We extend a warm welcome to our anesthesia colleagues who are interested in a career in Neuro-anesthesia.
The neuroanesthesia fellowship at VGH/UBC has been successful for a number of years. It has been carefully developed over this time to tailor the experience to each individual fellows needs and in order to maximize the fellow’s experience. It is the first Neuroanesthesia Fellowship in Canada to achieve ICPNT accreditation.
This is a 12 month program dedicated to subspecialty training gaining experience in the following areas:
• Interventional neuroradiology
• Neurosurgical/spinal/neurological critical care
• Intraoperative monitoring
• Research and academic activities
Neuroanesthesia Fellows are expected to:
- Become an expert in clinical anesthesia in this subspecialty
- Preoperative, intraoperative and postoperative management within the speciality of neuro-anesthesia.
- Learn to read basic CT, MRI/MRA imaging, cerebral angiography for brain and spinal cord.
- Preoperative assessment and perioperative management of the neurosurgical patient.
- Be an independent and excellent clinician.
- Undertake one research project within the specialty
- Present their work at a national meeting.
- Present at Grand Rounds
- Organise Neuroanesthesia rounds
- Learn the fundamentals of conducting basic clinical research.
- Teach residents, medical students, paramedics, repiratory therapists and nursing staff.
The fellow will be assigned to roughly 50% intracranial surgery and 50% spinal surgery over a period of 8 months. Whilst completing the Neuroanesthesia module the fellow will be supervised by a clinician who has completed a fellowship and has extensive experience in this field allowing for continuous assessment, discussion and feedback.
Neuroanesthesia procedures for which fellows will provide anesthesia care include:
- Craniotomy for tumor resection
- Craniotomy for intracranial vascular lesions, including intracranial aneurysms and arteriovenous malformations
- Suboccipital craniotomies
- Awake craniotomy for Essential tremor.
- DBS placement for Parkinson’s Disease
- Endoscopic fenestration of intracranial cysts
- Endoscopic Pituitary procedures
- Carotid endarterectomy
- Craniotomy for seizure focus localization or excision
- Intracranial cerebrospinal fluid shunt surgery
- Major spine surgery including instrumentation
They will be required, as a minimum to achieve:
• 50 neurosurgical procedures
o 5 awake craniotomies
o 5 craniotomies for seizure focus localization or excision
o 10 craniotomies for intracranial vascular lesions, including intracranial aneurysms and arteriovenous malformations
o 30 spine surgeries, 20 of which should include instrumentation
o 5 intracranial spinal fluid shunt procedures
Our facility offers a range of interventional neuroradiology opportunities. As an integral part of Neuro-anesthesia, the fellow will care for a variety of patients undergoing a number of procedures. These include:
• Acute stroke team involvement.
• Embolization of aneurysms
• Embolization of arteriovenous malformations
• Angiogram and therapy for patients with a “Hot” stroke
• Angioplasty intracranial vessels with stenoses.
• Carotid artery stenting
• Head and Neck AVM embolization therapy.
Patients undergoing a variety of neurosurgical and spinal operations require intraoperative monitoring through a variety of modalities. As part of the intraoperative monitoring module the fellow will work with a Neurophysiologist who will guide them in the interpretation of modalities such as EMG, SSEP, BAER and MEPs. They will also use techniques such as BIS, entropy and cerebral oximetry as part of their clinical repertoire in other domains as part of the spiral learning process.
EEG monitoring is routinely used in all carotid endarterectomies.
Neuro-intensive Care unit.
The critical care module would allow for experience in our various neuro-critical care areas including Neuro ICU, ICU and spinal ICU. The fellow will attend rounds in each designated area with supervision and assessment from experts in this area.
The fellow will learn to:
• develop a management plan for intracranial hypertension, using appropriate neuromonitoring eg. EEG, NIRS, ICP monitoring.
• effectively manage patients with ischemic and hemorrhagic strokes using appropriate diagnostic imaging modalities, endovascular intervention, pharmacological and physiological intervention.
• manage acute deterioration in mental status in neuro-icu both pre and post operatively.
• recognize and treat cerebral vasospasm, devise treatment plans for postoperative ventilation and weaning strategies in PACU and Neuro-icu.
• optimize and treat postoperative complications in collaboration with Neuro-intensivist and Neuro-surgeons.
• be involved in multidisciplinary consultations and with family discussions of fatal neurological outcome, brain death and end of life care.
Clinical and research opportunities are also available in Neuro ICU, neurophysiologic testing and blood bank.
The curriculum also provides for attendance at:
• Neuroanesthesia Journal Club
• Neurosurgical rounds
• Combined neuroscience rounds
• Anesthesia grand rounds
• Critical incident/M &M rounds.
• Visiting Professor monthly rounds.
The fellows are also encouraged to attend additional anesthesiology-related meetings. Financial support is available if presenting original work.
Research and academic activities.
Our department offers a wealth of experience and expertise in the research field. The fellow will be expected to actively participate in this area and will be assigned at least 20 days to complete their project. They will be expected to present this to the department and also at a national/international level. As part of their fellowship the fellow will also attend the fellowship bootcamp at the SNACC symposium. In addition to these projects the curriculum also provides for attendance at Neuroanesthesia Journal Club, Neurosurgical rounds, Combined Neuroscience rounds, Anesthesia grand rounds and Critical Incidents rounds.
• 2 days in neuroanesthesia,
• 2 days in general clinical anesthesia in independent practice (may be in neuroanesthesia)
• 1 academic day per week in order to prepare lectures or write manuscripts. Their research will be planned and undertaken during this time.
• This schedule will change when in different rotations.
The fellow will meet with Dr. Lennox and Dr. Dolman every 3-4 months and the Neuroanesthesia Fellowship Program Director Dr. Rieley at least once a month to review the progress being made during his or her fellowship.
A written summative evaluation is provided to the fellows and reviewed with the program directors at the end of the fellowship year.