NEUROANAESTHESIA

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Sign-off of the Stage 2 Completion of Capability Cluster (Triple C) form will be achieved through:

•  Achievement of the key competencies as evidenced by relevant SLEs

•  Appropriate case numbers and casemix

•  Feedback from trainers (MTR)

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Follow the links below for further details:

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Key Capabilities

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Triple C

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Subspecialties

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NBT Stroke Thrombectomy guideline (opens in new page)

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An excellent training resource from NACCS (opens in new page)

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There are 2 Key Capabilities within the Neuroanaesthesia section of the General Anaesthesia domain. The HaLO Guide states examples of evidence for these Key Capabilities “include SLEs from experience in Neurosurgery”. As you may not find this helpful (!) we have provided pragmatic suggestions for Supervised Learning Events below each Key Capability:

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Key Capability M – Applies relevant anatomical, physiological and pharmacological principles to neurosurgical patients

• CbD on the physiological parameters targeted in intracranial neurosurgery

• CbD on the effects of anaesthetic drugs on the CNS system (NMBs, opioids, TIVA vs Volatile)

• CbD on the physiological and pharmacological techniques for reducing ICP

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Key Capability N – Provides safe anaesthetic care to ASA 1-3 adults for simple elective and emergency intracranial, spinal and neuroradiological procedures under local supervision

• ACEX / CbD / ALMAT for elective / emergency intracranial surgery

• ACEX / CbD / ALMAT for elective / emergency spinal surgery

• ACEX / CbD for elective / emergency coiling or stroke thrombectomy

• CbD for recognition and management of the patient with an unstable cervical spine

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Additional Key Capabilities

There is another Key Capability within the General Anaesthesia domain specific to Neuroanaesthesia. Suggestions for SLEs are listed below.

 

Key Capability F – Applies physiological and pharmacological principles to reduce the risk of secondary brain injury in patients presenting with a severe head injury

• ACEX / CbD on the management of raised ICP in Theatre

• ACEX / CbD on the management of raised ICP on ICU

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Finally, there is a Key Capability within the General Anaesthesia Domain which, although not specific to Neuroanaesthesia, would be easy to achieve during the block given the positions commonly used for Neurosurgery.

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Key Capability G – Recognises, mitigates against risks and manages complications relating to patient positioning during surgery, including reference to the obese patient

• DOPS on proning a patient

• CbD on the risks of prone position and how this is mitigated

• CbD on the risks of the lateral position and how this is mitigated

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Completion of Capability Cluster (Triple C) form sign-off

To achieve sign-off of the Triple C form the following are suggested:

1. Achievement of Learning Outcome – the trainee feels able to provide safe anaesthetic care to ASA 1-3 adults for simple elective and emergency intracranial, spinal and neuroradiological procedures under local supervision

2. SLEs – Each Key Capability requires at least one SLE to allow sign-off. Ideally more will be obtained

3. Logbook showing evidence of a casemix of intracranial, spinal and neuroradiological cases. 20 cases has been used historically as a rough benchmark for achieving sign-off. No specific number of each subspecialty is suggested, but experience of all three is recommended

4. Multi-Trainer Report: This should be set up by your Educational Supervisor at the start of your module – label ‘neuroanaesthesia MTR’. It can run alongside your other MTRs i.e. you can have more than one going at a time

 

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How do I generate a Triple C on the LLP?

On LLP:

1. Open a General HaLO (Stage 2) – create HaLO will turn this blue on your LLP

2. Complete all appropriate SLEs and associate these with the neuro related capabilities M and N but also F and G (and any others deemed appropriate)

3. Ask educational supervisor to open a neuroanaesthesia MTR at the beginning of neuro placement and add consultants for feedback (label this as 'neuroanaesthesia MTR'). You can keep adding more consultants to this as you go but you need 3 to start with.

4. Create neuro CCC form

5. Add detailed neuro logbook to CCC form as a PDF (need to have type of cases, age, emergency/elective etc)

6. Neuro sign off consultant needs to be added to LLP as a clinical supervisor, (not your ES), which is done by editing your placement profile.

7. Once neuro CCC form has been approved and signed off, remove neuro sign off consultant from LLP

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There is no Triple C Form for Stage 3.

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Subspecialty lists

As of June 2024 the following surgeons undertake these subspecialties:

• Intra-cranial tumour: Mr Neil Barua (+ awake craniotomy), Mr Constantinos Charalambides, Mr George Malcolm, Mr Venkat Iyer

• Skull-Base: Mr Mario Teo (acoustic), Mr David Porter

• Endocrine: Mr Adam Williams, Mr Kumar Abhinav (+ extended endonasal)

• Neurovascular: Mr David Porter, Mr Mario Teo (+ EC-IC bypass), Mr Kumar Abhinav

• Neuromodulation: Mr Adam Williams, Ms Reiko Ashida, Mr Nik Patel (pain modulation / MVD)

• Epilepsy: Mr Angelo Picchierri

• CSF/Hydrocepahlus: Mr Richard Edwards

• Spine: Mr Nitin Patel, Ms Naomi Slater (+ general neuro), Mr Crispin Wigfield (+ general neuro), Mr Mark Nowell

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