Neurosurgical anesthesia

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Neurosurgical anesthesia
Occupation
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, Clinics

Neurosurgical anesthesiology, [1] neuroanesthesiology, or neurological anesthesiology [2] is a subspecialty of anesthesiology devoted to the total perioperative care of patients before, during, and after neurological surgeries, including surgeries of the central (CNS) and peripheral nervous systems (PNS). The field has undergone extensive development since the 1960s correlating with the ability to measure intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate (CMR). [3] [ page needed ] [4]

Contents

History

In 1961, a working group, the Commission on Neuroanesthesia, was created sponsored by the World Federation of Neurology. [4] The first textbook on neuroanesthesiology was published in 1964 by Andrew R. Hunter from Manchester, UK, which promoted the founding of the field. [5] [4] In 1965, Hunter and Dr. Allan Brown of Edinborough founded the Neuroanesthesia Traveling Club of Great Britain and Ireland. The first American organization for neuroanesthesiology met on June 15, 1973, in Philadelphia, PA and was named the Neurosurgical Anesthesia Society (NAS). It consisted of 36 anesthesiologists, including Maurice Albin, and 4 neurosurgeons, including Thomas W. Langfitt. It was renamed the Society of Neurosurgical Anesthesia and Neurological Supportive Care (SNANSC) in October, 1973, and finally the Society of Neurosurgical Anesthesia and Critical Care (SNACC) in 1986.

Practice

Neurosurgical anesthesiologists specialize in the care of patients with diverse conditions including but not limited to aneurysms, arteriovenous malformations, intracranial tumors, intractable epilepsy, head injuries, stereotactic procedures, neuroradiological procedures, pediatric neurosurgery and spine surgery.[ citation needed ]

Pediatric Deep Brain Stimulation surgery Peds DBS.jpg
Pediatric Deep Brain Stimulation surgery

In addition to standard anesthesthetic management of patients undergoing surgery, neurosurgical procedures require the anesthesiologist to have a strong knowledge base of neuroanatomy, neurophysiology, and understand advanced monitoring techniques including neuromonitoring of the brain and spinal cord. It is impossible to routinely "monitor" the effects of drugs on CBF (cerebral blood flow), CMR, or ICP (intra-cranial pressure) as there is no neuroanesthetic equivalent of the pulmonary artery catheter or the transesophageal echocardiograph that permits a wide range of cerebral physiologic and pharmacologic effects to be followed easily. [6] [ page needed ]

Tumor resection surgery from posterior fossa Sitting craniotomy.jpg
Tumor resection surgery from posterior fossa

Training

After satisfactory completion of Accreditation Council for Graduate Medical Education (ACGME) accredited residency program in anesthesiology formal advanced training in Neurosurgical Anesthesia is available as a 1 or 2 -year fellowship integrating research, teaching and clinical experience. Although fellowships differ slightly at various institutions, they generally involve the fellow in participating in 12–24 months of research (either clinical or basic sciences), participation in advanced cases in the neurosurgical O.R.s and interventional radiology suites, and develop experience in performance and interpretation of neuromonitoring. Neurosurgical anesthesia fellows may also rotate in neurosurgical intensive care unit and gain experience with transcranial doppler, basic EEG interpretation and Licox/Microdialysis interpretation. Some institutions also allow the fellow to participate in education and teaching efforts for neurosurgical departments in developing countries. [7] [8] [9] [10] [11] [12]

In 2021, the Association of University Anesthesiologists (AUA) announced the development of a new international curriculum for standardized neuroanesthesiology fellowship training developed in partnership with SNACC and accredited by the International Council on Perioperative Neuroscience Training (ICPNT). [13] [14]

Controversy surrounding fellowship accreditation

Despite its more than 60-year history, there are no ACGME-accredited or American Board of Medical Specialties (ABMS)-accredited neuroanesthesiology fellowships, as of 2021. [15] There has been widespread debate in medical societies and the peer-reviewed literature concerning the need for formal subspecialty training for anesthesiologists who staff neurosurgical cases. [16] [17]

Notable Physicians

Related Research Articles

<span class="mw-page-title-main">Neurosurgery</span> Medical specialty of disorders which affect any portion of the nervous system

Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.

