DM Neuroanaesthesia: Admissions, Medical Colleges, Eligibility Criteria, fee details

Course contents:

i) General principles:

1. General principles of Critical Care

2. Organization of Critical Care

3. An awareness of the importance of communication skills and interpersonal relationships

4. Various Scoring Systems

5. Admission and Discharge criteria in Neuro-intensive Care Unit

6. Transport of the patients – pre-hospital and intra-hospital

7. Internal Audit

8. Medical Ethics

9. Principles of consent taking and details of informed consent

10. Sterilization procedures

11. Maintenance of asepsis

12. Organizational capabilities, leadership qualities required to administer, manage and delegate responsibilities in Critical care

13. Training on development of protocols for Critical care management

14. Behaviour and team work in neuro critical care

15. Anaethetic management of various CNS tumors

ii) Basic Neuroanatomy and Neurophysiology

1. Anatomy of the brain and spinal cord

2. Physiology of the brain and spinal cord

3. The cerebrospinal fluid circulation

4. Cerebral and spinal circulation, metabolism and effects of various anaesthetics (inhalational and intravenous agents)

5. Intracranial pressure and various herniation syndromes

6. Determinants of brain elastance, cerebral perfusion pressure, cerebral autoregulation, and metabolic coupling

7. Mechanism of neuronal injury and brain protection

(iii) Respiratory physiology

1. Physiology of spontaneous respiration and mechanical ventilation

2. Indications for mechanical ventilation

3. Modes of ventilation

4. Weaning from ventilatory support

5. Complications of mechanical ventilation – recognition and management

6. Monitoring during ventilatory support

(iv) Cardiovascular physiology:

1. Recognition and management of arrhythmias

2. Management of hemodynamic disturbances – hypotension, hypertension, myocardial ischemia, pulmonary edema and heart failure

3. Knowledge of commonly employed vasoactive and anti-arrhythmic drugs

(v) Renal physiology:

1. Fluid and electrolytes physiology and pathophysiology

2. Prevention, diagnosis and management protocol for acute kidney disease

3. Basic knowledge of dialysis

(vi) Metabolic disorders

1. Pathophysiology and management of the Electrolyte disturbances in neurosurgical patients

2. Acid-base disorders

3 Understanding of endocrine disorders

(vii) Neurologic diseases

1. Neurologic examination

2. Manifestations of lobar syndromes

3. Neurological illnesses which can cause altered sensorium and critical care management

4. Differential diagnosis and work-up of patients presenting to Critical care.

5. Evaluation of patients in altered mental status with various coma Scores, stroke score

6. Nomenclature/criteria of altered levels of consciousness (coma, persistent & permanent vegetative states, minimally conscious states, etc)

7. Pathophysiology, and therapy of coma arising from metabolic, traumatic, infectious, mass lesions, vascular-anoxic or ischemic, drug induced events

(viii) Specific Neurological diseases

1. Status epilepticus, refractory status epilepticus, super refractory status epilepticus, epilepsy and encephalopathies

2. Understanding the pharmacology and interactions of various anti-epileptic drugs

3. Guillian-Barrie syndrome

4. Muscle dystrophies with complication

5. Systemic illnesses causing neurological manifestations:

Neuropathy, myopathy, dyselectrolytemias, renal and hepatic failures, multi organ failure etc.

6. Myasthenia gravis

7. Stroke (cerebrovascular accidents) and CVT (cortical venous thrombosis)

8. Other neurological diseases requiring ICU management

(ix) Neuroinfections

1. Bacterial, Viral, Fungal meningitis

2. Causative organisms of community-acquired & noscomial meningitis / ventriculitis / abcesses along with preferred antibiotic agents

3. Describe the pharmacodynamic/ pharmacokinetic principles influencing CNS antibiotic activity

(x) Peripheral Motor Neuron Disease

1. Review the natural history/expression of motor neuron disease related to degenerative diseases, infectious agents and inflammatory conditions

2. List the changes that occur in denervated muscles and implications for use of medications with activity at the neuro-muscular junction

3. Understand the presentation of respiratory failure and indications for non-invasive and invasive ventilatory support

4. Indications for and problems associated with plasmapheresis and intravenous immunoglobulin

5. Review the non-neurologic complications and management of motor neuron disease (cardiac denervation, intestinal movement disorders)

(xi) Traumatic Brain Injury:

