DEPARTMENT OF SURGERY

GENERAL HOSPITAL PORT OF SPAIN

160 Charlotte Street, Port of Spain
Republic of Trinidad and Tobago
Tel. (868) 623-2951-6/Fax 624-6255

Dr Shaheeba Barrow
Chief of Staff (Ag.)
Port of Spain General Hospital
NWRHA

4th April 2023

Re: Neuroanesthesia Proposal

Dear Dr Barrow

With the hope of continued improvement of the quality of care in POSGH, we would like
to propose the facilitation of a Neuroanesthesia subdepartment. Neuroanestheisa
specializes in the anesthetic peri, intra and postoperative care of patients with
neurosurgical pathologies. This is a new field, but has shown great improvements with
operative outcomes, as Neurosurgery has separated from General Surgery,
Neuroanesthesia focuses on the Neuroscience aspect of general anesthesia. We
propose a select group of the current anesthetic SMOs, be the set anesthesiologists for
all Elective Neurosurgical cases in POSGH.

There is no simple neurosurgical procedure, the highest degree of disability comes from
neurological complications. A devoted subset of anesthesiologists will ensure constant
familiarity of neurosurgical procedures, neurocritical care and neuroprotection. So as to
streamline neurosurgical care, and the recognition and management of intraoperative
neurosurgical complications and events.

Currently, the Neurosurgery team provides coverage for three regional heath authority
populations (NWRHA, ERHA, TRHA). This large population, with a multitude of different
pathologies/ surgical procedures (Spine, Cranial, Vascular, tumors, infections, trauma,
endoscopic, microscopic etc), and a deficiency of elective theater lists leads to complete
confusion on the nuances of anesthetic care for neurosurgical patients. A typical
neurosurgical case, generally requires complex and not mainstream set up of theater
and positioning of patients. Multiple occasions the covering anesthesiologist is
unfamiliar with the non- routine set up, leading to constant delays and complications in
the operating lists.

This further emphasizes the need for a cohesive and familiarity of the entire set up to
rapidly manage any unforeseen complication, or even just be familiar with the
positioning of the various procedures. A small, directed team will ensure this.
The end goal of this proposal will be decrease total operative times, decrease
neurosurgical anesthetic cancellations, decrease neurological complications and of
course vastly improve patient satisfaction, care and outcomes.

Regards

………………………….
Mr Patrick Knight
SMO Neurosurgery
Neurosurgery Department
POSGH

………………………….
Mr Ravindranath Narine
SMO Neurosurgery
Neurosurgery Department
POSGH

………………………….
Mr Robert Ramcharan
SMO Neurosurgery
Neurosurgery Department
POSGH