<span class="mw-page-title-main">Anesthesiology</span> Medical specialty concerned with anesthesia and perioperative care

Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist, anaesthesiologist, or anaesthetist, depending on the country. In some countries the terms are synonymous, while in other countries they refer to different positions and anesthetist is only used for non-physicians, such as nurse anesthetists.

The American Society of Anesthesiologists (ASA) is an educational, research and scientific association of physicians organized to raise the standards of the medical practice of anesthesiology and to improve patient care.

The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are:

  1. Healthy person.
  2. Mild systemic disease.
  3. Severe systemic disease.
  4. Severe systemic disease that is a constant threat to life.
  5. A moribund person who is not expected to survive without the operation.
  6. A declared brain-dead person whose organs are being removed for donor purposes.

In the United States, anesthesia can be administered by physician anesthesiologists, an anesthesiologist assistant, or nurse anesthetist.

Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.

Geriatric anesthesia is the branch of medicine that studies anesthesia approach in elderly.

Certified anesthesiologist assistants (CAAs) are highly trained master’s degree level non-physician anesthesia care providers. CAAs are integral members of the anesthesia care team as described by the American Society of Anesthesiologists (ASA). This designation must be disambiguated from the Certified Clinical Anesthesia Assistant (CCAA) designation conferred by the Canadian Society of Respiratory Therapists. All CAAs possess a baccalaureate degree, and complete an intensive didactic and clinical program at a postgraduate level. CAAs are trained in the delivery and maintenance of all types of anesthesia care as well as advanced patient monitoring techniques. The goal of CAA education is to guide the transformation of student applicants into competent clinicians.

The following outline is provided as an overview of and topical guide to anesthesia:

<span class="mw-page-title-main">Sean Mackey (physician)</span>

Sean C. Mackey is an American scientist, anesthesiologist and pain medicine specialist. Since 2012, he has served as the Redlich Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosciences and Neurology at Stanford University. He has been the Chief of the Division of Pain Medicine since 2007 and the Director and Founder of the Systems Neuroscience and Pain Laboratory (SNAPL) since 2002. Previously, he practiced anesthesiology and co-founded Stanford's regional anesthesia program in 2000.

Awake craniotomy is a neurosurgical technique and type of craniotomy that allows a surgeon to remove a brain tumor while the patient is awake to avoid brain damage. During the surgery, the neurosurgeon performs cortical mapping to identify vital areas, called the "eloquent brain", that should not be disturbed while removing the tumor.

<span class="mw-page-title-main">Kelly McQueen</span> American anesthesiologist and global health expert

Kathryn Ann Kelly "Kelly" McQueen is an American anesthesiologist and global health expert. She currently practices anesthesiology at the UW Health University Hospital in Madison, Wisconsin and serves as the chair for the Department of Anesthesiology at the University of Wisconsin School of Medicine and Public health.

Mervyn Maze, MD, MB ChB has been a Professor in the Departments of Anesthesia and Pain Medicine, Intensive Care at the University of California, San Francisco since 1988. He has also served as Professor and Chair at Imperial College London.

<span class="mw-page-title-main">Warren Zapol</span> American anesthesiologist (1942–2021)

Warren M. Zapol was the emeritus Anesthetist-in-Chief at Massachusetts General Hospital (1994-2008) and the Reginald Jenney Distinguished Professor of Anaesthesia at Harvard Medical School. From 1994 to 2008, Zapol served as anesthetist-in-chief at MGH and was the director of the MGH Anesthesia Center for Critical Care Research until his death.

<span class="mw-page-title-main">B. K. Misra</span> Neurosurgeon

Dr. Basant Kumar Misra is a neurosurgeon specialising in treating brain, spine, cerebrovascular and peripheral nervous system disorders, injuries, pathologies and malformations. He is the Vice-President of the World Federation of Neurosurgical Societies, and the former President of the Asian Australasian Society of Neurological Surgeons, and the Neurological Society of India. He is a recipient of Dr. B. C. Roy Award, the highest medical honour in India.

James Edward Cottrell is the Chair Emeritus, Department of Anesthesiology at SUNY Downstate Medical Center in New York City. He serves as a member of the New York State Board of Regents and is an avid collector of contemporary fine-art.

