Neuroanesthesiology is an essential component of perioperative neuroscience, playing a pivotal role in ensuring patient safety and optimal outcomes during neurosurgical and neuroradiology procedures. With advancements in technology and surgical techniques, the present and projected increasing complexity of neurosurgical interventions, and the intricate nature of the brain, it is imperative that we commit to continuous knowledge acquisition and innovation, optimally involving collaboration among experts worldwide. International collaboration in neuroanesthesiology not only fosters the creation and exchange of knowledge but also accelerates progress toward improved patient care and outcomes. This article will review the role of international collaboration in support of perioperative neuroscience research, education, and clinical improvement and the emerging role of the International Council for Perioperative Neuroscience Training (ICPNT), which presently has participation from 38 programs from North America, South America, the United Kingdom, Europe, Asia, Australia, and the Middle East (J Neurosurg Anesthesiol 2019;31:267-9).

International collaboration in neuroanesthesiology rests on a foundation of educational exchange programs and shared training opportunities. By fostering partnerships between academic institutions and health care facilities across borders, such collaborations facilitate the exchange of best practices, training methodologies, and educational resources (Curr Anesthesiol Rep 2021;11:467-76). ICPNT is the accrediting body for neuroanesthesia fellowships and has been at the forefront of such international collaborations.

While other accreditation organizations focus solely on evaluation of programs, ICPNT, in preparation to support future innovations, provides an infrastructure for interprogram education and quality improvement. This enhances education and may provide an infrastructure for an international interactive clinical and research network. Through ICPNT-organized international conferences, workshops, and seminars, neuroanesthesiologists have the opportunity to engage in interdisciplinary discussions, share clinical experiences, and learn from diverse perspectives (Int Anesthesiol Clin 2023;61:1-7).

Figure: The International Council for Perioperative Neuroscience Training (ICPNT) is a global accrediting body for neuroanesthesiology fellowships that standardizes training and ensures that accredited programs meet quality benchmarks. Unlike traditional accrediting bodies, it provides an infrastructure and encourages collaboration between programs in education, clinical practice, and research.

Figure: The International Council for Perioperative Neuroscience Training (ICPNT) is a global accrediting body for neuroanesthesiology fellowships that standardizes training and ensures that accredited programs meet quality benchmarks. Unlike traditional accrediting bodies, it provides an infrastructure and encourages collaboration between programs in education, clinical practice, and research.

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In addition to traditional in-person exchanges, technological advancements have led to anticipated ICPNT-organized virtual learning platforms and telementoring programs, which can allow experts to provide guidance and support remotely. Such initiatives are not yet extensively employed but are expected to be particularly valuable for enhancing the skills of health care providers in resource-limited settings, where access to specialized training may be limited. Moreover, the expense and time related to travel to international meetings can be attenuated through such technology.

Perioperative neuroscience fellowship training involves experience with the increasing complexity arising in the field. As such, this experience is foundational to future innovations in clinical care. This mindset then supports international collaboration, which plays a crucial role in the development of evidence-based clinical guidelines and consensus statements in neuroanesthesiology. By convening expert panels composed of clinicians, researchers, and policymakers from diverse geographic regions, professional societies can synthesize the latest evidence and formulate recommendations for optimal perioperative care.

Collaborative quality improvement initiatives are essential for enhancing patient safety and optimizing outcomes in neuroanesthesia practice. Through cross-institution international benchmarking and data-sharing initiatives (e.g., Multicenter Perioperative Outcomes Group (MPOG) or U.K. Biobank), data access, and analysis, health care institutions can identify areas for improvement, implement evidence-based interventions, and monitor performance metrics over time.

International collaborations enable benchmarking against global standards and facilitate the dissemination of best practices across borders. By participating in quality improvement networks and collaborative registries like MPOG and the U.K. Biobank, institutions can contribute data to large-scale analyses aimed at identifying trends, outcomes disparities, and opportunities for quality enhancement in neuroanesthesia care.

International collaboration in neuroanesthesiology research is essential for advancing the understanding of neurophysiology, pharmacology, and perioperative management of neurosurgical patients. Collaborative research efforts enable the pooling of resources, expertise, and data from diverse populations, leading to more robust findings and generalizable conclusions. Collaborative studies such as hypothermia for aneurysm surgery and pharmacological agents for neuroprotection have provided insights into mitigating neurologic injury during surgery.

Multinational consortia and research networks have a huge potential for engagement of trainees, mentorship, and organizational support, and large randomized controlled trials are possible. Notably, ICPNT has established an international network for education that could be used as a framework for international research collaboration. For example, ICPNT, a relatively young organization, has published international surveys as nascent efforts in collaborative research.

While international collaboration holds immense promise for advancing neuroanesthesiology, several challenges must be addressed to maximize its potential. These include disparities in health care infrastructure, disparate regulatory hurdles, language barriers, economic disparities, and cultural differences. Moreover, ensuring equitable participation and resource allocation among collaborating partners is essential for fostering sustainable partnerships. To overcome some of these barriers, ICPNT program requirements are written in a way that supports international differences in regional training culture and regulations, while describing a required minimum of curriculum and clinical experience to comprise an accredited neuroanesthesiology fellowship.

The benefits of international collaboration in neuroanesthesiology far outweigh the challenges. By leveraging the collective expertise and resources of the global community, stakeholders can drive innovation, improve patient outcomes, and address the evolving needs of neurosurgical patients worldwide.

International collaboration serves as a cornerstone for the growth and advancement of neuroanesthesiology. Through collaborative research, educational exchange programs, clinical guidelines development, and quality improvement initiatives, stakeholders can collectively tackle the complexities of neurosurgical care and drive innovation in perioperative management. By fostering a culture of collaboration and knowledge-sharing, we can ensure that patients receive the highest standard of care, irrespective of geographic boundaries.

∗ChatGPT was used for suggestions of an initial draft of this article, which then underwent significant editing by the authors. Drs. Rajan, Abdelmalek, and Kofke are fully responsible for the final content of this article.

Shobana Rajan, MD, FASA, Staff Anesthesiologist, Program Director for the Neuroanesthesia Fellowship, Cleveland Clinic Multispecialty Anesthesia, Board of Directors, Society for Neuroscience in Anesthesiology and Critical Care (SNACC), and Chair, International Council for Perioperative Neuroscience Training (ICPNT).

Shobana Rajan, MD, FASA, Staff Anesthesiologist, Program Director for the Neuroanesthesia Fellowship, Cleveland Clinic Multispecialty Anesthesia, Board of Directors, Society for Neuroscience in Anesthesiology and Critical Care (SNACC), and Chair, International Council for Perioperative Neuroscience Training (ICPNT).

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Mohab Abdelmalek, MD, Fellow, Neuroanesthesiology, Cleveland Clinic, Cleveland, Ohio.

Mohab Abdelmalek, MD, Fellow, Neuroanesthesiology, Cleveland Clinic, Cleveland, Ohio.

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Andrew W. Kofke, MD, MBA, FCCM, Professor, Neuroscience in Anesthesiology and Critical Care Program, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania

Andrew W. Kofke, MD, MBA, FCCM, Professor, Neuroscience in Anesthesiology and Critical Care Program, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania

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