Overview
The CA-3 rotation is intended to provide the resident with advanced clinical experience in the perioperative anesthetic management of adults and children undergoing neurosurgery and other neurosurgical procedures. The objective of the advanced program is to provide a foundation of competence and confidence to do complicated neurosurgical cases and to be able to act as a consultant in neuroanesthesia.

Goals and objectives
Upon completion of the rotation in neuroanesthesia the resident will be able to:
• Proper preparation for the entire spectrum of neurosurgical surgeries and procedures.
• Perform anesthesia on a variety of neurosurgical operations and other neurosurgical procedures, with emphasis on more complicated neurosurgical cases.
• Act as a consultant by communicating professionally and effectively with patients and family as well as colleagues and surgeons.
• Teach students and junior residents on aspects of neuroanesthesia.

The resident will demonstrate skill in the following six competences:
1. Patient Care
• Proper room preparation with anticipation of potential complications and utilizing appropriate equipment for elective and emergent neuroanesthesia procedures.
• Perform a skillful and compassionate preoperative interview.
• Develop an anesthetic plan based upon interpretation of laboratory results as well as the patient’s pathophysiology.
• Residents will be responsible for doing a wide spectrum of procedures as well as more complicated neurosurgical cases.
• Residents will work more independently.
• Residents will develop advanced clinical skills with monitoring techniques and line placements.
2. Medical Knowledge
Residents must demonstrate advanced knowledge about pathophysiology of neurosurgical disorders by reading, attending lectures and discussions. Residents are expected to demonstrate knowledge, including but not limited to:
• Care of the acutely unstable patient
• Cerebral aneurisms and arteriovenous malformations
• surgical considerations
• anesthesia considerations
• Occlusive cerebrovascular disease
• surgical considerations
• anesthesia considerations
• Pediatric neurosurgery
• physiology and pathophysiology
• monitoring
• temperature control
• blood, colloid and crystalloid administration
• anesthetic pharmacology
• anesthetic technique
• latex allergy and anaphylaxis
• hydrocephalus and V-P shunt
• anesthesia for brain tumors
• head and spinal cord injury
• myelomeningocele
• spinal cord detethering
• craniosynostosis surgery and cranial vault remodeling
• neurodiagnostic procedures
• Interventional neuroradiology and anesthesia for embolising and coiling of aneurisms
• Anesthesia for out of OR neuroradiological procedures
• MRI, CT-scan
• Anesthesia and surgical considerations for spine surgery
• tumor resection
• diskectomy
• laminectomy and fusion
• correction of scoliosis with instrumentation
• trauma of the spine
• Anesthesia for spine surgery
• anesthetic technique
• positioning
• monitoring
• fluid and electrolyte management and blood transfusion
• deliberate hypotension
• spinal cord protection
• complications
3. Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their perioperative care, appraise and assimilate scientific evidence and improve their perioperative care practice. Residents are expected to:
• Locate, appraise and assimilate evidence from scientific studies related to their patient’s pathophysiology.
• Use information technology to manage information and access on-line medical information in order to facilitate their self education as an adult learner.
• Facilitate the education of students, junior residents and other health care professionals.
• Apply knowledge of study designs and statistical methods to critically analyze clinical studies.
4. Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange among patients, families, surgical colleagues and operating room personnel. Residents are expected to:
• Skillfully perform a preoperative patient interview.
• Work effectively with other members of the operating room staff.
• Act as a consultant in anesthesiology in communicating effectively with colleagues, residents and surgeons, discussing perioperative concerns about a patient.
• Present interesting cases and contribute to presentations at department conferences.
• Teach students and junior residents about concepts in neuroanesthesia.
5. Professionalism
Residents must demonstrate a commitment to carrying out their professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient and staff population. Residents are expected to:
• Demonstrate sensitivity and responsiveness to patients and staff’s culture, age, gender and disabilities.
• Demonstrate an understanding of and maintain a commitment to ethical practices including confidentiality and informed consent.
• Demonstrate knowledge of ethical issues in neurosurgery such as:
• clinical decision making
• decision making for incapacitated patients
6. Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care. That includes there ability to use system resources to provide optimal care to patients. Residents are expected to:
• Demonstrate a logical process for maintaining and improving patient safety and efficiency.
• Demonstrate a rational perioperative plan to facilitate patient care in a safe and cost-containment fashion.

Resident Assessment
Residents will be evaluated by the Faculty according to the guidelines of the Clinical Competence Committee. Evaluations will also be solicited from the Neurosurgery department and neurosurgical operating room staff. Competencies will be assessed by the following:
1. Anesthesiology faculty will use their discussions with the residents to assess patient care, medical knowledge, interpersonal and communication skills and professionalism.
2. The attending will review patient charts for legibility, organization and thoroughness.
3. Evaluation of practice-based learning and improvement and systems-based practice during a specific case may be included in the resident’s portfolio, utilizing either self-assessment or the Healthcare matrix.
4. Residents will be evaluated on case presentations at department conferences and presentations at national meetings.
5. Residents will be evaluated on their ability to interact and teach students and junior residents.
6. The Neuroanesthesia subspecialty director will evaluate the resident at the end of their rotation on the six competencies as noted above. This will be based upon direct observation and feedback from other faculty members and perioperative neurosurgical staff.