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Halfway Done With Neuroanesthesia As A CA-3

It’s the middle of the month, the Texans got royally owned by the Patriots in the divisional playoff game last night, I submitted my hospital credentialing for fellowship this morning, and I’m so far behind聽with ITE studying… but I’m still going to reflect on my聽neuroanesthesia rotation has been thus far. 馃榾

Carotid aneurysm embolization and nicardipine vial

I’m working with a large聽private practice anesthesia group in the area, and often times, just the chief neurosurgery resident and attendings are performing the procedures together. Although cases can be complex, they’re also shorter in more experienced hands.

In the first two weeks, my case load has probably been 80% brain (craniotomies for tumor resections, neurovascular embolization, open vascular procedures) and 20% spine (laminectomies, anterior cervical discectomy and fusion). Many of these cases also utilize neuromonitoring like electromyography (EMG) and somatosensory evoked potentials (SSEP) which can considerably alter my anesthetic.

Transitioning from pediatric cases last month to adult neuro cases this month in operating rooms I’ve never worked in took a few days of adjustment, but at this point, I’m pretty comfortable… especially with聽all of the autonomy. As a CA-3, it’s important that I can manage these cases with minimal supervision and facilitate rapid turnover while maintaining patient safety.

Because I don’t have any “call shifts” during the week, I聽have neuro cases every single day. Although this is awesome (and why I’m here), it can be exhausting! Neuro cases can take a while to set up, and unlike most cardiac cases, these patients will almost always be extubated at the end of the surgery. To a large degree, I’m using this rotation to work on timing – fast turnover, quick emergences, induction of anesthesia followed by rapid line placement and positioning, etc.

So far, so good! 馃檪

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