Neuroanesthesia Division
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Our UVA Neuroanesthesia Faculty
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Neuroanesthesia Doctors Priya Singla, MD & Bhiken Naik, MBBCh discuss an upcoming spinal case.
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Dr. Zhiyi Zuo, MD, PhD, and Dr. Nadia Lunardi, MD, PhD discuss Neuroanesthesia procedures.
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Dr. Zhiyi Zuo, MD, PhD prepares for a day in the OR.
About
Neuroanesthesia as a subspecialty practice in the Department of Anesthesiology at the University of Virginia (UVA) dates back to 1977 when Dr. Robert Bedford joined the department as a faculty member. He became a national figure in neuroanesthesia, publishing clinical findings on intracranial pressure and hemodynamic changes during neurosurgical procedures. The division has other notable alumni, such as Dr. David Stone.
The Neuroanesthesia Division now has 10 faculty members covering the full range of neurosurgery cases and major orthopedic spine cases. These include functional neurosurgery, brain tumor surgery and intracranial aneurysm surgery. There is also a state-of-art facility where intraoperative magnetic resonance imaging (MRI) can be performed. In addition, the University of Virginia hospital is a comprehensive stroke care center. Our faculty covers stroke calls around the o’clock. In total, we perform about 2400 neurosurgical cases each year in the operating rooms
A Message from the Division Chief
Nadia Lunardi, MD, PhD, Neuroanesthesia Division Chief
The Neuroanesthesia Division is very dynamic. Our faculty provide excellent care to patients and also excels in education and research. We have developed a comprehensive educational curriculum for medical students, residents and trained neuroanesthesia fellows.
Diverse faculty academic interests include: education and simulation training, educational research, basic science and translational research, and data science. A unique feature of the division is that three faculty members attend intensive care units, including a neurosurgical intensive care unit. These faculty members provide perspectives on how patients do after surgery and an opportunity to broaden the view of patient care for neurosurgical procedures.
We look forward to collaborative work on education, research and patient care. We also welcome talented people to join us, either as a trainee or as a member of the team.
Our Division
Nadia Lunardi, MD, PhD
Nadia Lunardi, MD, PhD
Dr. Lunardi is an Associate Professor of Anesthesiology and Critical Care, and is the Principal Investigator of a Neuroscience research laboratory. She provides intraoperative and postoperative care to neurosurgical and neurological patients in the operating room and in the Neuro Intensive Care unit. Her laboratory’s research focus is on the interactions between anesthetics and sleep, and the mechanisms of postoperative delirium.
She is recognized as a local and national leader in her field of research, serving as UVA Neuroscience Graduate Program mentor and having received prestigious research awards from the International Anesthesia Research Society and the National Institutes of Health.
Read Dr. Lunardi’s Full Bio
Link to Dr. Lunardi’s Publications
Vaia T. Abatzis, MD
Vaia T. Abatzis, MD
Vaia Abatzis, MD is an associate professor of anesthesiology at the UVA School of Medicine. She is a neuroanesthesiologist specializing in providing anesthesia to patients having surgery for brain tumors, cerebral aneurysms, and complex spine surgeries. Dr. Abatzis is especially interested in providing care for patients who need to be awake for brain surgery.
As Medical Co-Director for the School of Medicine’s Simulation Center and Director of the Peri-Operative Medicine Clerkship, Dr. Abatzis is actively involved in training medical students and residents. Her research interests are in medical education, including medical simulation, Entrustable Professional Activities (EPAS), crisis management, interprofessional education, curriculum development, and faculty development. She has been awarded multiple medical education grants from UVA for work with EPAs and ACLS. In addition, she has been honored with the UVA Dean’s Excellence in Teaching Award for her outstanding teaching as director of the perioperative medicine clerkship.
