2021 Curriculum learning syllabus: stage 3 special interest areas

Published: 25/02/2021

Anaesthesia for Neurosurgery

Provides safe perioperative anaesthetic care for a wide variety of complex neurosurgical and neuroradiological procedures independently
Is capable of leading the delivery of care in this area of anaesthetic practice, to the benefit of both patients and the organisation

A	Deliver safe perioperative care to adults requiring elective intracranial surgery both supratentorial and infratentorial including craniotomies for vascular lesions, pituitary surgery
B	Delivers safe peri-operative anaesthetic care to adults for emergency intracranial surgery, CSF diversions, spinal surgery and endovascular thrombectomy
C	Deliver safe perioperative care to adults requiring complex spinal surgery
D	Describes and implements an anaesthetic plan for the complex endocrine and electrolyte disorders that accompany intracranial pathology
E	Analyses the risks and benefits of available anaesthetic techniques for differing neuroscience procedures including TIVA, processed EEG, neurophysiological monitoring, awake testing, and the implications of patient positioning
F	Delivers safe anaesthetic care for neuro-radiological investigations and interventions such as coiling, embolisation and endovascular thrombectomy

Experience and logbook:

preoperative clinic experience and the assessment and optimisation of patients presenting for elective neurosurgical procedures
a wide range of elective cases, which may include simple and complex spinal procedures, neurovascular procedures (surgical and interventional neuro-radiological), other neuroimaging eg MRI, trans-sphenoidal cases, neuro-oncology, functional neurosurgery, paediatric neurosurgery and may include awake craniotomies
Perioperative management of emergency neurosurgical presentations which may include decompressive craniectomy, emergency craniotomies, CSF diversion procedures, emergency spinal surgery, urgent neuro-radiological procedures such as aneurysm coiling or mechanical thrombectomy, and management of the patient with traumatic brain or spinal injury
experience may also include neuro-critical care, and the resuscitation and transfer of patients with neurological injury or pathology.

management of any of the above cases
effective list management of an elective or emergency neurosurgical or neuroradiology session
pre-operative assessment and optimisation of patients with complex neurological needs, for example patients with movement disorders, complex epilepsy, endocrine sequelae of pituitary disease, or with medical comorbidities, which may complicate neurosurgery eg conditions requiring anticoagulation
appreciation of the balance between risks and benefits of neurosurgery and anaesthesia in complex or frail patients and ability to work with patients, their families and multidisciplinary colleagues to plan best care
ability to safely position patients in a variety of positions for surgery and with different equipment, eg prone or park bench positioning, use of Allan table or stereotactic or robotic head-frames
advanced airway management skills relevant to neuro-anaesthesia eg awake intubation techniques, video-laryngoscopy
ability to adapt anaesthetic technique to facilitate neurophysiological monitoring, eg TIVA anaesthesia and intraoperative neuro-monitoring, awake cranial procedures, intra-operative EEG monitoring.

national and international meetings related to neuro-anaesthesia
presentation at relevant meeting eg abstract or free paper
development of neuro-anaesthetic or neuro-critical care guidelines and policies
leadership of QI projects related to neuro-anaesthesia
attendance at neurosurgical or neuro-radiological MDT meetings
eLearning relevant to neuro-anaesthesia and neurological conditions
sessions with radiology learning interpretation of neuroimaging
participation and leadership in local/regional/national neuro-anaesthesia teaching
simulation in neuro-anaesthesia and related emergencies.

4 - should be able to manage independently with no supervisor involvement (although should inform consultant supervisor as appropriate to local protocols).