TRAINING RECOMMENDATIONS FOR NEUROANAESTHESIA AND NEUROINTENSIVE CARE

Following a survey of members of the Neuroanaesthesia Society of Great Britain and Ireland and a selected survey of trainees from certain regions in the UK the members of the NAS agreed the following recommendations for training in neuroanaesthesia.

All Trainee Anaesthetists

During their training all trainee anaesthetists should be closely involved in the anaesthetic management of a minimum number of:

10 patients with head injury or intracranial haematoma
10 patients for shunt procedures
10 patients for spinal surgery
2 patients for carotid endarterectomy (experience in this area can be obtained during vascular block)
10 patients for intracranial surgery other than evacuation of intracranial haematoma
At least one of these cases should be for intracranial vascular surgery.
1 patient for posterior fossa surgery
2 patients for stereotactic surgery
5 patients for neuroradiological imaging

In addition, where possible, all trainees should be exposed to neurointensive care.

Specialist Neuroanaesthetists

During their training all anaesthetists intending to subspecialise in neuroanaesthesia and/or neurointensive care should be closely involved in the anaesthetic management of a minimum of:-

20 patients with head injury or intracranial haematoma
20 patients for shunt procedures
20 patients for spinal surgery
5 patients for carotid endarterectomy (experience in this area can be obtained during vascular block)
25 patients for intracranial surgery other than evacuation of intracranial haematomaAt least 5 of these cases should be for intracranial vascular surgery and some experience should be gained in anaesthesia for transphenoidal hypophysectomy
5 patients for posterior fossa surgery
5 patients for stereotactic surgery
15 patients for neuroradiological imaging including experience in anaesthesia and sedation for interventional neuroradiology and MRI

 

Neuroanaesthetists must have broad experience of anaesthesia for the whole range of the usual neurosurgical case-mix and anaesthetise at least one case in each category (except for very rare procedures)

In addition, all neuroanaesthetists should have experience of at least 1 month in neurointensive care and those wishing to have sessions in neurointensive care should have an attachment of at least 3 months to neurointensive care as part of their general ITU training.

Paediatric neuroanaesthesia should be carried out by specialist paediatric neuroanaesthetists. They can be paediatric anaesthetists with special training in neuroanaesthesia or neuroanaesthetists with special training in paediatric anaesthesia. Any anaesthetist who anaesthetises children under the age of 5 for neurosurgical procedures should have the equivalent of one paediatric list per week anaesthetising such children. Any trainee who wishes to have sessions in paediatric neuroanaesthesia as a consultant should receive appropriate training in paediatric anaesthesia and experience in anaesthetising a reasonable number of paediatric neurosurgical cases including examples from the whole range of the usual paediatric neurosurgical case-mix.

In formulating these guidelines the members of the NAS recognise the need to be realistic and set minimum targets that are achievable. Much neurosurgery is scheduled so that the case-mix over a given period is unpredictable. Therefore, it is appropriate to lump similar cases together for all trainees to achieve the training requirements. Specialist neuroanaesthetists must have broad experience of the full case-mix. It is accepted that to rectify deficiencies in experience some training may need to take place after taking up a consultant post. This could be in the unit in which the consultant is working or another centre.

 

E. Moss May1998