Dr. Abatzis was born in Greece and grew up in Northern Virginia. She received her undergraduate degree in biology from Georgetown University and her doctorate from The Johns Hopkins School of Medicine. She completed her medical internship,
anesthesiology residency, and medical simulation education and research fellowship at the University of Virginia. Dr. Abatzis and her sons enjoy all the wonderful outdoor activities in Charlottesville. You can find them hiking, biking, or kayaking almost every weekend.
Read Dr. Abatzis’ Full Bio
Link to Dr. Abatzis’ Publications
David L Bogdonoff, MD
David L Bogdonoff, MD
Dr. David Bogdonoff is an Associate Professor of Anesthesiology. He graduated from the Rochester School of Medicine and Dentistry. He then matriculated to the Milton S. Hershey Medical Center of The Pennsylvania State University to complete a residency program in Surgery, where he had the honor of serving as Chief surgical resident his final year of training. Dr. Bogdonoff continued his specialized training with an anesthesiology residency at the University of Virginia.
He is Board certified in both surgery and anesthesiology.
As a lifelong learner he has continued his education through the UVA Health Sciences Leadership Program at the UVA Darden Graduate School of Business Administration and the
Leadership Development for Physicians in Academic Health Centers at the Harvard School of Public Health. He has published widely in the area of surgical and anesthesia peri-operative medicine and has become an expert in OR management.
Dr. Bogdonoff served as the Vice-Chair for Clinical Affairs and as the head of Hepatic Transplantation Anesthesia. He was instrumental in the building and implementing of EPIC Anesthesia for UVA. He currently serves as our EPIC Physician Liaison.
Read Dr. Bogdonoff’s Full Bio
Link to Dr. Bogdonoff’s Publications
Lauren K. Dunn, MD, PhD
Lauren K. Dunn, MD, PhD
Dr. Dunn is an Associate Professor of Anesthesiology and Neurological Surgery. Her clinical work focuses on the care of patients undergoing craniotomy and complex spine surgery, as well as general anesthesia. Her research interests are analgesia and postoperative pain management, sleep and fatigue and physician well-being.
She is the recipient of a Foundation in Anesthesia Education and Research (FAER) Research in Education Grant studying interventions to improve anesthesiology resident wellness. She is a member of the American Society of Anesthesiologists Committee on Physician Well-being and Committee on Women and serves on the Editorial Boards for Anesthesia & Analgesia and the Journal of Neurosurgical Anesthesiology.
Kamilla Esfahani, MD
Kamilla Esfahani, MD
Kamilla Esfahani, MD, is an Assistant Professor of anesthesiology at the University of Virginia. She received her undergraduate degree and medical doctorate from Georgetown University, after which she attended UVA for her residency in anesthesiology. She completed a year-long fellowship in neuroanesthesia at UVA Health.
Dr. Esfahani is involved in resident education and curriculum development. Her interests also extend to gender equity research and diversity and inclusion advocacy. She is a polyglot and first generation Iranian-German, transplanted to the United States. She enjoys making special connections with her patients and being able to support them through one of the hardest days in their lives, particularly in the case of brain tumor resections and intracranial vascular repairs.
Read Dr. Esfahani’s Full Bio
Link to Dr. Esfahani’s Publications
Bhiken Ishwarlal Naik, MBBCh, MSCR
Bhiken Ishwarlal Naik, MBBCh
Dr. Naik is a tenured Associate Professor of Anesthesiology and Neurological Surgery, as well as the Associate Medical Director of the Nerancy Neuroscience Intensive Care Unit and Program Director of the Anesthesia Critical Care Fellowship at the University of Virginia.
He is board certified in Anesthesiology, Critical Care and Neurocritical Care through the American Board of Anesthesiology. His clinical practice encompasses patients with neurological diseases in the operating room and intensive care unit. Dr. Naik’s research interest includes predictions of postoperative complications, creating data equity for low-middle-income countries and developing recovery trajectories after surgery using mHealth technology.
