1. Neurovascular anatomy including cerebral circulation, circle of Willis, and venous drainage. Carotid and aortic bodies, and carotid sinus - their locations and functions including the physiological the impairments on hemodynamics and metabolisms.
2. The formation, composition, flow, pressure, and volume of cerebrospinal fluid (CSF).
3. Physiologic role of the blood brain barrier (BBB). What characteristics of a substance allow it to cross? What conditions disrupt the blood brain barrier and what are the clinical effects of osmotic agent (i.e.mannitol) on cerebral perfusion in patients with disruption of BBB.
4. Electroencephalography (EEG) – Different wave patterns, frequency, amplitude, raw and processed, and clinical applications/pitfalls as a measure of cerebral function and integrity. The effects of anesthetics and other factors on its interpretation. Understand the EEG patterns in various typical clinical situations – sleep, convulsions, and brain death.
5. Evoked potential measurements – the theory and clinical applications of the various types including sensory, motor, visual, brainstem auditory evoked potentials. The effects of anesthetics and other factors (i.e. temperature) on its interpretation.
6. Define cerebral metabolism (CMRO2) and how anesthetics and glucose levels effect the CMRO2.
7. Cerebral blood flow (CBF) – how it is measured, its normal values, and its clinical significance. Understand the regulation of CBF by cerebral perfusion pressure (CPP), autoregulation, PaO2, PaCO2, viscosity, temperature, and anesthetics.
8. Understand intracranial compliance and how it is monitored based on intracranial pressure (ICP) measurements.
9. The direct and indirect measurements of ICP, the signs and symptoms of elevated ICP, and therapeutic interventions to reduce it clinically.
10. Evidence-based fluid management strategy for craniotomies.
11. Review the Glascow Coma Scale (GCS) and anesthetic considerations for comatose patients due to trauma, infection, metabolic derangement, CVA, and cerebral hypoxia.
12. Considerations and complications of prone and sitting positions for neurosurgical procedures.
13. Detection, manifestations, and treatment of venous air embolism intra-operatively.
14. Strategies and mechanisms of cerebral protection from hypoxia, ischemia, and glucose effects.
15. Rationales, advantages and disadvantages, techniques, systemic effects, shivering, rewarming, complications, and evidence-based practice of mild hypothermia in neurovascular procedures and closed head injury patients.
16. Discuss anesthetic considerations for patients with AVM’s and aneurysms. Management of complications in patients with cerebral hemorrhage including, myocardial ischemia/infarction, rebleeding, and vasospasm.
17. Differential diagnosis, monitoring, and management of seizure patients.
18. Anesthetic considerations for patients with Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis.
19. Anesthetic considerations for patients with acute and chronic spinal cord injuries.
20. Anesthetic considerations for sterotactic surgery.
21. Anesthetic considerations for patients undergoing carotid endarterectomy, including the various methods of assessing/preventing cerebral ischemia (awake procedure, stump pressure, EEG, shunting) and management of complications (stroke, myocardial ischemia/infarction, bleeding, airway obstruction, hemodynamic instability, reperfusion syndrome) after the surgery.
22. Management issues in acute head injury and unstable cervical spine.
23. Intra-operative emergencies in neurosurgical anesthesia.