CA1 residents spend a compulsory one-month rotation performing anesthesia for a variety of neurosurgical procedures including routine craniotomies, stereotactic brain biopsies, cerebral aneurysm clippings, transphenoidal hypophysectomies, "awake" craniotomies, and spinal fusions. CA2 residents complete an additional month of neuroanesthesia. In addition, a specialized team of neurosurgeons at The George Washington University Hospital performs skull-based craniotomies for lesions in these anatomically difficult locations. These procedures require sophisticated anesthetic techniques such as burst suppression, controlled hypotension, and hypothermia for cerebral protection.
Occasionally, total circulatory arrest is used. The resident also learns monitoring techniques specific to neuroanesthesia such as precordial doppler ultrasound for venous air embolism, somatosensory evoked potentials (SSEP), brain stem auditory evokes responses (BAER), EEG, and EMG.
