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Every resident has an introductory rotation in neuroanesthesia in their CA-1 year beginning as early as September. A second rotation is given during the CA-2 year and many choose to add a third elective month in their final year. Emphasis is placed on emergence-based case planning and mastery of the difficult airway. To this end, we emphasize the judicious use of opioids to provide a predictable, smooth, and rapid assessment. Case planning entails an algorithmic approach to inhalational anesthetics and neuromuscular blockers as well, with each being applied to accomplish a safe and rapid emergence.
Neuroanesthesia is an Airway Rotation in that nearly every case employs an ancillary airway device in some manner. Awake intubations are commonly performed due to a great deal of cervical pathology on the service. Our residents routinely perform more than 50 fiberoptic intubations with several dozen being accomplished awake. We utilize several other ancillary airway devices, as well, recommending heavy application in the elective setting to increase their utility in the remote, more urgent setting. Specifically, we emphasize the Lightwand and its particularly unique capabilities: (fused C-spine, blood or vomit in airway, patient on ground, poor lighting/positioning, failed DL, etc). (Please see our teaching tutorial on its application and use.) We teach all of our residents the intubating LMA for its ability to rescue ventilation remotely, as well as the other standard rigid devices like the Glidescope and the Bullard Laryngoscope. Our section also conducts an airway mannequin workshopto further develop motor memory with the aforementioned tools, and a cadaver workshop to reinforce the anatomy of gag and cough ablation with nerve blocks. The cadaver workshop also serves to introduce the residents to techniques in the management of the surgical airway. The department supports our emphasis on airway training with 19 continually used fiberoptic bronchoscopes, an ample supply of intubating LMAs and Glidescopes, and an unending supply of lightwands, LMAs and a bougie for every machine and backpack. Each of our inpatient operating rooms has a jet ventilator as well. Our commitment to airway mastery, for both awake approaches and with ancillary devices, is a major focus of our training program.
The neurosurgical service is quite busy and performs more than 1700 cases annually, to include 250 intracranial tumors, 70 intracranial aneurysm clippings, 60 carotid endarterectomies, and more than 400 spine procedures. We take teaching very seriously. Our rotation has a strong academic slant with required reading, written study guides, and continuous in-room instruction and assessment. This is conducted in both didactic and question/answer formats. Key concepts are presented from at least three directions (reading, writing, speaking, even drawing) to facilitate retention. We strive to produce a strong foundation in concept comprehension to facilitate easy certification and life-long learning. Neuroanesthesia is an organ-system specialty, and thus we manage a great variety of pathophysiology at all stages of life. Please do not hesitate to contact me should you wish to discuss any aspect of this subspecialty. I can be reached at firstname.lastname@example.org or (336)716-4498.
John E Reynolds MD, Section Head, Neuroanesthesiology.
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