- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, United States.
DOI:10.25259/SNI_285_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ramsis F. Ghaly, Mikhail Kushnarev, Iulia Pirvulescu, Zinaida Perciuleac, Kenneth D. Candido, Nebojsa Nick Knezevic. A novel checklist for anesthesia in neurosurgical cases. 26-Apr-2021;12:184
How to cite this URL: Ramsis F. Ghaly, Mikhail Kushnarev, Iulia Pirvulescu, Zinaida Perciuleac, Kenneth D. Candido, Nebojsa Nick Knezevic. A novel checklist for anesthesia in neurosurgical cases. 26-Apr-2021;12:184. Available from: https://surgicalneurologyint.com/surgicalint-articles/10760/
Throughout their training, anesthesiology residents are exposed to a variety of surgical subspecialties, many of which have specific anesthetic considerations. According to the Accreditation Council for Graduate Medical Education requirements, each anesthesiology resident must provide anesthesia for at least twenty intracerebral cases. There are several studies that demonstrate that checklists may reduce deficiencies in pre-induction room setup. We are introducing a novel checklist for neuroanesthesia, which we believe to be helpful for residents during their neuroanesthesiology rotations. Our checklist provides a quick and succinct review of neuroanesthetic challenges prior to case setup by junior residents, covering noteworthy aspects of equipment setup, airway management, induction period, intraoperative concerns, and postoperative considerations. We recommend displaying this checklist on the operating room wall for quick reference.
Keywords: Anesthesiology, Checklist, Neurosurgery, Safety
Throughout their training, anesthesiology residents are exposed to a variety of surgical subspecialties, many of which have specific anesthetic considerations. Given the high pace of anesthesia, it can be difficult to ensure that the setup for the case is done efficiently and taking into account each aspect of a complex case. We are introducing a tool we believe to be helpful for residents during their neuroanesthesiology rotations. A checklist for neurosurgery cases could be posted on a wall of a neurosurgery-dedicated operating room for quick reference during case setup by a resident. We believe that it would reduce inadequate preparation and the stress and delays caused by missing equipment during the case.
According to the Accreditation Council for Graduate Medical Education requirements, each anesthesiology resident must perform anesthesia for at least twenty intracerebral cases.[
Checklists are ubiquitously used in medicine, however, they are arguably not commonly used in anesthesia practice. There are several studies that demonstrate that checklists may reduce deficiencies in pre-induction room setup.
Thomassen et al. created a 26-point pre-induction checklist, which was used in 502 inductions during a 13-week study period.[
Wetmore et al. studied a pre-anesthetic induction patient safety (PIPS) checklist in a simulation setting.[
Beck et al. investigated whether self-training with an electronic audiovisual checklist app on a smartphone would improve safe pre-induction setup in anesthesiology residency beginners in the first 8 weeks of their training.[
To the best of our knowledge, there are no published checklists for neuroanesthesia, which has multiple considerations distinguishing it from more basic cases. We hope that our checklist can provide a quick and succinct review of neuroanesthetic challenges prior to case setup by junior residents [
Neurosurgery cases are frequently long, positioning is prone, the head of the bed may be rotated away from the anesthesia provider, and the patient’s head may be stabilized with a horseshoe or pins.[
Some neurosurgical patients have a history of prior cervical spine surgeries, making neck extension for direct laryngoscopy limited; other patients may have trauma that requires inline cervical stabilization. These patients typically require video laryngoscopy or fiberoptic intubation.[
Following induction and positioning, the anesthesiologist must prepare for intraoperative use of navigation systems and imaging, as the equipment can share the space with the breathing circuit, IV lines, and monitor cords, which must be secured to prevent accidental dislodgement. Cases that require neuromonitoring or cerebral vasoconstriction may require total IV anesthesia (TIVA) as opposed to inhalational anesthesia with neuromuscular blockade.[
Checklists have been demonstrated to improve safety and efficacy in delivery of anesthesia. They are particularly important early in training when residents lack the experience to take into consideration every aspect of a complex and challenging case. We believe that organizing typical neuroanesthetic concerns into a checklist could prove beneficial for residents, standardize operating room setups prior to cases, decrease missed items that would have to be retrieved later in the case, and improve patient safety by reducing common mistakes.
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