Published: 05/09/2019

Anaesthesia for neurosurgery, neuroradiology and neuro critical care

Learning outcomes:

  • Application of basic science knowledge and understanding gained in CT1 and 2 to the principles and practice of neuroanaesthesia and neuro-critical care.
  • Develop and modify the skills of administering general anaesthesia [as identified in the Introductory Curriculum and in the basic level sections entitled ‘Trauma Stabilisation’ and ‘Transfer’] to include a focus on the special difficulties presented by neurosurgery. This will include developing knowledge, skills and experience of the perioperative anaesthetic care of patients undergoing major elective and emergency surgery on the brain and spinal cord and associated bony structures as well as for neuroradiology 

Core clinical learning outcomes:

  • Deliver safe perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients undergoing non-complex elective intracranial and spinal surgery with direct supervision
  • Deliver safe perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients undergoing non-complex emergency surgery with distant supervision [e.g. insertion of V-P shunt/EVD]
  • Be an effective team member for resuscitation, stabilisation and transfer of adult patients with brain injury with distant supervision  

 NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

 

Knowledge

Competence

Description

Assessment

Methods

GMP

NA_IK_01

Recalls/describes the relevance of the anatomy of the skull, skull base, vertebral column and central nervous system to neuroanaesthetic practice [Cross ref applied sciences]

A,C,E

1

NA_IK_02

Recalls/explains the relevance of applied physiology and pathophysiology related to the central nervous system to neuroanaesthetic practice [Cross ref applied sciences]

A,C,E

1

NA_IK_03

Describes techniques for decreasing the intra-cranial pressure

A,C,E

1

NA_IK_04

Explains the indications for using neurophysiological monitoring [including EEG, evoked potentials and ICP measurement] to benefit patients requiring neurosurgery/neuro-critical care   

A,C,E

1

NA_IK_05

Recalls how drugs can impact on neurophysiological monitoring

A,C,E

1

NA_IK_06

Recalls/explains the pharmacology of drugs which act on the central nervous system [Cross ref applied basic sciences]

A,C,E

1

NA_IK_07

Explains the complications of positioning for neurosurgical procedures: prone, sitting, lateral, park bench

A,C,D,E

1,2

NA_IK_08

Demonstrates understanding of the perioperative anaesthetic management of patients for neurosurgery and neuroradiology.

This includes:

  • Preoperative assessment and optimization of patients with neurological disease
  • Induction and maintenance and reversal of anaesthesia
  • Early postoperative care including the specific areas of fluid management and the control of pain

A,C,E

1,2,3,4

NA_IK_09

Demonstrates understanding of anaesthesia for neurosurgical procedures including but not exclusively:

  • Shunt surgery
  • Evacuation of intracranial haematoma
  • Planned supratentorial and posterior fossa surgery [including vascular disease and tumours]
  • Emergency surgery for traumatic brain injury
  • Spinal column surgery

A,C,E

1,2,3,4

NA_IK_10

Discusses the principles of anaesthesia for neuroradiology including but not exclusively: 

  • Emergency and elective imaging of the central nervous system [including the principles of stereotactic surgery]
  • interventional procedures [including coiling of intracranial aneurysms]

[Cross reference anaesthesia in the non-theatre environment]

A,C,E

1,2,3,4

NA_IK_11

Explains the anaesthetic implications of pituitary disease including endocrine effects and trans-sphenoidal surgery

A,C,E

1

NA_IK_12

Describes anaesthesia for trigeminal neuralgia including thermocoagulation

A,C,E

1,3

NA_IK_13

Explains the anaesthetic implications of spinal cord trauma 

A,C,E

1,2,3

NA_IK_14

Describes how to recognize an unstable cervical spine and explains how it should be managed

A,C,D,E

1,2

NA_IK_15

Discusses the indications for postoperative ventilation

A,C,E

1,2

NA_IK_16

Explains the techniques used for recognition and management of air embolism

A,C,E

1,2

NA_IK_17

Describes the special risk associated with prion diseases during neurosurgery

A,C,E

1,2

NA_IK_18

Demonstrates understanding of the principles of anaesthesia for patients with neurological disease [including but not exclusively]:

  • Guillain-Barre
  • Myasthenia gravis
  • Myasthenic syndrome
  • Dystrophia myotonica
  • Muscular dystrophy
  • Paraplegia and long term spinal cord damage

A,C,E

1,2,3,4

NA_IK_19

Discusses the specific risks of venous thromboembolic disease in neurosurgical patients and how these are managed

A,C,E

1,2

NA_IK_20

Demonstrates understanding of the neurocritical care management of traumatic brain injury [including but not exclusively]:

  • indications for ventilation
  • recognition and management of raised ICP
  • cerebral protection strategies
  • fluid and electrolyte balance in the head injured patient
  • systemic effects of traumatic brain injury

The principles of management of acute spinal cord injury

C,E

1,2,3,4

NA_IK_21

Describes the control of status epilepticus

C,E

1

NA_IK_22

Describes the requirements for safe transfer of patients with brain injury

C,E

1,2,3

NA_IK_23

Explains the issues related to the management of organ donation in neuro-critical care [Cross reference intensive care]  

C,E

1,3,4

Skills

Competence

Description

Assessment

Methods

GMP

NA_IS_01

Demonstrates a full and focused preoperative assessment, followed by optimization, of patients presenting with neurological disease

A

1

NA_IS_02

Demonstrates understanding of the problems of obtaining consent in patients who are not competent, including those with impaired consciousness and confusion

A

1,3,4

NA_IS_03

Demonstrates provision of safe perioperative anaesthetic care for a variety of neurosurgical procedures [including but not exclusively]: 

  • elective and emergency intracranial surgery 
  • shunt surgery
  • cervical and lumbar spinal surgery

A,C

1,2,3,4

NA_IS_04

Demonstrates the ability, via physiological and pharmacological manipulation, to improve intra-cranial homeostasis in pathological states

D,A

1

NA_IS_05

Demonstrates the ability to manage patients with acute head injuries for: 

  • anaesthesia for emergency neurosurgery
  • non-surgical management if indicated
  • the on-going neuro critical care

A,C

1,2,3,4

NA_IS_06

Demonstrates safe patient positioning – prone, lateral [park bench]

A,D

1,2

NA_IS_07

Demonstrates the ability to resuscitate, stabilise and transfer safely patients with brain injury

A,C,D

1,2,3,4

NA_IS_08

Shows sensitivity in giving support to patients and relatives during end of life care

A,M

2,3,4

NA_IS_09

Demonstrates ability to communicate well with the surgical team including ensuring the exchange of relevant information

A,M

2,3,4

NA_IS_10

Demonstrates the ability to select and use appropriate invasive monitoring when indicated in patients undergoing neurosurgical procedures

A,C

1,2

NA_IS_11

Demonstrates the ability to recognise and manage diabetes insipidus/SIADH

A,C

1

NA_IS_12

Demonstrates the ability to manipulate blood pressure as appropriate for the clinical situation

A,C

1

NA_IS_13

Demonstrates the ability to manage emergence from anaesthesia in a smooth and controlled way

A,D

1,2

NA_IS_14

Demonstrates the ability to manage neurosurgical patient in the immediate postoperative period

A,C,D

1,2