University of Illinois Neuroanesthesia Fellowship

The Department of Anesthesiology at the University of Illinois sponsors a fellowship for anesthesia residents who have completed their residency and desire specialized training in neuroanesthesia.  This training includes several components.

Neuroanesthesiolgy Fellowship Curriculum

Goal and Objectives

Clinical Neuroanesthesia

1. The fellow should be competent in the preanesthetic evaluation including basic neurological examination and seek appropriate consultation in particular the cardiovascular- pulmonary system for optimization of complex medical conditions in patients ASA III and IV undergoing neurosurgical procedures.

2. The fellow should develop technical skills set and advance anesthetic plan required in perioperative management in neurosurgical patients, including recognizing instability of cervical spine and management for advance airway management needed for neurological assessment after intubation, ultrasound guided central line placement either subclavian, internal jugular and femoral vein approach, ultrasound guided arterial line placements, rapid infusion catheter and scalp block.

3. The fellow will develop the management plan for increase intracranial pressure, adequacy of cerebral perfusion pressure using the appropriate physiologic, pharmacologic and positioning technique. Recognize and prevent complications associated with positioning such as venous air embolism. Recognize and develop an anesthetic plan for procedures that require neurophysiology monitoring, or anesthetic management for deep brain/spinal stimulator trail and placement.

4. The fellow will develop anesthetic plan suitable for awake craniotomy, and execute a rapid emergence plan after craniotomies both supratentorial and intratentorial lesions. Recognize the unmasks focal neurologic dysfunction in neurological patients with history of previous stroke and prioritize the plan to manage unexpected prolong emergence after neurological procedure.

5. The fellow will be able to manage spinal and ventriculostomy drains we well as intracranial pressure (ICP) monitors.

6. The fellow will recognize and manage intraoperative hemodynamic management including the volume resuscitation and blood products infusion in complex degenerative multilevel spine surgery.

Neurointensive Care

1. The fellow should recognize and develop management plan for intracranial hypertension, using appropriate neuromonitoring such as EEG, NIRS and ICP monitoring.

2. The fellow will effectively manage patients with ischemic and hemorrhagic strokes using appropriate diagnostic neurologic imaging modalities, endovascular intervention, pharmacological and physiological intervention.

3. Manage and optimized patients with acutely deterioration of mental status in intensive care unit, prior to surgical intervention and post surgically. Recognize the cerebral vasospasm sign, symptoms and interpret the diagnostic tools for such conditions and prompt management for poor cerebral perfusion or hyperemia bleeding.

4. Provide the mechanical ventilation management and plan for weaning in intensive care unit. Optimize and treat complications associated with hospitalization such as pneumonia, ARDE, UTI, electrolyte abnormalities and cardiac ischemia. Work in collaboration with Neurointensivist and Neurosurgeons.

5. Evaluate and manage postoperative plan and implement the analgesic plan tailor to limitation of neurological status and the need for neurological assessment.

6. Actively involves in multidisciplinary consultations and family greeting and discussion of severe neurological outcome, brain death and end of life care.

Neuroradiology/Endovacular Care

1. The fellow can identify the indications for interventional neuroradiology procedures in patients with acute ischemic stroke or hemorrhagic stroke such as intravenous or intra-arterial tissue plasminogen activator administration and mechanical thrombolysis.

2. The fellow can identify the indication for endovascular intervention for aneurysm such as elective embolization, pipeline stenting, AVM endovascular treatment. Identify indication for emergent cerebral angiography in a patient with suspected cerebral vasospasm

3. Mange basic technical issues in arterial access such as sheath placement, manage anticoagulation( and reversal ) in patients undergoing interventional procedure, recognize and manage complication associated with interventional procedures such as hematoma, retroperitoneal bleeding.

4. Fellow will be able to read basic CT scan and MRI/MRA imaging for brain and spinal cord as well as a cerebral angiogram effectively.

Intraoperative monitoring

1. The fellow will develop understanding the indications, limitation and describe the appropriate neuromonitoring ( MEP, SSEP, BAER, Visual evoke potentials, EMG, EEG, cranial nerve and peripheral nerve monitoring, trancranial doppler) for plan procedure.

2. The fellow will understand technical issue involved in neuromonitoring, able to place leads, set up the monitor apparatus, interpret data/signal correctly and troubleshooting the equipment failure.

3. The fellow will be able to response and develop plan appropriately to change in neuromonitoring signals, effects of ischemic changes and surgical manipulation on neuromonitoring.

4. The fellow will understand the anesthetic effects and physiologic effects on neurmonitoring (evoke potentials, EEG, EMG). Understand the principles of near-infrared spectroscopy(NIRS) and Jugular venous bulb oximetry.

Neuroscience Scholarship

The fellow will develop the skill scholarship activity with the mentor faculty that is not only subject to only one of these activities.

1. The fellow will be able to design or conduct a new clinical investigation or the continue the ongoing research project within the division related to neuroanesthesiology, neurocritical care or a related discipline. The fellow will understand the role of Institutional review Board in the studies and maintenance of ethical standard.

2. The fellow will assist with a review article, book chapter, case report/series, a data base project or safety/quality improvement projects including the preparation for the manuscript.

3. The fellow will gain an experience in oral presentation and submit work for publication. The fellow is expect to submit the abstracts for a presentation at the national/international meeting.

4. The fellow will gain an experience in judging scholar works from such as abstracts, articles submitted for review (editorial). The fellow will be able to critical review the published/unpublished studies, understand study designs and statistical method .

Educational Activities schedule

1. Neuroanesthesia conferences Monday and Tuesday 630-700 am with faculty and residents

2. Fellow journal club once a month, in addition to journal club with resident. The journal club for the fellow will be from the SNACC article of the month

3. Neurosurgery M&M once a month (with neurosurgery department)

4. Neurological Discussion with program director/faculty once a month ( activity will be assigned one month in advance)

5. Fellow is responsible to teach 2 topics/month to anesthesia residents rotate in neurosurgery. The fellow will be evaluated by residents at the end of the block regarding, clinical skill, interpersonal skills and knowledgebase.