Dr. Naik is the Principal Investigator for the Multicenter Perioperative Outcomes Group at UVA and is currently completing his Masters in Clinical Research at the School of Public Health. He serves on multiple national committee’s including the American Society of Anesthesiologist, Society of Neuroscience in Anesthesiology and Critical Care and the North American Spine Society.
Thomas N. Pajewski, MD, PhD
Thomas N Pajewski, MD, PhD
Dr. Pajewski is an Associate Professor of Anesthesiology in the Department of Anesthesthesiology at the University of Virginia who also holds a secondary appointment in the Department of Neurosurgery. He joined the faculty in 1992 and served as director of the Division of Neuroanesthesiology from August 2000 to April 2020.
Dr. Pajewski specializes in the care of patients undergoing neurosurgical procedures for diseases of the central nervous system including the brain and the spine. He is particularly interested in optimizing the care of patients undergoing complex spine operations.
Priyanka Singla, MD
Priya Singla, MD
Dr. Singla was born and grew up in New Delhi. She attended medical school in India. Dr. Singla joined the University of Virginia (UVA) faculty in 2016 as a research associate. She completed both an internship in general surgery followed by a residency in anesthesiology at UVA.
During the course of her anesthesia training in two different countries, pain became the medical specialty that intrigued her the most. Dr. Singla completed a fellowship in pain medicine, as she truly believes she can make a difference in patient’s lives by treating their pain. She enjoys teaching young medical students and is the Assistant Clerkship Director for fourth year medical students.
Her research interests include exploring novel interventional procedures for chronic pain relief. She was the first pain physician in the state of Virginia to implant the novel neurostimulation system for restorative therapy for low back pain.
Danny J. Theodore, MD
Danny J. Theodore, MD
Dr. Danny Theodore is the Director of Respiratory Therapy and the Associate Fellowship Director of the Anesthesia Critical Care Fellowship. He is an Associate Professor of Anesthesiology and specializes in critical care and neurocritical care. He is dual board certified in neuro critical care.
Dr. Theodore is heavily involved in the Society of Critical Medicine as a member of the neurocritical care subcommittee and the respiratory care subcommittee. He is also currently the SCCM national representative for respiratory care and holds the title of Fellow of the American College of Critical Care Medicine. His current research interests are in traumatic brain injury and acute respiratory distress syndrome
Read Dr. Theodore’s Full Bio
Link to Dr. Theodore’s Publications
Zhiyi Zuo, MD, PhD
Zhiyi Zuo, MD, PhD, Executive Vice-Chair
Zhiyi Zuo, M.D., Ph.D., is a physician-scientist and has been a faculty member at the University of Virginia for more than 20 years. He takes care of the full range of neurosurgery patients and patients for other surgeries.
Currently, his research team focuses on two projects: 1) mechanisms of postoperative cognitive dysfunction and delirium, and 2) cerebral vascular remodeling and brain ischemic injury. His research has been funded continuously by extramural funding for more than 20 years and is well cited.
He has been awarded by many professional societies, such as American Society of Anesthesiologists that is the largest anesthesiologist society in the world, for his research work.
Read Dr. Zuo’s Full Bio
Link to Dr. Zuo’s Publications
The Neuroanesthesia Rotation
The Neuroanesthesia Rotation offers a great variety of cases and exposure to complex neurosurgical procedures. These procedures include craniotomy for tumor resection and arteriovenous malformations, endovascular and open treatment of aneurysms, transsphenoidal pituitary surgery, and advanced functional surgeries, such as deep brain stimulator placement, focused ultrasound and epilepsy surgery.
Our renowned spine surgeons perform significantly large spinal fusions (with multiple levels) that require advanced monitoring, and often significant resuscitation. The neuroanesthesia rotation exposes residents to many advanced techniques, including asleep and awake fiberoptic intubation, alternative airway techniques, anesthesia to facilitate neurophysiological monitoring, thromboelastography and ICP monitoring. There are two operating rooms with capability for intraoperative MRI as well as a Comprehensive Stroke Center with a large referral area for interventional thrombectomy procedures.
