Neuroanaesthesia and intensive care

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“Trainees should gain an understanding of the principles of neuroanaesthesia and the associated neuro-critical care in order to manage, with safety, patients for routine operations on the brain and spinal cord. For patients with head injury, trainees should be able to manage their resuscitation, stabilisation and transfer”.

1. Safe patient positioning for neurosurgery – sitting, prone, park-bench (lateral)
2. Principles of anaesthesia for craniotomy, to include vascular disease, cerebral tumours and posterior fossa lesions
3. Anaesthetic implications of trans-sphenoidal surgery
4. Perioperative management of interventional neuroradiological procedures
5. Anaesthesia for spinal column surgery and anaesthetic implications of spinal cord trauma
6. Principles of immediate postoperative management including pain relief and special considerations with narcotics
7. Principles of thymectomy for myasthenia gravis
8. Principles of neurological monitoring
9. Management of raised intracranial pressure and manipulation of cerebral perfusion pressure
10. Cerebral protection and prevention of cerebral ischaemia
11. Principles of the management of head injury
    1. Mechanisms and effects of raised intra-cranial pressure: coup and contra-coup injuries
    2. Methods of preventing the ‘second insult’ to the brain
    3. Principles of anaesthesia in the presence of a recent head injury
    4. The non-surgical management of the head trauma patient
    5. Emergency neurosurgery for head trauma
12. Spinal drainage
13. Fluid and electrolyte balance in neurocritical care, including an appreciation of SIADH and the effects of Mannitol