Neuroanesthesia Fellowship, University of Washington

The Neuroanesthesia Fellowship of University of Washington offers a one-year neuroanesthesia fellowship for trainees who have completed a three-year anesthesia residency training program in an accredited program in the U.S. or an equivalent program. This clinical fellowship is based at Harborview Medical Center. The general goal is to provide advanced training in all aspects of neuroanesthesia including monitoring techniques. The program is flexible and can accommodate candidates with different areas and levels of interest.

Description

This flexible neuroanesthesia training program primarily include:

  • Clinical experience with a variety of neurosurgical procedures
  • Clinical research and training.

Although primarily clinical, opportunities exist within the University of Washington to pursue training in laboratory research as part of the fellowship training. Some clinical duty functioning as an attending physician is required as part of the program.

Clinical Experience

All four teaching hospitals (UWMC, Harborview, VA, and Children's hospital) have neurosurgical procedures although the majority of them are conducted in the first two hospitals.

  • UWMC
    • epilepsy surgery
    • tumor surgery
    • transphenoidal pituitary tumor
    • carotid endarterectomy
    • limited opportunity for clinical research
  • Harborview
    • trauma, 150 / year
    • aneurysm, 200 / year
    • AVM, 20-30 / year
    • tumor, 40-50 / year
    • sitting position, 10 / year
    • ICP monitors are placed routinely in all postoperatively
  • Children's Hospital
    • Experience in pediatric neuroanesthesia can be arranged with rotation through Children's Hospital

Dr. Michael Souter and Dr. Arthur Lam, in conjunction with Dr. Steve Deem, actively participate in the Neurocritical Care Unit as attending physicians. The Neuroanesthesia Fellowship can be structured to incorporate neurocritical care training.

Research Interest

Clinical Research

Arthur Lam, MD
Professor of Anesthesiology, Chief of Neuroanesthesiology.
Cerebrovascular hemodynamics in the clinical setting. Application of transcranial Doppler in monitoring. EEG and evoked potential monitoring. Influence of anesthetic agents on cerebral blood flow and metabolism. Jugular venous oxygen saturation. CO2 reactivity during anesthesia. Cerebral blood pressure autoregulation.
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Lorri Lee, MD
Assistant Professor of Anesthesiology
Perioperative ischemic optic neuropathy. Influence of position on intraocular pressure. Vascular and CO2 reactivity of ophthalmic artery.
 

Monica Vavilala, MD
Assistant Professor of Anesthesiology
Pediatric head injury. Cerebral autoregulation
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Michael Souter, MD
Associate Professor of Anesthesiology
Neurocritical Care

Basic Science Research

Alan Artru, MD
Professor and Head of Research Committee
Major interest in CSF absorption and production, cerebrovascualar hemodynamics and influence of pharmacological agents, brain protection
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Clinical Responsibility

The split between clinical time and non-clinical time is by agreement between the candidate and the Chairman of the Department of Anesthesiology. The clinical time will vary between 70% to 80%. More research-oriented candidates may negotiate for more non-clinical time. Clinical responsibility will include functioning in the capacity of an attending anesthesiologist as well as a resident depending on the clinical needs. On-call duty will be primarily at the level of an attending anesthesiologist although resident on-call duty may also be periodically required. The level of supervision received when functioning as a neuroanesthesia attending will be a graduated one, depending on the confidence and the competence of the trainee. The goal will be to have the fellow functioning as an independent neuroanesthesia attending within 2 months, but always with support and backup from senior faculty members.

Faculty Supervision and educational Resources

The Division of Neuroanesthesia consists of the following faculty members: Dr. Arthur Lam (chief), Dr. Lorri Lee, Dr. Karen Domino, Dr. Michael Souter, and Dr. Monica Vavilala. Immediate questions regarding the training program should be directed to Dr. Lam.

The department maintains an excellent library and all major textbooks on neuroanesthesia are available either from the department library or from Dr. Lam's own collection. A neuroanesthesia manual maintained and updated for use by residents is also available for use by the fellow.

Learning will occur from active participation in discussions with senior faculty and reading of recommended texts and publications. The fellow is expected to pursue some areas of interest in depth. Participation in other educational activities including presentation of cases at mortality/morbidity conferences and teaching of residents and medical students are required.

Medical conferences of educational value include the following:

  • Twice-monthy neuroanesthesia rounds held at 0600 on second and fourth Thursday morning of each month. Current topics and journal articles are discussed.
  • Departmental M and M conference on Wednesdays at UWMC at 0630.
  • Neurosurgical Grand Round on Wednesdays at HMC at 0700. (Harborview R and T Building). Note the time conflict with the above anesthesiology conference.
  • Monthly Neurosurgery M and M conference held on the second Saturday of every month at 0830 at HMC (This covers all four teaching hospitals)
  • Neurosurgery radiology rounds held every Wednesday at 1630 at UWMC. (All patients in all four teaching hospitals are presented and discussed)

Fellows are encouraged to attend these conferences when they are not in direct conflict with clinical responsibilities.

Educational Objectives

  1. Academic Objectives
    1. Basic Knowledge Acquisition
      1. Understanding of basic cerebral physiology (control of CBF, CBV, ICP, CPP, CO2 reactivity etc.)
      2. Understanding of influence of anesthetic agents and techniques on the normal control mechanisms.
      3. Understanding of the influence of disease pathology on normal cerebral physiology and pharmacology.
    2. Research Experience
      1. Understanding of basics of hypothesis formulation, literature review, experimental design, methodology, data acquisition, statistical analysis, interpretation of data, penmanship, peer-review process, and publication of results.
      2. Participation in clinical research in neuroanesthesia.
  2. Practical Objectives
    1. Patient Management Skills
      1. Understanding of anesthetic management of acute head injury.
      2. Understanding of anesthetic management of cerebral vascular surgical procedures including aneurysms, arteriovenous malformations, carotid endarterectomy, extracranial-Intracranial bypass procedure.
      3. Understanding of anesthetic management of supratentorial tumors.
      4. Understanding of anesthetic management of posterior fossa lesions.
      5. Understanding of anesthetic management of the seated position.
    2. Technical Monitoring Skills
      1. Proficiency in cannulation of the jugular bulb.
      2. Proficiency in the use of transcranial Doppler ultrasonography
      3. Proficiency in the us of EEG, somatosensory and brainstem auditory evoked potentials for interested parties. The Department of Anesthesiology does not actively participate in the monitoring program, but arrangement can be made with the Rehab Department for such experience.

Note: Actual experience and knowledge acquired during the fellowship is variable, and is dependent on the fellow's own learning objectives, area of interest, level of motivation, enthusiasm and efforts put into it.

Contact us

Inquiries and applications should be directed to:

Kati Koszegvari
Program Coordinator
Department of Anesthesiology
University of Washington
1959 NE Pacific Street, BB1415
Box 356540
Seattle, WA 98195-6540

E-mail: katibell@u.washington.edu
Phone: 206-221-6453

 

Arthur Lam, M.D.
Professor
Anesthesiology
Harborview Medical Center
Box 359724
University of Washington
Seattle, WA 98195-6540

Voicemail: 206-731-3059
FAX: 206-731-8009
E-mail: artlam@u.washington.edu

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