UVA Neurosurgery and Neurology are consistently ranked in the top fifty in the nation resulting in significant referrals of complex cases. The Neuroanesthesia Division faculty are nationally recognized for our excellence in research and in education.
Society for Neuroscience in Anesthesia and Clinical Care (SNACC)
The Society for Neuroscience in Anesthesia and Critical Care (SNACC) under the Trainee Engagement Committee developed a curriculum resource for residents to utilize during their Neurosurgical Anesthesia rotations. The “Neuroanesthesia Classroom” project is led by Dr. Kamilla Esfahani and Dr. Lauren Dunn.
We divided the core concepts into Basic and Advanced Neuroanesthesia Classrooms with week-by-week guides. The goal is to provide junior and senior anesthesiology residents with focused exposure to PBLDs, articles, and CME questions among other valuable SNACC resources to supplement their learning during a four-week neuroanesthesia rotation.
Faculty members in the division have been investigating how to improve patient outcomes during the perioperative period and assess residents’ performances in order to provide the best patient care.
Y Li, D Chen, H Wang, Z Wang, F Song, H Li, L Ling, Z Shen, C Hu, J Peng, W Li, W Xing, J Pan, H Liang, Q Zhou, J Cai, Z He, S Peng, W Zeng, Z Zuo. “Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery A Multicenter, Randomized Trial.“ Anesthesiology 134:381-394, 2021.
Q Zeng, We Shan, H Zhang, J Yang, Z Zuo. “Paraventricular thalamic nucleus plays a critical role in consolation and anxious behaviors of familiar observers exposed to surgery mice.“ Theranostics 11:3813-3829, 2021.
Z Lai, W Shan, J Li, J Min, X Zeng, Z Zuo. “Appropriate exercise level attenuates gut dysbiosis and valeric acid increase to improve neuroplasticity and cognitive function after surgery in mice.“ Molecular Psychiatry In press (2021 Oct 18. doi: 10.1038/s41380-021-01291-y)
Dunn LK, Kleiman AM, Forkin KT, Bechtel AJ, Collins SR, Potter JF, Kaperak CJ, Tsang S, Huffmyer JL, Nemergut. “Anesthesiology Resident Night Float Duty Alters Sleep Patterns: An Observational Study.“ EC.Anesthesiology. 2019 Aug;131(2):401-409. doi: 10.1097/ALN.0000000000002806.PMID: 31149926
Dunn LK, Thiele RH, Lin MC, Nemergut EC, Durieux ME, Tsang S, Shaffrey ME, Smith JS, Shaffrey CI, Naik BI.Neurosurgery. “The Impact of Alvimopan on Return of Bowel Function After Major Spine Surgery – A Prospective, Randomized, Double-Blind Study.“ 2019 Aug 1;85(2):E233-E239. doi: 10.1093/neuros/nyz005.PMID: 30951602 Clinical Trial.
Dunn LK, Chen CJ, Taylor DG, Esfahani K, Brenner B, Luo C, Buell TJ, Spangler SN, Buchholz AL, Smith JS, Shaffrey CI, Nemergut EC, Durieux ME, Naik BI.Neurospine. “Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis.“ 2020 Dec;17(4):888-895. doi: 10.14245/ns.2040114.057. Epub 2020 Dec 31.PMID: 33401867 Free PMC article.
Esfahani K, Bunker BA, Heller SJ, O’Connor EG, Walters SM, Kleiman AM. “Anesthetic Considerations for Endovascular Neurologic, Vascular, and Cardiac Procedures.“
Adv Anesth. 2020 Dec;38:63-95. doi: 10.1016/j.aan.2020.07.004. Epub 2020 Sep 18.
PMID: 34106841 Review. No abstract available.
Esfahani K, Lacomis C, Dunn LK, Chen CJ, Zuo Z, Naik BI.
