EDUCATION COMMITTEE

A Sneak Peek at SNACC’s New Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies

By John Bebawy, MD
Chair of Education Committee

Amie Hoefnagel, MD
Member of Education Committee

John F. Bebawy, MD
John F. Bebawy, MD
Amie Hoefnagel, MD
Amie Hoefnagel, MD

Utilization of cognitive aids and evidence-based checklists in complex situations is no longer a novel concept in the operating room. The purpose of these aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the crisis are considered and accounted for and that the task at hand is completed fully, despite possible distractions. As clinicians, we are already quite familiar with checklists and algorithms and encounter them in our day-to-day practice in the form of “timeouts,” and more rarely for crisis management, such as adherence to the American Heart Association Advanced Cardiac Life Support (ACLS) guidelines. In recent years, several groups (Ariadne Labs, the Stanford Anesthesia Cognitive Aide Group, The Society for Pediatric Anesthesia) have developed and published cognitive aids for the treatment of anesthetic emergencies. The SNACC Education Committee felt it was important to provide clinicians with similar guidelines tailored to the treatment of neuroanesthetic emergencies. Our cognitive aids and an accompanying manuscript detailing the evidence base for these recommendations were designed to provide an expert consensus for the treatment of neuroanesthetic emergencies based on the current available literature.   

A small group comprised of neuroanesthesiologists, neurocritical care intensivists, and neuroscientists from all over the world were selected to participate in this endeavor. Upon completion of the first draft of the manuscript and cognitive aids, these items were released to all of the SNACC membership for an open comment period and some very helpful feedback was incorporated. For the purposes of this project, we identified 11 neuroanesthetic emergencies: acute stroke, aneurysm rupture in the OR or IR, autonomic hyperreflexia, major bleeding in spine surgery, delayed emergence, acute increase in ICP, loss of evoked potentials, seizure during craniotomy, acute vasospasm and venous air embolism. For each scenario, we developed a step-by-step guide for patient management, which conveniently fits on a standard sheet of paper. Each algorithm is divided into color-coded sections for steps to stabilize the patient, provide further treatment, drugs and dosages and common causes or differential diagnoses. The cognitive aid “cards” are designed to be printed and collated into a manual that can be physically placed into the operating room so that they can be readily utilized in the event of an emergency. Each event is accompanied by an evidenced-based summary of treatment recommendations.  

You can find the article (“Published Ahead of Print” at this time) on the Journal of Neurosurgical Anesthesiology (JNA) website. The manuscript and accompanying cognitive aid cards will be available on the SNACC website as well (via a JNA link) when the article is officially published in the January 2019 issue of JNA. 

We hope you, the SNACC membership, will enjoy and benefit from the results of this endeavor. As always, please feel free to give us on the Education Committee your feedback as to how we can continue to deliver the highest quality products for your teaching and clinical practice.

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