Education

Neuroanesthesia Rotation Primer

Room Set-Up

• Ambu-Bag, Anesthesia Machine Test, and Suction
• TableTop Stuff (gauze, ETOH, lubricant, oral/nasal airways, blades, anode ETTs for most cases or oral Rae ETTs for transsphenoidal resections, eye pads and 2 medium Tegaderm pads)
• Standard Monitors
  • 1 large Tegaderm for each EKG lead for prone cases
  • OG tube (especially for prone cases)
  • BIS monitor for cases not involving the head
  • Triple Transducer for A-line/CVP with 500mL NS and pressure bag + manifold at downstate and 2 single transducers for A-line/CVP in a single 500ml NS pressurized bag
  • Be prepared to have to reapply stray monitors/EKG leads and prone positioning and be mindful of pressure points when placing EKG leads; the best place is on the free edges of arms/torso/legs for prone cases
• A-line kit (arm board, ETOH, lidocaine, gloves, iodine, sterile gauze, catheter, end of transducer tubing with stopcock and flush syringe, suture, Tegaderm, tape)
• IV Lines
  • Peripheral IV 18G or larger→ 1L NS with macro-drip tubing for intracranial cases; remember that NS is the more hypertonic solution and will minimize additional brain edema from fluid administration (for spine cases you can use LR/Isolyte)→ +2 stopcocks + 1 extension
  • Volume/Blood Line for central line → 1L NS with Y-tubing + 2 stopcocks + 1 extension on fluid warmer
  • If you are not using a central line usually an 18G is started first and another larger peripheral line is starting after intubation with NS macro-drip
• Infusion Pumps and pump tubing  x 2
• Drips
  • Ultiva (Remifentanil) 5mg in 100mL NS bag (Downstate) or 2mg in 40ml NS in 60cc syringe (LICH/Lutheran) → 50mcg/mL
  • Propofol can be placed directly in 60cc syringe as 10mg/ml preparation
  • Precedex (Dexmedetomidine) 200mcg in 100mL NS → 2mcg/mL
  • Mannitol (exact dosage dictated by surgeon; in a 250ml NS bag extract CC for CC the amount of mannitol to be added or the bag will not hold the volume); mannitol should be run through a fluid warmer line (helps prevent crystallization) should be given over 30 minutes or may cause an increase in ICP if given too quickly; at each hospital you must receive this from the nursing staff and should be available prior to case start

• Syringes/Emergency Drugs
  • Succinylcholine (200mg → 10mL)
  • Lidocaine (pre-packaged syringe)
  • Calcium Chloride (100mg/mL → 10mL); you may need to supplement after blood transfusion
  • Esmolol (10mg/mL → 10mL)
  • Neosynephrine (.1mg/mL → 10mL)
  • Ephedrine (5mg/mL → 10mL)
• Atropine (.4mg/mL → 3mL syringe)
• Induction Drugs
  • Glycopyrrolate – 3ml syringe
  • Versed (Midazolam) – 3mL syringe
  • Fentanyl – 5mL syringe
  • Zemuron (Rocuronium) /Nimbex (Cisatracurium) – 10mL syringe (most cases they will be monitoring SSEPs +/- MEPs therefore they may ask no to give any more muscle relaxant after induction; communicate with surgeon)
  • Etomidate – 10mL syringe or Sodium Thiopental (pre-packaged syringe)
  • Lidocaine (pre-packaged syringe)
  • Note: Propofol and Succinylcholine may be used for induction when appropriate for the patient's airway and medical condition

• Maintenance
  • Usually complete with ½ MAC Isoflurane, (NO Nitrous), Remifentanil/Propofol infusions titrated to effect
• ABG  syringes

• Paperwork

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