Neuroanesthesia Curriculum

1. Clinical Neuroanesthesia

a. Anesthesia for:

i. Craniotomy (including awake techniques)

1. Tumor surgery

2. Epilepsy Surgery

3. Supra vs. Infra-tentorial surgery

ii. Cerebrovascular Surgery

iii. Endovascular Neurosurgery

1. Acute ischemic stroke

2. Aneurysm, AVM’s, Atherosclerotic disease

iv. Neurotrauma

1. Craniectomy

2. Hematoma evacuation

3. Spine injury

v. Endoscopic neurosurgery

vi. Functional/stereotactic neurosurgery (neurostimulators)

vii. Pediatric neurosurgery

viii. Spine Surgery

b. Positioning

c. Air Embolism

2. Neurocritical Care

a. Blood pressure management

b. Intracranial pressure management

c. Sodium disorders

d. Seizures & status epilepticus

e. Stroke (Ischemic, Hemorrhagic, Subarachnoid hemorrhage)

f. Cerebral Vasospasm

g. Neurotrauma (head injury, spine trauma)

h. Brain death

3. Neuromonitoring

a. Neurophysiologic Monitoring

i. Intraoperative monitoring (IOM)

ii. Electroencephalography (EEG)

EEG is brain electrical activity recorded from scalp electrodes. EEG is commonly utilized in neurology to detect areas of epileptogenesis (seizure origination), define seizure type, and analyze sleep states. In Neurocritical Care, continuous EEG (cEEG) is used to detect ongoing seizure activity in neurologically injured patients as well as to assess brain injury, activity, and reactivity. Processed EEG signals, such as the Bispectral Index (BIS), are used in the operating room to monitor level of consciousness in an effort to prevent intraoperative awareness. In the ICU, such monitoring is used to prevent awareness in pharmacologically paralyzed patients, as well as to assist care providers in titrating sedative drugs so as to avoid oversedation. Finally, for the neuroanesthesiologist, keep in mind that brain electrical activity recorded directly from the brain surface is called ‘electrocorticography’ (ECoG) rather than EEG.

iii. Evoked Potentials (EP)

b. Cerebral Perfusion monitoring

i. Transcranial Doppler & Carotid Duplex (intro to TCD & Carotid Duplex video)

ii. Cerebral Oximetry

iii. Jugular Oximetry

c. Depth of Anesthesia Monitoring

d. Intracranial pressure monitoring

4. Neuroanatomy

a. Vascular & functional anatomy of the brain and spinal cord

b. Neuroradiology

i. CT interpretation

ii. MRI interpretation

iii. Angiography

5. Cerebral Physiology

a. Cerebral Blood Flow

b. Cerebrospinal fluid dynamics