Overview
During the CA-1/CA-2 year, Anesthesia Residents will spend one or two months on the Neuroanesthesia rotation. During this rotation they will provide anesthesia for neurosurgical operations, beginning with those that are more routine and as prepared begin to do more complicated neurosurgical cases. The residents will learn and understand the basic cerebral anatomy and physiology and the effects of surgical interventions and anesthetics.

Goals and objectives
Upon completion of the rotation in neuroanesthesia, the resident will be able to:
• Proper room preparation with anticipation of potential complications and utilizing appropriate equipment for elective and emergent neuroanesthesia procedures.
• Evaluate both elective and emergent neuroanesthesia patients and be able to apply physiologic, pharmacologic and pathophysiologic principles during perioperative care.
• Develop an anesthetic plan, based upon the information obtained by preoperative evaluation of the neurosurgical process, patient’s pathophysiology and co-morbid disease state.
• Application of principles and knowledge to respond appropriately to patient’s condition during the perioperative period.
• Progression of technical skills and judgment throughout the rotation.
• Effectively communicate with the patient and family about the anesthetic, risks, benefits and expected course during the perioperative period.
• Communicate effectively with health care professionals and patients in order to provide optimal care to neurosurgical patients.

The resident will demonstrate skill in the following six competences:
1. Patient Care
Residents must be able to provide patient care that is appropriate, effective and compassionate in the perioperative period. Residents will be expected to:
• Perform an appropriate history and physical examination specifically focused on patient’s neurological condition, in addition to identifying other co-morbid conditions that may effect anesthetic management.
• Interpretation of appropriate diagnostic tests to help in evaluation of the patient’s condition.
• Discuss the potential anesthetic options and risks with the patient, including his or her condition during the postoperative period.
• Provide anesthesia for neurosurgical operations, beginning with those that are more routine and as prepared begin to do more complicated neurosurgical cases.
• Perform a proper postoperative evaluation of the patient the next day.
2. Medical Knowledge
Residents must demonstrate knowledge regarding the patient’s pathophysiology, in particular cerebral implications and perioperative care. Residents are expected to gain knowledge in:
• Cerebral physiology, including but shall not be limited to:
• cerebral metabolism
• cerebral and spinal cord blood flow
• regulation of cerebral blood flow
• pathophysiology of brain injury
• cerebrospinal fluid
• blood-brain barrier and cerebral edema
• intracranial pressure and regulation
• intracranial pressure monitoring, interpretation and treatment
• The effects of various anesthetic agents on cerebral hemodynamics, including cerebral blood flow and intracranial pressure.
• effect of inhalational agents
• effect of intravenous agents
• Cerebral ischemia and strategies for brain protection
• Neurophysiologic monitoring
• effects of anesthetic agents on: SSEP, BAEP and MEP
• basic concepts of EEG monitoring
• bis monitoring
• burst suppression
• Intraoperative fluid and electrolyte management during craniotomy.
• Perioperative management of increased intracranial pressure.
• positioning, hyperventilation, drugs and surgical interventions
• Supratentorial masses
• surgical considerations
• anesthesia considerations
• Posterior fossa tumors
• surgical considerations
• anesthesia considerations
• Anesthesia for surgery of the pituitary fossa
• Anesthesia for epileptic surgery
• Anesthesia for steriotactic surgery
• Anesthesia for head trauma
3. Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their perioperative care, appraise and assimilate scientific evidence, and improve their perioperative care practice. Residents are expected to:
• Locate, appraise and assimilate evidence from scientific studies related to their patient’s pathophysiology.
• Use information technology to manage information and access on-line medical information in order to facilitate their self education as an adult learner.
• Apply knowledge of study designs and statistical methods to critically analyze clinical studies.
4. Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange with patients, families, surgical colleagues and operating room personnel. Residents are expected to:
• Skillfully perform a preoperative patient interview.
• Work effectively with other members of the operating room staff.
• Communicate appropriately with the patient, family members and colleagues.
• Present interesting cases and contribute to presentations at department conferences.
5. Professionalism
Residents must demonstrate a commitment to carrying out their professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient and staff population. Residents are expected to:
• Demonstrate sensitivity and responsiveness to patients and staff’s culture, age, gender and disabilities.
• Demonstrate an understanding of and maintain a commitment to ethical practices including confidentiality and informed consent.
6. Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care. That includes there ability to use system resources to provide optimal care to patients. Residents are expected to:
• Demonstrate a logical process for maintaining and improving patient safety and efficiency.
• Demonstrate a rational perioperative plan to facilitate patient care in a safe and cost-containment fashion.

Resident Assessment
Residents will be evaluated by the Faculty according to the guidelines of the Clinical Competence Committee. Evaluations will also be solicited from the Neurosurgery department and neurosurgical operating room staff. Competencies will be assessed by the following:
1. Anesthesiology faculty will use their discussions with the residents to assess patient care, medical knowledge, interpersonal and communication skills and professionalism.
2. The attending will review patient charts for legibility, organization and thoroughness.
3. Resident’s participation during the neuroanesthesia subspecialty conferences.
4. Evaluation of practice-based learning and improvement and systems-based practice during a specific case may be included in the residents portfolio, utilizing either self-assessment or the Healthcare matrix.
5. The Neuroanesthesia subspecialty director will evaluate the resident at the end of their rotation on the six competencies as noted above. This will be based upon direct observation and feedback from other faculty members and perioperative neurosurgical staff.