Neurosurgical Anesthesia Rotation
There is a busy neurosurgical practice at Albany Medical Center with several busy, well established Neurosurgeons.
The caseload represents a wide variety of pathology and specialty cases. Being the Capital Region's only level one trauma center, our residents become well experienced with the anesthetic management of emergent craniotomies and spinal trauma. 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 substantial number of spinal patients using the latest technology in SSEP and Motor evoked Potential monitoring.
At the end of the rotation, there is a boards-like oral examination with Dr. Trickey, the head of Neurosurgical Anesthesia.
What's A Day like in the Life of a Neuro Anesthesia Resident?
"A typical day starts at 6:30 am when I arrive to the hospital. My first task is to check the Operating Room schedule at the front desk. There I will see if there are any emergency cases currently underway in my scheduled operating room or if any changes have been made to the scheduled cases. I then acquire the appropriate medications and tools for the cases and set up the operating room. Today my first case was canceled by the neurosurgeon so I proceed to set up for the second case. While setting up I am informed that there is an emergency coming into my OR. It is a 1 year old child that was hit in the head by debris from a motor vehicle accident. I am told that the patient has a subdural hematoma and intraventricular hemorrhage. I quickly change the setup to accommodate a pediatric emergency . I am reassigned attendings and now working with a pediatric attending. We met the patient and family in the preoperative holding area obtained consent for the anesthesia and discussed the risks and benefits of the anesthesia. We brought the child to the OR and placed non-invasive monitors and performed a mask induction. After the pt was anesthetized we placed an endotrachial tube, radial artery line and intravenous line. We calculated the blood loss and her blood volume and transfused her blood. When the surgery was finished we extubated her an brought her to the recovery room. The second case of the day was an adult non-emergent scheduled evacuation of a subdural hematoma. I was reassigned to a neuroanesthesiologist. We met with the patient in the preoperative holding area and examined the patient discussed the plan with the patient and brought him back to the operating room.
We induced anesthesia intravenously and intubated the trachea, placed an arterial line and positioned the patient. Throughout the case the attending anesthesiologist would periodically discuss topics appropriate to this case.Working at a center with a busy neurosurgical practice provides plenty of opportunity to care for common and unique neurosurgical pathologies as well as plenty of emergencies. Neurosurgery patients are assigned to a special 24-bed neuroscience inpatient area. There is also a designated Spinal Cord Injury Unit and rehabilitation facilities are located near these areas. In addition, the Neurosurgical service has patients in the Pediatric and Neonatal Intensive Care Units. There are designated Neurosurgical operating rooms, which are fully equipped with state-of-the-art equipment. We have an acute stroke program with a dedicated 8 bed stroke unit."
By Dr. J.P. Ouanes
