WINNER in FOCUS: Dr. Nidhi Bidyut Panda
This month’s WINNER in FOCUS is Dr Nidhi Bidyut Panda, Professor of Neuroanaesthesia at the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India. As the Director of the Division of Neuroanaesthesia, Dr. Panda serves as the course director for
the Doctorate of Medicine program (DM, three years of Doctorate level coursework studied after successful completion of postgraduate study). She has dedicated her career to Education, Clinical Care, and Research in Neuroanaesthesia. She is an active member of ISNACC and was installed as President in 2020.
1. What/Who influenced you to choose a career in Neuroanesthesia?
During my postgraduate training in Anesthesia, I was assigned to Neurotrauma & Neurosurgery OTs (Operation theatres) for 1-2 months in each semester for three years. Though the duty was very hectic, I regularly followed the cases postoperatively in the Neurosurgery ICU and HDU (High Dependency Units). There I gained considerable insight into the role of sound anesthetic care in mitigating further neurological deterioration of our critical patients. In addition, I began to understand how the contributions of expert anesthesiologists matters in overall neurological outcomes. This feeling attracted me to the subspecialty of Neuroanaesthesia.
2. Where did you receive most of your training in Neuroanesthesia?
I received my training in neuroanesthesia at PGIMER in Chandigarh, India. I also completed an observership in Neuroanaesthesia in Seattle, WA. I have gained considerable experience in the specialty of Neuroanesthesia during the last 31 years of my career, with a complete focus on neuroanesthesia for the last 15 years and as director of this subspecialty in my institution for the last six years.
3. At what point in your career did you meet your first mentor?
My mentors were Professor J. Wig and Professor VK Grover, who are renowned neuroanesthesiologists in India. They were my seniors at the Institute, and I had worked under their direction since my 3rd semester of MD anesthesia coursework. I was impressed with their dedication and knowledge of neuroanesthesia.
4. How has your mentor/s helped you in your career in Anesthesia/Neuroanesthesia?
My inspirations were the father figure of Neuroanesthesia in India, Prof HH Dash, and other senior neuroanesthesiologists like Prof Umamaheswara Rao and Prof Bibhukalyani Das. Their personality, knowledge of the subject, and dedication to improving neuroanesthesiology in India inspired me to dedicate my career to the care of neurosurgical and neurological patients. My senior colleagues and teachers in the department, Prof J Wig and Prof VK Grover, who had dedicated their careers to neuroanesthesia, were my mentors. They helped me fulfill my desire to join this group and excel in the practice of neuroanesthesia. I love working in neuroanesthesia, and I have focused much of my time trying to improve the neuroanesthetic care in our Institute and this region of our country.
5. How did you find out about SNACC/ISNACC, and when did you join?
I joined the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC), the parent body of Neuroanesthesia in India, at its inception in 1999. As a member of the society, I have participated in annual meetings. As an executive member of the society, I have played an active role in the growth of this subspecialty in India. I organized the National conference of ISNACC in 2017, and then in 2020, I became President of the ISNACC for two years. I am a member of SNACC and have been attending SNACC conferences and the annual meeting since 2010.
6. Which area of clinical Neuroanesthesia interests you the most? Why?
Management of cases of aneurysmal SAH is exciting to me. We neuroanesthesiologists are involved in the management of these patients throughout their hospital stay: from the admission of these patients in the emergency area; diagnosis in DSA suites (Digital subtraction angiography); to anesthesia for clipping in the Neurosurgery OT or coiling in neuro-intervention suits; and to postoperative care in neurocritical care units. Our in-depth knowledge of neuroanesthesia and neurocritical care, meticulous multimodal monitoring, and timely management of complications contribute positively to neurological outcomes. This is a vast area for research, which can help in prognostication and influence the neurological consequences of these patients. I have done much research in this field, and my work has been published in well-established national and international journals. Neurotrauma is another field that interests me. I have had many new research projects in this field and subsequently published research results in JNA and the Asian Journal of Neurosurgery. Acute pain management in spine cases is another important area of anesthesia which I find interesting.
