The neuroanesthesia team provides anesthetic care for a wide array of surgical and neuroradiologic procedures, ranging from repair of trauma to the brain and spinal cord, to complex, delicate, lengthy procedures on neural tissue at the far reaches of the surgical “solar system” deep within the skull. It can be likened to space exploration on a biologic scale.
The neurosurgical faculty and their residents work intimately with our neuroanesthesia team, and provide exposure to the full breadth of neurosurgery, including procedures involving in cerebrovascular and neoplastic disease, pituitary, spine, and movement disorder, epilepsy and stereotactic surgery. Our understanding of neurosciences remains a dynamic process, and in conjunction with our surgical colleagues, this has lead to modifications and changes in the practice of neuroanesthesia and neurointensive care.
Intraoperative anesthetic management of the neurosurgical patient demands a fundamental knowledge of the physiology of the brain and spinal cord, a working knowledge of complex anatomy, and understanding the pathophysiology associated with the disease at hand.
Ultrashort-acting drugs permit our patients to wake up quickly, even after prolonged anesthetics. Complex intraoperative monitoring improves our ability to scrutinize real-time neurophysiology. The knowledge of potential problems that the patient will encounter while under our care is vast, and time-critical. Neural tissue has the least tolerance for disruption of oxygen supply. The neuroanesthesiologist has to know as much about the patient’s perioperative condition as the surgical team.
The neurosurgical service continues to provide a forum of opportunity for anesthetic management of complex intra- and extra-cranial neurosurgical procedures. Our patients continue to arrive to the operating room in more critical conditions, and the procedures required are more complex
Because of the explosive pace of developments in neuroscience, the curriculum for the neuroanesthesia rotation is adjusted annually. The entire faculty contributes greatly to the effort of ensuring that our residents have state-of-the-art information in hand. This focus on education and training translates into patients receiving the most current, effective care.
Residents also have the unique opportunity of interacting not only with the neurosurgical team intraoperatively but also collaborating in a multidisciplinary fashion with neuroscientists and engineers of the Dartmouth Epilepsy Program. Electrophysiologic monitoring (somatosensory and motor evoked potentials, intraoperative EEG monitoring, electromyography, and brainstem auditory evoked potentials) are frequently and straightforwardly used. The addition of the Center for Surgical Innovation, a state-of-the art operating suite which can provide real-time MRI and CT intraoperatively, has added to the complexity and level of patient care in the intraoperative arena. In this way, residents gain the appreciation for assessment of the functional status of the nervous system during altered states of consciousness.
It is this combination of dynamic, innovative teachers, broad clinical exposure, and access to the most current scientific literature that continues to propel our anesthesia program to national recognition.
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