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Elective neuroanaesthesia for highly specialised procedures that have limited case numbers, e.g. craniofacial procedures, awake neurosurgery, and deep brain stimulation, should be provided by a dedicated subgroup of neuroanaesthetists within the department to ensure that they are able to treat sufficient numbers in order to maintain their competence in these areas.
The use of simulation training for critical incident scenarios should be available to all members of the multidisciplinary team. Examples include CPR of patients not in the supine position, patients with their head pinned, or if anaesthesia is being provided in an isolated site.27
As trainees spend limited time in the specialty, departments should facilitate the delivery of structured training programmes, developed by the school of anaesthesia, to ensure all core topics are covered. To ensure that their time in neuroanaesthesia is of maximum benefit, departments might consider allowing the trainees some flexibility in list attachments so once case mix is known, they can...
Trainees should be encouraged to attend other training opportunities within the neuroscience unit, such as grand rounds, radiology and pathology case conferences, and mortality and morbidity meetings.
Fellowship posts should be identified to allow additional training for those who wish to follow a career in neuroanaesthesia or neurocritical care. These should be suitable for trainees who wish to take time out of training programmes, or for those who are post CCT. Such posts should provide similar or enhanced levels of teaching, training and access to study leave...
Communication with critical care should occur at the earliest possible time (preoperative clinic letter) to enhance the appropriate allocation of beds.
In exceptional circumstances, anaesthetists working singlehandedly may be called on briefly to assist with or perform a life saving procedure nearby. This is a matter for individual judgement and the dedicated anaesthetic assistant should be present to monitor the unattended patient.4
Standardisation of the handover process can improve patient care by ensuring information completeness, accuracy and efficiency.10,41 The use of perioperative care bundles should be considered.42
The 24/7 acute pain service should be available for postoperative neurosurgical patients and be trained to address the specific needs of neurosurgical patients such as those with impaired communication.43
Pain is a useful outcome measure for audit.44,45 The utility of specific local and regional techniques for neurosurgical patients is established and pain teams should be aware of these.43,46
