Anesthesia — Core of Discipline

C17 Providing perioperative anesthetic management for patients undergoing intracranial procedures

- This EPA includes preoperative assessment, investigation/optimization if needed, informed consent, anesthetic management, invasive monitoring if required and determination of postoperative disposition.
- A focus of this EPA is mastery of neuroprotective strategies.
- The postoperative management plan includes attention to early assessment of neurologic status, adequate management of hemodynamic parameters and optimal pain management.
- The observations of this EPA should include a large breadth of neurosurgical patients and cases and various surgical timing (e.g. scheduled, urgent or emergent surgeries).

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of neurophysiology relevant to optimal anesthetic agents choice, management of increased intracranial pressure and basic principles of neuroprotection

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during preoperative evaluation and determination of timing for surgery

• ME 2.2. Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management

• ME 2.2. Synthesize patient information to determine indications for invasive and non- invasive monitoring

• ME 2.2. Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan

• ME 3.1. Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches

• ME 3.4. Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 3.4. Optimize the patient and surgical conditions throughout the procedure, anticipating, preventing and treating complications in relation with the specific procedure

• ME 3.4. Establish and implement a plan for post-anesthesia care

• COM 1.5. Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

• COM 4.3. Obtain and document informed consent for the planned anesthetic management in a manner that engages the patients and their families using established principles of effective communication

• COL 3.2. Organize the handover of care to the most appropriate physician or health care professional

• L 1.2. Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations

• L 4.2. Assume a leadership role in managing complex cases in the OR

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Type of neurosurgical procedure: tumour; pituitary tumour; vascular intracranial surgery; functional neurosurgery; neuroradiology; other procedure
• Increased intracranial pressure: yes; no
• Timing of surgery: elective; emergency
• Collect observations from a large breadth of training experiences with the expectations not all will be achieved, with a minimum of 8 observations of achievement
• At least two patients with increased intracranial pressure