Communicator: Saudi Board Anesthesia Curriculum
carotid body dysfunction, airway and ventilation problems, cardiac
ischemia/MI
Endovascular treatment of carotid disease: carotid angioplasty and stenting
q) To demonstrate knowledge in postoperative management of vascular patients,
including postoperative pain management:
Mechanical ventilation and invasive monitoring in ICU complications,
including: complications of invasive monitoring, complications of the
surgical procedure, respiratory complications (risk factors, pulmonary
disease, cardiac disease, emergency surgery)
Technical skills
Proficiency in the provision of thoracic epidural analgesia for upper
abdominal and thoracic surgical procedures
Airway management for bronchoscopy, one lung ventilation and insertion
of spinal drains and CSF monitoring for thoracic aneurysm repair
Starting large bore intravenous infusions, arterial lines, CVP and PA lines in
vascular surgical patients
2. Communicator
a) To demonstrate effective communication with patients and families of
description of procedures, informed consent and anesthetic options and
risks.
b) To demonstrate effective communication with the OR team (vascular
surgeons, nurses and other members of the healthcare team) and
postoperative team (ICU, PACU), by providing clear and concise written
consultation and anesthetic records.
3. Collaborator
a) To seek perioperative consultation with colleagues when required, and to
contribute effectively with other interdisciplinary team activities by
demonstrating the ability to function in the clinical environment using the
full abilities of all team members.
4. Manager
To manage OR time by efficiently conducting the anesthetic, continuing education and
personal activities utilize information technology to optimize patient care and lifelong
learning.
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5. Health Advocate
To provide patient advocacy for various perioperative issues (i.e., patient safety, analgesia,
postoperative monitoring).
6. Scholar
To demonstrate commitment to continuing personal education, be able to critically review
vascular anesthesia literature and describe the principles of research relevant to this
population, and assist in the education of other members of the OR team.
7. Professional
a) To demonstrate a sense of responsibility, integrity, honesty and compassion
when caring for patients.
b) To demonstrate respect for patients and colleagues by delivering the highest
quality care to patients, practicing medicine ethically consistent with the
obligations of a physician, respecting the opinions of fellow consultants and
referring physicians in the management of patient problems, and be willing to
provide means whereby differences of opinion can be discussed and resolved.
c) To show recognition of limits of personal skill and knowledge by
appropriately consulting other physicians and paramedical personnel when
caring for the patient.
67 SAUDI BOARD ANESTHESIA CURRICULUM
NEUROANESTHESIA
Duration: Three months during Senior Residency
Rotations in Neuroanesthesia will provide the resident with a theoretical basis and clinical
experience in the anesthetic management of patients undergoing surgical treatment of
diseases of the CNS and spine.
This includes the preoperative evaluation, intraoperative management, and postoperative
care utilizing the most current medical/anesthetic knowledge.
The clinical experience will provide exposure to a variety of basic and complex procedures
in patients with neurologic disease with graded independence and responsibility.
Objectives:
At the end of the Neuroanesthesia rotation, the resident should exhibit the following
knowledge, skills and attitudes:
1. Medical Expert / Clinical Decision-Maker
The resident will be able to:
a) Demonstrate knowledge of basic sciences as applicable to neuroanesthesia,
including: neuroanatomy, neurophysiology and neuropharmacology.
b) To understand the pathway and physiology of CSF circulation and factors affecting
it. Also it is important to know the anatomy of cerebral circulation and factors
affecting it and methods for controlling intra-cranial pressure (ICP).
c) Demonstrate basic understanding of the impact of commonly performed
neurosurgical procedures on anesthetic management.
d) Demonstrate clinical knowledge and skills necessary for the practice of
neuroanesthesia including:
• Preoperative neurological assessment (using Glasgow Coma Scale,
Classification for SAH and basic neurological exam).
• Intraoperative support including:
• Special Positioning (sitting, prone, park-bench, lateral and knee-chest).
• Understanding basic principles of neurophysiologic monitoring: EEG,
evoked potential (SSEP, BAEP), transcranial Doppler, cerebral
oximetry, and intracranial pressure monitoring methods available.
