Every resident has an introductory rotation in Neuroanesthesia in their CA-1 year beginning as early as September. A second rotation is completed during the CA-2 year, and many choose to add a third elective month in their final year. Emphasis is placed on emergence-based case planning and mastery of the difficult airway. To this end, we emphasize the judicious use of opioids to provide a predictable, smooth and rapid assessment. Case planning involves an algorithmic approach to inhalational anesthetics and neuromuscular blockers as well, with each being applied to accomplish a safe and rapid emergence.
Neuroanesthesia is an Airway Rotation in that nearly every case employs an ancillary airway device in some manner. Awake intubations are commonly performed due to a great deal of cervical pathology on the service. Our residents routinely perform more than 50 fiberoptic intubations with at least two dozen being accomplished spontaneously ventilating ("awake"). We utilize several other ancillary airway devices as well, recommending heavy application in the elective setting to improve their utility in remote, more urgent, settings. Specifically, we emphasize the Lightwand and its particularly unique capabilities: fused C-spine, blood or vomit in airway, patient on ground, poor lighting/positioning, failed DL, etc. Please see our teaching tutorial on its application and use. We teach all of our residents the intubating LMA for its ability to rescue ventilation remotely, as well as the other standard rigid devices like the Glidescope and GMAC. Our section also conducts a cadaver workshop to reinforce the anatomy of gag and cough ablation with nerve blocks and introduce techniques in the management of the surgical airway. The department supports our emphasis on airway training with 19 continually used fiberoptic bronchoscopes, an ample supply of intubating LMAs and Glidescopes, and an unending supply of lightwands, LMAs and a bougie for every machine and backpack. Each of our inpatient operating rooms has a jet ventilator as well. Our commitment to airway mastery, for both awake approaches and with ancillary devices, is a major focus of our training program.
The neurosurgical service at Wake Forest is outstanding and performs nearly 4,000 cases annually, split between intracranial and spine procedures. We have the lowest craniotomy mortality in the UHC community. We take teaching very seriously. Our rotation has a strong educational slant with required reading, written study guides and continuous in-room instruction. This is conducted in didactic and question/answer formats. Key concepts are presented from multiple directions (reading, writing, speaking, even drawing) to facilitate retention. We strive to produce a strong foundation in concept comprehension to facilitate easy board certification and life-long learning. As an organ-system specialty, we get to manage a great variety of pathophysiology at all stages of life. Please do not hesitate to contact me should you wish to discuss any aspect of our subspecialty. I can be reached at jereynol@wakehealth.edu or 336-716-4498.
John E Reynolds MD, Section Head, Neuroanesthesiology.