Neurosurgical Anesthesia Rotation

Albany Medical Center is home to a busy neurosurgical practice with several well-established Neurosurgeons that are dedicated to advancing academia and patient care.

Our residents are exposed to a diverse caseload representing an extensive variety of pathology and specialty cases. We owe this to being the only level one trauma center in the Capital Region and having the largest catchment area of patients by any hospital within 150 miles. Our residents become well-versed with the anesthetic management of emergent craniotomies, spinal trauma, and cerebral endovascular procedures. We also commonly care for patients with other intracranial problems from tumors, vascular anomalies, and epilepsy, to movement disorders in all age groups. We also care for a substantial number of spinal patients using the latest technology in SSEP and Motor-Evoked Potential monitoring.

At the end of our first month rotation, there is a boards-like oral examination with Dr. Trickey, the head of Neurosurgical Anesthesia. After our second month we are expected to give a presentation on a topic of our choice related to Neuro-anesthesia.

What's A Day like in the Life of a Neuro-anesthesia Resident?

"A typical day actually starts on prior afternoon  as I investigate the scheduled cases and discuss relevant information with my attending, usually Dr. Trickey. This involves the patient history and nature of the surgery as well as any special monitoring and patient positioning that may be required. The following morning I arrive at 6:30 and double check the schedule to make sure there aren't any emergency procedures or other changes. If not, my routine is to check my anesthesia machine, draw up the appropriate medications and set up any vascular access  or airway equipment that I'll need all the while as I hum the tune I heard on the radio coming in to work. At this point in our training the setup becomes second nature, or "cerebellar" as I like to call it. I'll then confirm monitoring and positioning with the OR nurse before I grab my stethoscope, meet up with my attending, and go see the patient in the pre-op area…usually by 7:00.  My first patient is a healthy, young woman with an arachnoid cyst pressing on her brainstem. After spending 20 minutes going over her medical history, obtaining consents and answering her questions, we head back to the OR. She is intubated, receives a radial arterial catheter for blood pressure monitoring, and then placed prone so that the neurosurgeon can guide an endoscope to the cyst and remove it. Throughout the operation, my attending evaluates my performance and we discuss topics appropriate to this case. The surgery is completed with only two brief episodes of iatrogenic Cushings' reflex--two more than I care to see for the day. The patient is extubated and brought to the post anesthesia care unit. My next patient is a middle-aged man with a cortical tumor. He will be placed in a lateral position with his head in pins. The neurosurgeon is planning to use neuronavigation and 3-dimensional mapping to locate and excise the tumor. It is a pretty normal day so far, that is, until an emergent subarachnoid bleed sneaks in to the schedule.

Working at a center with a busy neurosurgical practice provides plenty of opportunities to care for patients with unique neurosurgical pathologies as well as seemingly routine back surgeries and an occasional emergency. As I alluded to earlier, we have designated operating rooms which are fully equipped with state-of-the-art equipment. Neurosurgery patients are assigned to a special 24-bed neuroscience inpatient area. They also benefit from a designated Spinal Cord Injury Unit and nearby rehabilitation facilities. Younger patients also have access to dedicated Pediatric and Neonatal Intensive Care Units.  In addition, there is an acute stroke program with a dedicated 8 bed stroke unit. All of this provides for excellent patient outcomes and a one-of-a kind learning experience for our residents."

Duane Ellsworth, DO
Anesthesiology Resident