The Neuroscience in Anesthesiology and Critical Care Program (NACCP) offers a variety of opportunities for those interested in an advanced experience in neuroanesthesia, neurocritical care, and neuroscience research. We accept no more than a small number of candidates each year and thus provide a highly individualized program modifiable to meet a variety of needs.
The typical fellow will spend 12 months with the time divided between clinical work and clinical research. However, our program in neuroanesthesia has been coordinated with major laboratory and/or clinical research training, research-oriented course work within the University and work required for advanced degrees. We provide a core experience in the care of the adult neurosurgical patient and, depending on individual fellow's goals, can provide variable amounts of elective experience in pediatric neuroanesthesia, anesthesia for interventional neuroradiology, neuromonitoring and neurointensive care. Our aim is to train physicians who will be fully prepared to become exemplary attending neuroanesthesiologists in either clinical or academic practice.
The case range is extensive with a predominance of patients requiring intracranial surgery, including for intracranial aneurysms (approximately 80 patients per year). The number of patients requiring craniotomies for tumors and other problems is usually on the order 5-10 per week. We also have a growing seizure surgery practice with about 1-2 patients per week, and one of our neurosurgeons does carotid endarterectomies (about 40 per year). With surgery for the spinal cord and column, shunts and other miscellaneous procedures, the service provides anesthesia for an average of 15-20 neurosurgical cases each week. We use a variety of anesthetic techniques including both general and regional anesthesia for carotid endarterectomies, inhalational and intravenous approaches for intracranial processes and both general and conscious sedation for seizure surgery. Presently we perform about one awake craniotomy per week.
Portions of the fellowship can be spent on the neurophysiological monitoring service. We have close working relationships with experienced, clinical neurophysiologists and can provide experience with intraoperative electroencephalographic monitoring (standard as well as processed) and somatosensory and motor evoked potential monitoring. The degree of monitoring used on some patients is extensive and may include monitoring cranial nerves as well as standard somatosensory sites. Motor monitoring is done using magnetic stimulators as well as direct cortical or spinal cord stimulation.
Neuroanesthesia faculty at Penn work closely with the neurosurgeons to deliver neurocritical care. This improves the continuum of acute care for these patients, fosters collaborative clinical research projects, and provides an additional opportunity for fellows to further augment their clinical experience. The Neuroanesthesia experience can be integrated into a two-year neuroICU fellowship which can lead to certification in Neurocritical care.
Pediatric anesthesiologists at the world-renowned Children's Hospital of Philadelphia are members of the Penn anesthesia department. They take care of children with the full spectrum of pediatric neurosurgical problems. Rotations in pediatric neuroanesthesia can be arranged to be a component of the fellowship.
One important way to consolidate one's knowledge is to teach it. Accordingly, fellows tend to work with second and third year anesthesia residents and have progressively increasing case supervision (and teaching) responsibility as their experience grows. Fellows also play a significant role in our didactic program and have guided experience in lecture preparation and delivery.
A key feature of the training program is a controlled clinical obligation so that virtually all of our trainees have time for clinical or laboratory research. Current research interests include improved techniques for patient cooling and rewarming during neurosurgery, evaluation of origins of postoperative cognitive dysfunction, pathophysiology of traumatic brain injury, and the measurement of local blood flow and its correlation with local brain electrical activity. Our department is unusual in the extent of externally supported funding supporting research activities of clinically active anesthesiologists. A summary of this work can be found in the research section. Notably, we offer the option to participate in our NIH training grant program. Most of our fellows have had at least one publication as a result of their research activities, and many have had more than one.
The Penn neuroanesthesia program has a many-decade tradition of excellence in clinical care, education and research. Our past trainees hold positions at major medical centers including the University of Pennsylvania Health System, the Johns Hopkins Medical Center and the University of Washington Medical Center. Two of our former trainees head Divisions of Neuroanesthesia at major medical centers. Some have gone into private practice and have leadership positions in their practice.
In general, fellow candidates will have completed an anesthesia residency accredited by the Accreditation Council for Graduate Medical Education.
For further information, please contact:
- W. Andrew Kofke, MD MBA
Director, Neuroscience in Anesthesiology and Critical Care Program
Department of Anesthesia
Perelman School of Medicine
To request applications, please contact:
- Jane R. Maugeri
Administrative Coordinator for Critical Care Medicine Fellowship
Department of Anesthesiology and Critical Care
University of Pennsylvania Health System
5 Dulles, 3400 Spruce Street
Philadelphia, PA 19104-4283