1. Pre-hospital care of the patient with neurologic injury

2. Resuscitation of the head injured

3. Airway management -conventional laryngoscopic intubation, insertion of LMA, fibreoptic intubation, manual inline stabilisation (MILS), use of videolaryngoscope and surgical airway

(xi) Pharmacology

1. Basic idea on pharmacodynamics and pharmacokinetics of drugs, drug interactions, complications of various drugs used in neurological patients

2. Sedatives and anaesthetic agents

3. Analgesics - Narcotics and non-narcotic agents

4. Muscle relaxants

5. Anticonvulsants

6. Vasopressors and ionotropes

7. Antibiotics

8. Steroids

(xii) Brain Death:

1. Criteria, determination and certification of Brain death

2. Differential diagnosis e.g. drug induced, locked-in syndrome, etc

3. Organ donation: metabolic and hemodynamic management pending organ harvesting

(xiii) Cerebral Vascular Accidents:

1. Pathophysiology of stroke and management

2. Treatment modalities for arterial and venous stroke

3. Long term care of stroke patient, rehabilitation

4. Understand the indications/contraindications/side effects of intrarterial / intravenous thrombolysis in ischemic cerebrovascular accident

5. Describe the natural history, risk factors and management options for "malignant infarcts". Understand about surgical options

6. Describe the natural history of intracerebral haemorrhage along with the role of early surgical interventional, and medical treatment (i.e. Blood pressure & glycemic control, administration of factor VIIa)

(xiv) Subarachnoid Hemorrhage:

1. Various types of cerebral aneurysms

2. Describe the common aneurysm locations leading to SAH

3. Understand the clinical and radiographic grades of SAH

4. Methods used to detect cerebral vasospasm & strategies to treat Cerebral vasospasm to prevent secondary ischemic stroke

5. Indications for temporary external ventricular drains / permanent Shunts

6. Non-neurological complications of SAH and their management

7. Surgical clipping and coiling of cerebral aneurysm

8. Giant intracranial aneurysms and their implications

9. Anastomotic procedures in cerebral ischemia

(xv) Toxicity of anaesthetic agents on developing brain

(xvi) Monitoring in Critical Care

1. Neurological monitoring at the bedside

2. EEG- understanding basic EEG, role of continuous EEG monitoring in ICU

3. Monitoring cerebral oxygenation

4. Monitoring cerebral blood flow

5. Monitoring biomarkers

6. Hemodynamic monitoring

7. Respiratory monitoring

8. Intracranial pressure monitoring

(xvii) Nutrition in the neuro-critical care

1. General principles and indications

2. Total parenteral nutrition—indications, advantages/ disadvantages

3. Enteral nutrition: indications, advantages, and side effects

4. Nutrition in presence of metabolic and systemic diseases

(xviii) Neuroimaging

1. Basics of neuroradiology

2. CT, MRI, TCD (Trans cranial Doppler), USG (Ultrasound)

3. Interventional Neuroradiologic procedures

4. Identify the basic structures in the central nervous system (ventricles, cisterns, sinuses, major anatomic landmarks)

5. List the imaging techniques/signs used to identify acute intracranial hemorrhages, mass lesions, arterial and venous lesions, and ischemic penumbras / infarcts

6. Distinguish imaging characteristics of SAH, epidural hematomas, subdural hematomas, intra - parenchymal hemorrhage and relate to anatomic structure

7. Understanding the concepts of medical and surgical managements of various emergencies based on imaging and various decision paradigms

8. Management of complications in neuroradiological procedures

(xix) Neuro-rehabilitation

Head injured and spinal cord injured patients

1. Prevention of acute problems

2. Attendant training and counselling

3. Understanding long term goals in neuro- rehabilitation

(xx) Chronic neurological diseases

1. Stroke

2. Brain tumours postoperative

3 Epilepsy

(xxi) Temperature regulation

1. Understand the physiology of temperature regulation in OT and ICU and management of hypothermia/ hyperthermia in the neuro-intensive care population

Psychomotor Domain

At the end of the course the student should be able to perform independently the following:

