manipulate hemodynamics based on
neurophysiological monitoring
3.
Balance the anesthetic technique to accommodate neurophysiological monitoring
4.
Demonstrate the ability to manage neuroanesthetic complications, prepare anesthetic
plans for complex neurosurgical patients including those involving sophisticated,
neurological monitoring or techniques such as deep hypothermic arrest for aneurysm
clipping
5.
Manage the anesthetic care of the complex and difficult neurosurgical patient which may
range from an infant with a brain tumor to complex AV malformation
6.
Manage anesthesia for neuroradiologic procedures in remote location anesthetic
7.
Manage anesthesia for supratentorial lesions to include rationale and positioning
8.
Demonstrate appropriate management for severe head injury to include interpretation and
therapy for ICP monitoring techniques
9.
Demonstrate appropriate management for posterior fossa procedures in the prone and
sitting position
10.
Demonstrate the ability to use:
a)
b)
precordial Doppler monitoring
right heart catheter (air aspiration)
11.
Demonstrate anesthesia management for neurovascular procedures (neuroradiology,
aneurysm and endarterectomy)
12
Demonstrate appropriate implementation and interpretation of neurophysiologic
monitoring: EEG, SSEP, BAER, MEP
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REQUIRED READING
Week 1
Newfield Chapters 6 (Head trauma), 7 (Supratentorial tumors), and 8 (Posterior
fossa), total of 42 pages including references.
Week 2
Newfield Chapters 9 (Intracranial aneurysms), 10 (Cerebral ischemia), and 11
(Neuroendocrine tumors), total of 54 pages including references.
Week 3
Newfield Chapters 4 (Cerebral protection), 12 (Epilepsy and epilepsy surgery,
etc.), and 16A (Interventional neuroradiology), total of 55 pages including
references.
Week 4
Selected reading of faculty publications.
Additional reading: Residents are encouraged to seek additional materials about specific cases.
More detailed references can be identified through the SNACC Internet Web site and other
anesthesia related Web sites. There are several resources (textbooks/journals) also available at
the department library.
EVALUATION
Final evaluation will be based upon clinical performance with a written evaluation
Rev. 7/2009
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