“A retrospective observational pilot study on the effects of dexmedetomidine on neurological outcomes after aneurysmal subarachnoid hemorrhage.“ J Clin Anesth. 2021 Feb;68:110106. doi: 10.1016/j.jclinane.2020.110106. Epub 2020 Oct 16.
PMID: 33075634 No abstract available.
Atluri N, Ferrarese B, Osuru HP, Sica R, Keller C, Zuo Z, Lunardi N. “Neonatal anesthesia impairs synapsin 1 and synaptotagmin 1, two key regulators of synaptic vesicle docking and fusion.“ Neuroreport. 2019 May 22;30(8):544-549.
Lunardi N, Sica R, Atluri N, Salvati KA, Keller C, Beenhakker MP, Goodkin HP, Zuo Z. “Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia.“ Anesthesiology. 2019 Jun;130(6):981-994.
Illendula M, Osuru HP, Ferrarese B, Atluri N, Dulko E, Zuo Z, Lunardi N. “Surgery, Anesthesia and Intensive Care Environment Induce Delirium-Like Behaviors and Impairment of Synaptic Function-Related Gene Expression in Aged Mice.“ Front Aging Neurosci. 2020 Sep 25;12:542421.
Naik BI, Kuck K, Saager L, Kheterpal S, Domino KB, Posner KL, Sinha A, Stuart A, Brummett CM, Durieux ME, Vaughn MT, Pace NL; MPOG EOS Investigator Group. ” Practice Patterns and Variability in Intraoperative Opioid Utilization: A Report From the Multicenter Perioperative Outcomes Group.“ Analg. 2022 Jan 1;134(1):8-17. doi: 10.1213/ANE.0000000000005663.PMID: 34291737
Naik BI, Dunn LK, Wanchek TN. “Incremental Cost-effectiveness Analysis on Length of Stay of an Enhanced Recovery After Spine Surgery Program: A Single-center, Retrospective Cohort Study.“ J Neurosurg Anesthesiol. 2021 Dec 15. doi: 10.1097/ANA.0000000000000827. Online ahead of print.PMID: 34907145
Mayer SA, Frontera JA, Jankowitz B, Kellner CP, Kuppermann N, Naik BI, Nishijima DK, Steiner T, Goldstein JN; CNS Bleeding/Neurosurgery Subgroup of the NHLBI Hemostasis Trials Outcomes Working Group. “Recommended Primary Outcomes for Clinical Trials Evaluating Hemostatic Agents in Patients With Intracranial Hemorrhage: A Consensus Statement.“ JAMA Netw Open. 2021 Sep 1;4(9):e2123629. doi: 10.1001/jamanetworkopen.2021.23629.PMID: 34473266
Pajewski TN, Arlet V, Phillips L. “State of the art spinal cord monitoring in spine surgery: the point of view of the neurologist, the anesthesiologist and the spine surgeon.” Eur Spine J 16(S2):115-29, 2007
Education and Training
Neuroanesthesia is a formal rotation for our residents in the department. In addition to patient care related teaching, residents receive education in the simulation center during the clinical rotation. An eight week Neuroanesthesia teaching block with didactic and hand-on teaching workshops runs every two years.
Medical students often rotate with the department and may be assigned with residents to neuroanesthesia cases.
Neuroanesthesia Fellowship
The yearlong Neuroanesthesia fellowship is offered to trainees after successful graduation from an ACGME anesthesia residency. Physicians are hired as Clinical Instructors for this 12 month period. They function as an attending anesthesiologist for 6-10 days per month in the ORs and spend the remainder of days advancing their skills and medical knowledge as a neuro fellow. Research time can be incorporated into this fellowship.
This educational experience requires an understanding of CNS physiology, pathophysiology of neurosurgical disorders, and of the procedures and specific anesthetic techniques, including managing cases requiring neuromonitoring. Fellows will be taught these concepts and their practical applications.
Fellows will frequently be involved in administration of anesthesia for neurosurgical procedures and exposed to emergent neurosurgery and neurotrauma.
Interested applicants should contact Dr. Nadia Lunardi.