7. What area of Neuroscience research most interests you, and/or what is the focus of your neuroscience research?
Patients with aneurysmal SAH and neurotrauma are areas of interest to me. My research focuses on exploring methods of neuroprotection, particularly in neuro-emergencies. Ketamine is an anesthetic drug that I find very interesting. Ketofol, the combination of Ketamine and Propofol, is used in much of my clinical research. Another focus of my research is opioid-free anesthesia. Multimodal approaches for preventing early deterioration and improving neurological outcomes are the objectives of my research work. I have enjoyed learning and scientific discovery with over 100 publications in national and international journals.
8. What has been the most challenging aspect of your educational career and/ or training?
The most challenging aspect of my training has been working as an anesthesiologist in managing critical neurotrauma and aSAH cases in the operating room. These patients are often under-resuscitated, and surgeons are in a hurry to operate. In such circumstances, providing anesthetic care that must include close attention to maintaining cerebral perfusion is always a challenge for the neuroanesthesiologist. EYet, everyday, I feel we learn something new, and our patients are our best teachers.
9. What has been the most gratifying aspect of your academic career?
Improving outcomes in critical cases managed in the operating theater and in the ICU is one of the most gratifying aspects of my work as a clinician. I am both a teacher and a trainer. I was actively involved in establishing the neuroanesthesia division in my Institute, supported by a well-defined academic and training curriculum. DM neuroanesthesia students, after training in my Institute, have joined different established neuroanesthesia Institutes nationally and internationally, and they are doing good work. The most gratifying aspect of my career as a teacher is the appreciation of the good work done by the students trained by us. Another gratifying moment for me was when I was selected as Professor in neuroanesthesia at my Institute.
10. What has been the highlight of educating residents/fellows in Neuroanesthesiology?
Teaching and training students pursuing a DM in neuroanesthesia is my passion. I have been a core member of our neuroanesthesia training program since the inception of the course in our Institute in 2013, and I have directed this course since 2016. During my tenure, 33 students (4-5 students per year since 2013) have been selected through national level entrance exams to complete training in DM in neuroanesthesiology, and 16 of these students have completed their dissertation with me as their advisor. All students who trained in our program passed their examinations on their first attempt. We have set a competitive benchmark for training and teaching neuroanesthesia in our country.
11. What is your advice to women interested in pursuing work in this field?
This field requires focused multimodal approaches to patients with neurological insults. Women are very meticulous in their work. They are sincere and focused and are determined to complete the job they love well. Their work in neuroanesthesia is very hectic and challenging but striving for and achieving good outcomes provides so much satisfaction, mental peace, and the feeling of achievement. My advice to my lady colleagues is that the wholehearted effort they bring to the job and their careful attention to their patients are essential assets they bring to improving the care of these patients.
12. What does the future hold for the Neurosciences in Anesthesiology and Critical Care?
The future of neuroanesthesia is filled with opportunities to improve neurological outcomes as age-dependent neurological problems and cases of brain injury due to various medical and environmental conditions continue to rise with our increasing populace. The continued growth of the geriatric population will contribute to a host of neurological emergencies, which will require the expertise of neuroanesthesiologists. Newer anesthetic drugs, advances in neuromonitoring, improvement in research in neuroscience, a better understanding of basic physiology and pathological changes in various neurological and neurosurgical cases will help improve neurological outcomes in these patients. State-of-the-art neurocritical care facilities will further help neuroanesthesiologists improve the lives of these patients.
13. What advice/story would you like to share with medical students, residents, fellows, and junior faculty choosing a career in NA. \
My advice to the students, fellows and junior faculty is that neuroanesthesiology is a specialty where your dedication and in-depth knowledge of anatomy, physiology, pathology, pharmacology, medicine, and surgery, along with neuroanesthesia and neurocritical care, can help patients. The patient is one of the best teachers we have, so try to spend more time managing your patient and following up to learn and perhaps make a difference in the lives of patients you serve today and tomorrow.