Updates in Neuroanesthesia

Providing anesthesia care to neurosurgical and neurocritical care patients presents unique challenges to the anesthesiologist. Over the last century, anesthetic care for such patients has become a robustly studied field, with tools and techniques to keep patients safe and comfortable in the perioperative period. A review of the major updates and considerations for perioperative care for awake craniotomies, thrombectomy for stroke, and endoscopic neurosurgery is critical for the anesthesiologist. Additionally, newly developed enhanced recovery after surgery procedures have improved patient experiences and outcomes after both cranial and spinal neurosurgery. Finally, post-operative delirium is a major neurologic complication in elderly patients undergoing all types of procedures which all anesthesiologists should be well versed in. Here, such topics are reviewed with a focus on recent updates to the literature which are important for clinical practice

Creating Long-Lasting Clinical Connections: A Trainee-Centered, Leadership-Based Perspective on Provider-Patient Relationship

The nature of provider-patient relationship (PPR) goes far beyond the simplified paradigm of “chief complaints,” “clinical problems” and corresponding “therapeutic solutions.” In order to more comprehensively explore the scope of PPR in the context of leadership-based partnership (LBP), various factors and their contributions were researched in terms of both the success and optimization of health-care interactions. This is especially relevant to graduate medical education (GME) and advanced practice (AP) training programs. There are numerous nuances to PPR, including various communication, behavioral, ethical and leadership considerations. Body language and tone of voice are essential in establishing rapport, beginning with the so-called ‘first impression,’ which serves as a foundation for developing the PPR. Health-care providers (HCPs) with greater ability to empathize with their patients may achieve higher levels of treatment adherence, better clinical outcomes, and ultimately increased patient satisfaction. The inclusion of a patient as a co-leader and an essential member of their health-care team (HCT) should be a natural step and a top priority for GME and AP trainees. Such collaboration requires an open-minded approach by all stakeholders. Finally, recognizing patient well-being in all domains, including physical, emotional and spiritual, is critical to the holistic approach toward maximizing the benefits of an optimal PPR. Same can be said about the HCP. In this chapter, we will explore key aspects of PPR in the context of both the trainee and the patient being co-leaders within the bounds of the LBP framework