Neuroanesthesia Division
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Our UVA Neuroanesthesia Faculty
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Priya Singla, MD & Bhiken Naik, MBBCh discuss an upcoming spinal case.
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Zhiyi Zuo, MD, PhD, and Nadia Lunardi, MD, PhD discuss Neuroanesthesia procedures.
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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 Asssociate 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
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 and Analgesia and the Journal of Neurosurgical Anesthesiology.
Tyler Johnson, MD
Tyler Johnson, MD
Tyler Johnson, M.D. is an Assistant Professor of Anesthesiology and Sleep Medicine at the University of Virginia. His clinical interests include neuroanesthesia (i.e. anesthesia for brain and spine surgeries) and perioperative medicine. In addition to caring for patients undergoing surgery, Dr. Johnson also holds outpatient clinics in sleep medicine, where he treats patients with a wide variety of sleep disorders. Dr. Johnson was born and raised in Alexandria, Virginia. He completed his undergraduate degree at the University of Virginia, his medical doctorate from Virginia Tech Carilion School of Medicine, his residency in anesthesiology from University of Virginia, and his fellowship in sleep medicine at the University of Pennsylvania, where he was a chief fellow.
Outside of medicine, Dr. Johnson enjoys spending time with his fiancée and their three cats. They love to spend time outdoors and appreciate all the wonderful features of central Virginia.
Emmad Kabil, MD
Assistant Professor
Emmad Kabil, MD
Dr. Emmad Kabil is an Assistant Professor of Anesthesiology and originally joined the Faculty at UVA as a Clinical Instructor within the School of Medicine. In 2006 Dr. Kabil earned his Bachelor of Arts in Biology from the College of Charleston, and later graduated with his Medical Degree in 2013. During his time at the Medical University of South Carolina he was awarded the College of Medicine’s Dean Scholarship for academic achievement.
Following medical school, Dr. Kabil first joined the University of Virginia (UVA) for his Anesthesiology residency from 2017-2021. Recently, Dr. Kabil’s research centered on the “Efficacy of transverse Abdominis Plane Block in Live-Donor Laparoscopic Nephrectomy.” He currently lives in Charlottesville with his wife and son.
Bhiken Ishwarlal Naik, MBBCh, MSCR
Bhiken Ishwarlal Naik, MBBCh
Dr. Naik is a tenured 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.
Brian Reon, MD, PhD
Brian Reon, MD, PhD
Dr. Reon recently joined the Neuroanesthesia Division as an Assistant Professor of Anesthesiology. Dr. Reon obtained both an MD, and a PhD in experimental pathology from the University of Virginia, spanning the years 2011-2019. He then pursued his residency in Anesthesiology at the University of Pittsburgh Medical Center, successfully completing it in 2023. In Spring 2024, he will be one of two fellows in the MPOG Outcomes Research Fellowship.
With a strong focus on clinical research, Dr. Reon’s interests lie in exploring the relationship between intraoperative parameters (such as bispectral index, anesthetic concentration, and blood pressure) and postoperative delirium. Additionally, Dr. Reon is interested in leveraging large clinical and genomic datasets to risk stratify patients in perioperative medicine.
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.
Johnson T, Gurubhagavatula I. Assessment of Vigilance and Fatigue. Sleep Med Clin. 2023 Sep;18(3):349-359.
Broadhead P, Cook J, Johnson T, Nahass B, Miltner R, McMullan S. Improving Obstructive Sleep Apnea Care in the Postanesthesia Care Unit. J Perianesth Nurs. 2022 Feb;37(1):40-43.
Schnetz MP, Reon BJ, Ibinson JW, Kaynar M, Mahajan A, Vogt KM. Bispectral Index Changes Following Boluses of Commonly Used Intravenous Medications During Volatile Anesthesia Identified From Retrospective Data. Anesth Analg. 2024 Mar 1;138(3):635-644.
Kabil E, Lunardi N, Tennant WG, Esfahani K. Serotonin Syndrome After Prolonged Remifentanil and Propofol Infusion for Craniotomy: A Case Report. A & A Practice 18(6):p e01793, June 2024.
Lele AV, Vail EA, O’Reilly-Shah VN, DeGraw X, Domino KB, Walters AM, Fong CT, Gomez C, Naik BI, Mori M, Schonberger R, Deshpande R, Souter MJ, Mathis MR; MPOG Perioperative Clinical Research Committee. Identifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis. Anesth Analg. 2024 Jul 25. Epub ahead of print.
Naik BI, Lele AV, Sharma D, Akkermans A, Vlisides PE, Colquhoun DA, Domino KB, Tsang S, Sun E, Dunn LK; Multicenter Perioperative Outcomes Collaborator Group. Variability in intraoperative opioid and nonopioid utilization during intracranial surgery: A multicenter, retrospective cohort study. J Neurosurg Anesthesiol. 2024 Mar 28. Epub ahead of print.
Esfahani K, Tennant W, Tsang S, Naik BI, Dunn LK. Comparison of oral versus intravenous methadone on postoperative pain and opioid use after adult spinal deformity surgery: A retrospective, non-inferiority analysis. PLoS One. 2023 Jul 21;18(7):e0288988.
Abatzis VT, Park CS, Sumler ML, Littlewood KE. Exploring Fraught Boundaries and Landscapes of Practice. Anesth Analg. 2023 Sep 1;137(3):548-550.
Atluri N, Dulko E, Jedrusiak M, Klos J, Osuru HP, Davis E, Beenhakker M, Kapur J, Zuo Z, Lunardi N. Anatomical substrates of rapid eye movement sleep rebound in a rodent model of post-sevoflurane sleep disruption. Anesthesiology. 2024 Apr 1;140(4):729-741.
Dulko E, Jedrusiak M, Osuru HP, Atluri N, Illendula M, Davis EM, Beenhakker MP, Lunardi N. Sleep fragmentation, electroencephalographic slowing, and circadian disarray in a mouse model for intensive care unit delirium. Anesth Analg. 2023 Jul 1;137(1):209-220.
Vasunilashorn SM, Lunardi N, Newman JC, Crosby G, Acker L, Abel T, Bhatnagar S, Cunningham C, de Cabo R, Dugan L, Hippensteel JA, Ishizawa Y, Lahiri S, Marcantonio ER, Xie Z, Inouye SK, Terrando N, Eckenhoff RG; NIDUS Delirium Network. Preclinical and translational models for delirium: Recommendations for future research from the NIDUS delirium network. Alzheimers Dement. 2023 May;19(5):2150-2174.
Zeng X, Li J, Shan W, Lai Z, Zuo Z. Gut microbiota of old mice worsens neurological outcome after brain ischemia via increased valeric acid and IL-17 in the blood. Microbiome. 2023 Sep 12;11(1):204.
Huang X, Guo M, Zhang Y, Xie J, Huang R, Zuo Z, Saw PE, Cao M. Microglial IL-1RA ameliorates brain injury after ischemic stroke by inhibiting astrocytic CXCL1-mediated neutrophil recruitment and microvessel occlusion. Glia. 2023 Jul;71(7):1607-1625.
Knio ZO, Clancy PW 3rd, Zuo Z. Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthoplasty: A matched-pair cohort analysis. J Clin Anesth. 2023 Aug; 87:111083.
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.