68 SAUDI BOARD ANESTHESIA CURRICULUM
• Specific interventions: systemic arterial hypotension/hypertension,
CSF drainage, ICP management, hypothermia and precordial Doppler
monitoring for air embolus.
• Management of specific perioperative complications such as seizures,
cerebral ischemia, intracranial hypertension, intraoperative aneurysm
rupture, air embolism, cranial nerve dysfunction and neuroendocrine
disturbance (DI, SIADH).
• Postoperative management of neurological patients in PACU, ICU and
the Neuro-Observation Unit.
e) Demonstrate competence in all technical procedures commonly employed in
neuroanesthesia practice, including airway management (basic and difficult),
cardiovascular and neuroresuscitation, invasive monitoring (arterial line, central
line and LP drain placement).
f) Develop and implement a rational anesthetic plan of management for each of the
following neurosurgical procedures:
• Craniotomy for mass lesions (tumor, abscess, hematoma)
• Cerebrovascular procedures (aneurysm, AVM, carotid vascular disease)
• CSF shunting procedures
• Transsphenoidal surgery
• Stereotactic procedures
• Awake craniotomy
• Neuroradiological procedures (embolization, thrombolytic, MRI)
• Spine surgery
2. Communicator
By the end of this rotation, the resident will be able to:
a) Establish a therapeutic relationship with patients and their families in the limited
time available.
b) Obtain and collate relevant history from patients and families.
c) Demonstrate empathy, consideration and compassion in communicating with
patients and families.
d) Communicate effectively with medical/surgical colleagues, nurses, and
paramedical personnel regarding the anesthetic management of the patient.
69 SAUDI BOARD ANESTHESIA CURRICULUM
e) Demonstrate appropriate written communication skills through accurate, legible,
and complete documentation of the anesthetic record, patient chart and in
consultation.
3. Collaborator
By the end of this rotation, the resident will be able to:
a) Demonstrate the ability to function in the clinical environment using the full
abilities of all team members (surgical, nursing, ICU, etc.).
b) Develop their anesthetic plan for their patients in consultation and in concert
with surgery, nursing and ICU for more complicated neurosurgical patients.
c) Understand and value the skills of other specialists and healthcare professionals.
d) Understand the limits of their knowledge and skills.
e) Be able to understand, accept and respect the opinions of others on the
neuroteam.
f) Function in the OR as a member of the neuroteam and work in a positive,
constructive manner, respecting the importance of the roles of all team members.
4. Manager
By the end of this rotation, the resident will be able to:
a) Demonstrate the ability to manage the OR by ensuring the necessary
equipment, monitoring, and medication are available, making the preparations
to deal with anticipated complications, and conduct all these activities should be
conducted in an effective and efficient timely manner in order to avoid OR delays.
b) Utilize personal resources effectively in order to balance patient care, continuing
education and personal activities.
c) Utilize information technology to optimize patient care and lifelong learning.
70 SAUDI BOARD ANESTHESIA CURRICULUM
5. Health Advocate
By the end of this rotation, the resident will be able to:
a) Recognize the opportunities to advocate for neurosurgical patients, in particular
with regards to patient safety.
b) Adopt a leadership role in the postoperative care of their patients by anticipating
and arranging for the PACU, ICU, or Neuro-Observation Unit care.
6. Scholar
By the end of this rotation, the resident will be able to:
a) Be responsible for developing, implementing and regularly re-evaluating a
personal continuing education strategy.
b) Contribute to the development of new knowledge through
facilitation/participation in ongoing departmental research activities.
c) Be prepared in advance for the OR cases scheduled through additional reading,
patient chart review/assessment.
7. Professional
By the end of this rotation, the resident will be able to:
a) Demonstrate a commitment to executing, professional responsibilities with
integrity, honesty and compassion.
b) Demonstrate appropriate personal and interpersonal professional behaviors and
boundaries.
c) Recognize limits of personal skill and knowledge by appropriately consulting
other physicians when caring for the patient.
