neuroanesthesiologists

Neuroanesthesiology is a subspecialty of anesthesiology focused on the perioperative care of patients undergoing neurosurgical procedures and neurointerventional treatments. Neuroanesthesiologists manage anesthesia for operations involving the brain, spine, and peripheral nervous system, as well as endovascular procedures such as aneurysm coiling or AVM embolization. The specialty emphasizes protecting cerebral physiology, controlling intracranial pressure, and ensuring safe anesthesia and analgesia while supporting intraoperative neuromonitoring.

Training and certification typically involve completing a residency in anesthesiology, followed by a fellowship in neuroanesthesiology or neurocritical care. Board certification requirements vary by country, but many programs grant subspecialty certification or accreditation based on clinical training and examinations.

Key roles include preoperative assessment of patients with intracranial pathology, optimization of cerebral perfusion pressure, airway management with consideration of potential difficult intubation, and planning hemodynamic and respiratory strategies to minimize secondary brain injury. Intraoperatively, neuroanesthesiologists provide advanced monitoring such as invasive arterial and central venous pressure monitoring, intracranial pressure monitoring when indicated, and intraoperative neuromonitoring (EEG, SSEP, MEP).

They select anesthesia techniques balancing cerebral protection and patient comfort, often using total intravenous anesthesia or balanced anesthesia with volatile agents, and employ strategies to control carbon dioxide, temperature, and blood pressure. They manage fluids and osmotherapy, manage blood loss, and coordinate with neurosurgical teams on CSF drainage, positioning, and neuroprotection measures.

Settings and collaboration: employed in neurosurgical operating rooms, endovascular neuroradiology suites, and neurocritical care units, working closely with neurosurgeons, neurologists, interventional radiologists, and neurophysiologists. The goal is to minimize perioperative neurological injury, optimize recovery, and enable complex procedures.