Guidelines for the management of devastating brain injury

Produced in conjunction with several other stakeholders.

Guidelines for the provision of anaesthetic services – services for neuroanaesthesia and neurocritical care

The NACCS and the Standards committee of the Royal College of Anaesthetists have worked together to produce the Neuroanaesthetic department chapter for the Colleges’ Guidelines for the Provision of Anaesthetic Services (GPAS) Document. This document provides guidance on the resources and service provision required to run and develop a department of neuroanaesthesia. This can be accessed here.  Feedback to the society will be welcome as we will be reviewing and updating the document year on year.

 Management of cardiac arrest during neurosurgery in adults

The resuscitation council have worked jointly with NACCS and SBNS to produce this guidance. This provides a useful overview of the issues amd problems associated with a cardiac arrest occurring a spinal or neurosurgical procedure. It covers resuscitation according to patient position, as a well as dealing with such issues as defibrillation if the patient is in pins, managing an open head wound and air embolism. The document can be accessed here .

 Joint statement by NACCS and SBNS on the measurement of CPP

After requests from members of the society for the NACCS to take a view on standards for monitoring and calculating CPP, the following joint statement has been agreed with the SBNS: Joint position statement by the Councils of the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland(NACCS) and the Society of British Neurological Surgeons (SBNS) with regards to the calculation of cerebral perfusion pressure in the management of traumatic brain injury.

Standards for providing safe acute ischaemic stroke thrombectomy services

 The NACCS welcomes and fully supports this document as an important first step in introducing a standard of care for those patients who require urgent thrombectomy after failed thrombolysis for ischaemic stroke. Although thrombectomy is still not in itself a recognised standard of therapeutic intervention for stroke patients and large studies are still on going to look at this, those patients within these studies still need a standard of care to which we should aspire. For those of us who work in units with a clearly defined neuroanaesthetic emergency on call rota, then this standard is clear with regard to what is recommended. However the NACCS is aware that not all neuroscience units have a separate neuroanaesthetic on call rota, thus a statement to clarify the recommendation is appropriate. “The anaesthetic care of these patients should be supervised by Neuroanaesthetists with skilled assistance. It should be consultant led.”  As contributors to this document, the NACCS is clear that the Neuroanaesthetic supervision in this case is to the service and not to the care of each individual patient. The intention is that the service including audit should be overseen, and any local policies and guidelines drawn up by a Consultant Neuroanaesthetist within the centre. It is not the intention that all of these patients need to have a consultant Neuroanaesthetist present. However we do agree that it should be a Consultant Anaesthetist delivered service.