(I) Procedures in the OT and ICU

1. Arterial line placement

2. Central venous line placement

3. Tracheostomy – surgical and percutaneous dilatational tracheostomy

4. Chest drain insertion

5. Care of patients with invasive equipment e.g ICP monitor, EVD Deep epilepsy electrode , grid, etc.

6. Patient controlled analgesia pump

7. Application of trancranial Doppler

8. Ultrasound and its applications

9. Bronchoscopy

10. Transfer of critical neurosurgical patients to different areas of hospital

(II) Traumatic Brain/Spinal Cord Injury Management of TBI (Traumatic Brain Injury)

1. Assessment and resuscitation

2. Airway management

3. Laboratory and radiological investigations

4. Pathophysiology of head injury

5. Factors causing secondary injury

6. ICP (Intracranial pressure) - physiology and pathophysiology, and principles of management. Controversies of ICP monitoring in TBI

7. CPP (Cerebral perfusion pressure); its role in TBI management, concept of individualized CPP

8. ICP-CPP targeted management of TBI

9. Biochemical markers of brain injury, molecular and cellular mechanisms of injury

10. Brain Trauma Foundation Guidelines in the management of TBI / spinal cord Injury

11. Role of hyperventilation in traumatic brain injury

12. Methods available to measure/estimate ICP/ cerebral perfusion along with advantages and disadvantages of each method

13. Approaches to management of refractory ICP elevation

Management of Spinal cord injury

1. Resuscitation and care of the affected area

2. Airway management of C-spine injury

3. Pathophysiology of spinal cord injury

4. Conservative management of spine injury

5. Role of steroids administration in spinal cord trauma

6. Spinal shock and autonomic hyperreflexia

7. Care of the cardiovascular and pulmonary complications

(III) Miscellaneous

1. Sepsis - Pathophysiology and management

2 Haemodynamic management

3. Pregnancy and Neurosurgery

4 Cyanotic heart disease and neurosurgery

5. Multiple Organ Dysfunction Syndromes

6. Nosocomial infections

7. Antibiotics and immunotherapy

8. Reperfusion injury and antioxidants

9. Shock-types and management

10. Deep vein thrombosis prophylaxis, management and Pulmonary Embolism

11. Coagulopathies and their management

12. Infection Control in the ICU

13 Sterilisation procedures in ICU

14. Patient safety and prevention of adverse effects

15 Management of cardiac patients on antiplatelets/anticoagulants

16. Clinical Audit

17. Various ethical issues in Neurointensive care

18. End of life care issues in the intensive care unit

Career Options

After completing a DM in Neuroanaesthesia, candidates will get employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from which include Registrar, Senior Resident, Demonstrator, Tutor etc.

While in the Private sector the options include Resident Doctor, Consultant, Visiting Consultant (Neuroanaesthesia), Junior Consultant, Senior Consultant (Neuroanaesthesia), Neuroanaesthesia Specialist.

Courses After DM in Neuroanaesthesia Course

DM in Neuroanaesthesia is a specialisation course that can be pursued after finishing a Postgraduate medical course. After pursuing specialisation in DM in Neuroanaesthesia, a candidate could also pursue certificate courses and Fellowship programmes recognized by NMC and NBE, where DM in Neuroanaesthesia is a feeder qualification.

Frequently Asked Question (FAQs) –DM in Neuroanaesthesia Course

Question: What is the full form of DM?

Answer: The full form of DM is a Doctorate of Medicine.

Question: What is a DM in Neuroanaesthesia?

Answer: DM Neuroanaesthesia or Doctorate of Medicine in Neuroanaesthesia also known as DM in Neuroanaesthesia is a super specialty level course for doctors in India that is done by them after completion of their postgraduate medical degree course.

Question: What is the duration of a DM in Neuroanaesthesia?

Answer: DM in Neuroanaesthesia is a super specialty programme of three years.

Question: What is the eligibility of a DM in Neuroanaesthesia?

Answer: Candidates must be in possession of a postgraduate medical Degree (MD/MS/DNB) from any college/university recognized by the Medical Council of India (now NMC)/NBE.

Question: What is the scope of a DM in Neuroanaesthesia?

Answer: DM in Neuroanaesthesia offers candidates various employment opportunities and career prospects.

Question: What is the average salary for a DM in Neuroanaesthesia candidate?

Answer: The DM in Neuroanaesthesia candidate's average salary is between Rs. 5,00,000 to Rs. 18,00,000 per year depending on the experience.

Question: Can you teach after completing DM Course?

Answer: Yes, candidate can teach in a medical college/hospital after completing DM course.