GOALS AND OBJECTIVES: The fellowship in Neuroanesthesiology is a 12-month period of specialized training in the perioperative management of patients undergoing neurological surgery and interventional neuroradiological procedures.
The goals of this program are:
1) To stimulate reading and understanding of neurophysiology and neuropharmacology;
2) To develop the technical, intellectual, and intuitive skills needed to manage patients undergoing a broad variety of intracranial, spinal, and radiological procedures;
3) To gain sufficient training, experience, and interpretive knowledge of various modes of neurological monitoring including electroencephalogram (EEG), somatosensory-evoked potentials (SSEP), brainstem auditory-evoked potentials (BAER), and motor-evoked responses (MER);
4) To gain a working knowledge of various neurological diagnostic modalities, including computerized tomography (CT), magnetic resonance imaging (MRI), and angiography;
5) To develop expertise in various techniques of invasive monitoring and airway management, including arterial lines (A-line), central venous pressure (CVP) and pulmonary artery catheter (PAC) monitoring, and fiberoptic bronchoscopy (FOB).
AFFILIATION: The fellow will be affiliated with the Department of Anesthesiology and Pain Management at The University of Texas Southwestern Medical Center (UT Southwestern). The majority of time will be spent at UT Southwestern University Hospitals - Zale Lipshy Building, where the surgical caseload exceeds 1,000 per year: over 300 neurovascular cases, including aneurysms, arteriovenous malformations (AVM), hematoma evacuations, extracranial-intracranial (EC-IC) bypasses, and carotid endarterectomies (CEA); almost 300 tumor resections; over 300 spine cases, including transabdominal, transthoracic, and transoral approaches, complex fusions and instrumentations; and a variety of other specialized procedures, including ventricular and spinal shunts, and implantation of spinal and intracranial neurostimulators for pain and movement disorders. Zale also has a very active and progressive interventional neuroradiology section, performing almost 200 cases per year requiring anesthesiology participation: angioplasties and stents; embolization of aneurysms, AVMs, carotid-cavernous (CC) fistulas, and tumors; intracranial thrombolysis; and sclerotherapy for venolymphatic malformations. A rotation can be arranged at Children's Medical Center Dallas if specific pediatric neuroanesthesia experience is desired.
SELECTION: The fellowship is restricted to one fellow per year to provide optimal exposure to challenging and complex cases. Any graduated anesthesiologist or any anesthesiology resident who will have completed his/her CA-3 year in good standing by the start of the fellowship year is eligible to apply for the position. Applicants should submit the standard Application for Fellowship Training in Anesthesiology and Pain Management and should forward their curriculum vitae (CV), evidence of medical school graduation, US medical licensure exam (USMLE) scores, and anesthesia in-training examination scores. Three letters of recommendation from faculty who have worked with the trainee will be required. A personal interview will be arranged by the Department.
Final selection will be made by the Chairman of Anesthesiology and Pain Management, upon the recommendation of the Division Director of Neuroanesthesia.
DUTIES AND RESPONSIBILITIES/CALL: The fellow is expected to work five days per week in the operating room (OR) providing direct patient care. Time will be provided each day as available for reading and personal study. He/she is expected to provide total perioperative management, including preoperative and postoperative patient visitations. The fellow will not take call in either a staff or resident capacity, but should be available via pager weekdays and two weekends per month for emergency cases of significant educational value. He/she will have the next day off if working past midnight. [Time away(holidays, vacation, meetings, sick leave) will be granted in accordance with University and Departmental policy.] The fellow will be expected to take part in the training and teaching of residents. He/she will be encouraged to attend the annual meeting of the Society of Neurosurgical Anesthesia and Critical Care (SNACC), which immediately precedes the annual American Society of Anesthesiologists (ASA) meeting.
SUPERVISION: An attending faculty member will directly supervise the fellow in all cases. The Fellowship Program Director (William J. Krippner, MD), will serve as personal mentor over the course of the year.
FORMAL EDUCATIONAL EXPERIENCE: The fellow is expected to attend the monthly/bi-monthly Neurosurgical Seminar as well as the weekly Neurovascular Surgery Conference at Zale, unless superseded by neuroanesthesia Grand Rounds at Parkland Health and Hospital System. The fellow is expected to present and discuss articles at bimonthly anesthesia section meetings, as well as to prepare and formally present two topics in neuroanesthesia over the course of the year. Expected reading will include the Neuroanesthesia Division syllabus, a major textbook of neuroanesthesia (e.g., Cottrell's Anesthesia and Neurosurgery), and selected readings from major texts of neurosurgery (e.g., Grossman's Principles of Neurosurgery) and neuroradiology (e.g., Connors' Interventional Neuroradiology), as well as from texts on neuromonitoring (e.g., Russell's Primer of Intraoperative Neurophysiologic Monitoring) and positioning (e.g., Martin's Positioning in Anesthesia and Surgery). These will be made available at the start of the fellowship and pertinent reprints from The Journal of Neurosurgical Anesthesia and Critical Care and other periodicals will be provided on an ongoing basis.
RESEARCH REQUIREMENTS: Research activity is strongly encouraged but not required. The fellow could collaborate with faculty in a clinical research project comparing the efficacy of the two most commonly used neuroprotective agents.
EVALUATIONS: The fellow will be evaluated monthly by the attending faculty members and will be reviewed biannually by the Clinical Competency Committee. He/she will receive formal evaluation by his/her mentor at six and twelve months. The fellow must demonstrate proficiency in the perioperative and intraoperative care of patients undergoing neurovascular surgery and interventional neuroradiology, tumor resections, complex spine surgery and interventional neuroradiology, tumor resections, complex spine surgery, as well as a variety of miscellaneous neurosurgical operations. He/she must demonstrate a working knowledge of the major modalities of neurological monitoring (EEG, SSEP, BAER, MER) and diagnosis (CT, MRI, angiography). He/she must demonstrate expertise in the various techniques of airway management (awake/asleep FOB, LMA, etc.) and invasive monitoring (A-line, CVP, PAC). The fellow will have the opportunity to evaluate supervising faculty.
CREDIT BY SPECIALTY BOARD: There is currently no exam and no credit given for this program by a specialty board.
Dr. William J. Krippner, Jr., is Division Director of Neuroanesthesiology and oversees the Neuroanesthesiology Fellowship Program.
