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Neuroanesthesia
Faculty The Division of Neuroanesthesia is a vibrant, active service, which, like the Neurosurgery Department itself, has undergone recent, rapid expansion of its clinical caseload. Cases include complex intracranial and spine surgeries, and the patient population includes significant numbers of pediatric and geriatric patients, as well as adults. As the Department of Neurosurgery continues to enhance its national reputation, the number and complexity of these cases can be expected to continue to grow. Our basic philosophy can be simply stated as "The five P's": Proper Planning Prevents Poor Performance. Dealing with complex neurological cases, each of which typically has unique issues requires an approach which is consistent yet flexible. To attain this, we have fostered a culture of open communication with the surgeons, nurses, OR technicians, and other services to create a true "team approach" system which maximizes patient safety, OR efficiency, and team morale. FacultyThe members of the Division of Neuroanesthesia are:Director, Jeffrey W. Kolano, M.D. Section Members: Ashwani K. Chhibber, M.D. , Joseph Dooley, M.D. , Sushma A. Jain, M.D. , Lata U. Sabnis, M.D. Member Emeritus: Sriyalatha I. (Ira) Nadaraja, M.D. Additionally, the members of the Pediatric Anesthesia service work closely with the Neuroanesthesia service in the care of pediatric neurosurgical patients undergoing procedures including repair of meningomyelocele and craniosynestosis. Patient CareThe Division of Neuroanesthesia is finalizing its practice guidelines to assist clinicians and residents. The practice guidelines are designed to help the practitioner(s) involved in the care of neurosurgical patients in clinical decision making based on scientific evidence and broad departmental consensus, and thereby improving the process and delivery of quality of care. The entire contents of these documents will be annually reviewed and updated. These guidelines will be posted on the departmental web-site.Areas of Clinical ExcellenceThe Neuroanesthesia service participates in the care of patients undergoing both common and uncommon procedures. Among these procedures are included:Sitting Craniotomies Many surgical procedures involving the posterior fossa are performed with the patient in the sitting position, which presents a unique set of potential problems. Residents will become familiar with the risks of this procedure. The diagnosis and treatment of venous air emboli, a potential hazard, becomes part of the resident's repertoire, as well as placement of antecubital "long-arm" central venous catheters, the use of precordial Doppler probes, and the use and theory behind Ramen spectroscopy. Epilepsy Surgery As the only institution in Western New York which supports an epilepsy surgery program, the University of Rochester gives residents a rare opportunity to manage the anesthetic care for a patient undergoing a craniotomy while awake, responsive, and communicative. Awake craniotomies are also performed for selected patients for tumor resection or vascular malformation ablation. Cervical Spine Surgery Spinal cord or spinal nerve root compression can present a significant hazard for neurological injury, especially during manipulation of the airway. Residents become proficient with multiple modalities of airway management, including flexible fiberoptic laryngoscopy, the use of the illuminated stylet "light wand", and the video assisted laryngoscopic techniques including the Glidescope and VideoMac. Evoked Potential Monitoring To monitor continuity of neurological pathways during spinal or brain surgery, evoked potential monitoring is often employed. Somatosensory evoked potentials (SSEP) become a familiar tool for residents, as well as becoming familiar with brainstem auditory evoked responses (BAER) and visual evoked potentials (VEP). Deep Brain Stimulation Diseases associated with the geriatric population are being seen more frequently in the OR setting. Among these diseases, Parkinson's Disease may be treated with a surgical implant. The localization of the optimal site for the implant, performed on an awake patient, presents a delicate balance between patient safety and comfort, while maintaining tremor and responsiveness to commands. Areas of Ongoing Activity
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