<span class="mw-page-title-main">Alex Bekker</span> Physician, author and academic

Alex Bekker is a physician, author and academic. He is a professor and chair at the Department of Anesthesiology, Rutgers New Jersey Medical School. He is also professor at the Department of Physiology, Pharmacology & Neurosciences. He serves as the Chief of Anesthesiology Service at the University Hospital in Newark.

George Alexander Mashour is an American anesthesiologist.

Global neurosurgery is a field at the intersection of public health and clinical neurosurgery. It aims to expand provision of improved and equitable neurosurgical care globally.

<span class="mw-page-title-main">Talmage Egan</span> American academic

Talmage D. Egan is an anesthesiologist, academic, entrepreneur, and author. He is a professor and chair in the department of anesthesiology, and an adjunct professor in the departments of pharmaceutics, bioengineering, and neurosurgery at the University of Utah School of Medicine.

References

  1. "UpToDate". www.uptodate.com. Retrieved 2022-05-03.
  2. Freund, Felix G. (1965-08-02). "Neurological Anaesthesia". JAMA. 193 (5): 407. doi:10.1001/jama.1965.03090050083047. ISSN   0098-7484.
  3. Longnecker DE, Brown DL, Newman MF, Zapol WM, eds. (2008). Anesthesiology. Mcgraw-Hill.
  4. 1 2 3 4 5 6 Albin, Maurice S. (October 1997). "CELEBRATING SILVER: The Genesis of a Neuroanesthesiology Society NAS → SNANSC → SNACC". Journal of Neurosurgical Anesthesiology. 9 (4): 296–307. doi:10.1097/00008506-199710000-00002. ISSN   0898-4921.
  5. "History of SNACC" . Retrieved 2022-05-03.
  6. Todd MM, Warner DS, Maktabi MA, Vagnerova K (2008). "Neuroanesthesia". Anesthesiology. New York: Mcgraw-Hill. pp. 1081–1139.
  7. "Neurosurgical Anesthesia". Department of Anesthesiology, Perioperative and Pain Medicine (in Samoan). Retrieved 2022-03-27.
  8. "Neurosurgical Anesthesiology Fellowship". www.feinberg.northwestern.edu. Retrieved 2022-03-27.
  9. Keith C. "Neurosurgical Anesthesiology Fellowship". Duke Anesthesiology. Retrieved 2022-03-27.
  10. "Anaesthesia for neurosurgery, neuroradiology and neuro critical care | The Royal College of Anaesthetists". rcoa.ac.uk. Retrieved 2022-03-27.
  11. Mashour GA, Avitsian R, Lauer KK, Soriano SG, Sharma D, Koht A, Crosby G (January 2013). "Neuroanesthesiology fellowship training: curricular guidelines from the Society for Neuroscience in Anesthesiology and Critical Care". Journal of Neurosurgical Anesthesiology. 25 (1): 1–7. doi: 10.1097/ANA.0b013e3182785d5d . PMID   23171854. S2CID   28454552.
  12. Rajan S, Bustillo M, Lee C, Kofke WA (2021-12-01). "Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward". Current Anesthesiology Reports. 11 (4): 467–476. doi:10.1007/s40140-021-00477-y. PMC   8546382 . PMID   34720755.
  13. "ICPNT Accredited Programs - ICPNT". icpnt.org. 2022-03-02. Retrieved 2022-05-03.
  14. "New Accreditation Process for Neuroanesthesiology Fellowships". Association of University Anesthesiologists. Retrieved 2022-05-03.
  15. "Frequently Asked Questions: Anesthesiology Review Committee for Anesthesiology ACGME" (PDF). acgme.org. April 2021. Retrieved May 3, 2022.
  16. Ma, Alfred C; Siddiqi, Javed; Ninan, David (2020). "Value of Neuroanesthesiology Fellowship Training". Cureus. 12 (10): e10943. doi: 10.7759/cureus.10943 . ISSN   2168-8184. PMC   7661010 . PMID   33200057.
  17. 1 2 Ghaly, Ramsis F. (2014-05-23). "Do neurosurgeons need Neuroanesthesiologists? Should every neurosurgical case be done by a Neuroanesthesiologist?". Surgical Neurology International. 5: 76. doi: 10.4103/2152-7806.133106 . ISSN   2229-5097. PMC   4061581 . PMID   24949219.