INTERNATIONAL NEUROANESTHESIA NEWS

19th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC 2018)

By Rajshree Deopujari, MD
Senior Consultant Anesthesiologist, Jaslok Hospital and Research Centre
Mumbai, India

The 19th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) was held at the Leela Hotel, Mumbai, Maharashtra, India from January 18-21, 2018.

Mumbai was an ideal host city for the conference due to its long-standing association with neuroanesthesia and was successfully kept abreast with the international standards. The field of medical sciences is exponentially growing with the advent of newer technologies aiding diagnosis in healthcare. The need to keep abreast with this explosion of medical technologies is acutely felt by all, hence the theme of our conference was “Integrating Technologies and Enhancing Outcomes”.

This theme was suitably brought out in the preconference workshops as well as in the scientific content prepared for the conference. The scientific committee had meticulously framed the scientific program to keep the theme as the epicenter objective.

Three scholastic workshops were conducted a day prior to the conference proceedings and all were in unification with the theme of integration of new technologies to enhance outcomes. The first workshop focused on advantages of simulation learning, optimal management of critical scenarios, technical aspects of simulation, resource management and soft skills. This Neurosimulation Workshop was arranged for the first time during ISNACC and employed the High Fidelity Simulation (HSF) based learning module for a comprehensive understanding of critical scenarios in neurosciences. This was in collaboration with a dedicated neurosimulation group consisting of Drs. D.Y. Patil (Mumbai), Brain Stem (New Delhi), and Sandeep Lakhani and Sudhindra Kulkarni from the UK.

The second workshop was on Multimodality Neuromonitoring. This era of modern neuroanaesthesia is a huge proponent for optimal utilization of various modalities for perioperative neuromonitoring thereby leading to improved outcomes. Knowledge about the various neuromonitoing techniques like transcranial doppler, bispectral index monitoring, near infrared spectroscopy, evoked potentials, and their importance to the anesthesiologist in the perioperative period was the focus of this workshop. Hands-on skill stations were also conducted for better understanding of the subject and familiarization with the techniques. Various international and national faculties were involved with skill stations and active teaching. Dr. Antoun Koht spearheaded the IONM workshop. All the faculties were enthusiastic and enriched the delegates’ knowledge.

The Emergency Neurological Life Support (ENLS) workshop was conducted by the Neurocritical Care Society (NCS) under the able command of Dr. Michel Torbey. This workshop was a feast for all the clinicians working toward the management of critically ill neurological patients. It consisted of didactic lectures and discussions and dwelt on various guidelines and recommendations for management of patients requiring treatment during the critical first hours of a patient's neurological emergency. ENLS is a collaborative multidisciplinary approach with set protocols, checklists, decision points and communication to use during patient care which, when followed diligently, reduces delays and improves patients’ outcomes. Other faculty included Drs. Moser, Lele, Shaikh (Coordinator), and Mathews.

The conference started with the first session about basic physiology. Dynamics of intracranial pressure determinants of cerebral blood flow and the deliberation on brain oxygenation and metabolism were the key focus. This was followed by a symposium on advances in neuroanaesthesia practice. Drs. Irene Osborn, V. Bhadrinarayan and Lashmi Venkatraghavan gave lectures on advances in airway in neurosurgery, advances in ventilation in neurosurgical cases and enhanced recovery protocols in neurosurgery, respectively.

Keynote lectures were delivered on ‘Brain Relaxation During Craniotom’ by Dr. Adrian Gelb and ‘Update in Neuroprotection’ by Dr. Padmaja Durga. The Dr. Malathi Memorial Oration was delivered by Dr. Antoun Koht which dealt with all aspects of ‘Awake Craniotomy’. Symposium on ‘Newer Drugs/Techniques’ deliberated upon ‘Ultrasound and Doppler in Neuroanaesthesia’, novel anticoagulants and emergency neurosurgery and ‘Reversal of General Anaesthesia with GABA Antagonists’. This was followed by guest lectures on special populations. Dr. Venkatesh deliberated upon cerebral toxicity of anesthetics in neonates. Dr. Kulkarni discussed ‘Anesthetics in Aging’ or previously injured brain, while Dr. Shobha Purohit spoke on ‘Anesthetic Challenges for Trans-sphenoidal Pituitary Surgery’.

The penultimate session of the day was a panel discussion on essential monitoring in neuroanaesthesia which was interesting in the fact that panelists were varied but finally arrived to a logical conclusion which did justice to the theme of the conference.

The second day commenced with discussion on depth of anaesthesia monitoring, CONOX (multimodality anaesthesia monitor) and ‘Development of Brain Stress Test’ which were discussed by Drs. Pragati Ganjoo, M. Katikar, and Lashmi Venkatraghavan, respectively. The highlight of the morning session was the SNACC Panel on ‘Advancing Technology’ and the speakers were Drs. Antoun Koht, Paul Garcia, and Martin Smith. They discussed evoked potentials, EEG and optical methods of brain monitoring and how these methods are used for enhancing outcomes.

Drs. Antoun Koht, Paul Garcia, and Martin Smith

A mini symposium on ‘Acute Ischemic Stroke’ was up next with speakers being Drs. Michel Torbey, Deepak Sharma and S. Manikandan. It encompassed ‘Medical Management, Anesthesia for Endovascular Approach and Neurorehabilitation for AIS’. An interesting session on ‘Transformational Technologies – Game Changers in Neurosciences’ was the afternoon highlight. Various luminaries from neuroanesthesiology (Dr. Dash), neurosurgery and neurocritical care (Drs. Anthony Figaji, Milind Deogaokar and Paresh Doshi) and neuroradiology (Srinivas Desai) took us on an audio visual journey about how technological advances have changed the face of neurosciences. Interesting topics amongst them was the effect of the futuristic technologies like brain machine interface, neuroimaging, and neuromodulation. A session on neurocritical care followed, and the topics discussed were delirium in ICU, recent advances in postoperative management in SAH, and targeted temperature management by Drs. S. Lakhani, M. Radhakrishnan and K. Sriganesh, respectively.

One of the main highlights of the conference was the ‘International Symposium on Neurotrauma’ which was the opening session on the last day. The symposium addressed the burning issues in neurotrauma in teeming, overburdened cities in India, specially Mumbai. The role of the anesthesiologist in traumatic brain injury was discussed by Dr. Phuphing Akavipat and the challenges of traumatic spine injury were discussed by Dr. Tripathi. Dr. Martin Smith deliberated upon the role of lactate in the injured brain. The second part of the neurotrauma symposium deliberated upon the ‘Brain Trauma Foundation’ (BTF). Guidelines were discussed by Dr. Anthony Figaji; ‘Neuroinflammation in TBI’ and outcome assessment were discussed by Drs. AK Gupta and Dhaval Shukla, respectively. The neurotrauma session concluded with Dr. Deepak Sharma delivering the Hariwir Singh Oration on ‘Neurotrauma Anaesthesia in Differing Scenarios’. An interesting case discussion on separating craniopagus conjoined twins by Dr. Girija Rath was very much appreciated.  Dr. G. Kakkar dwelled upon target controlled infusion technique. Another highlight of the conference were the simultaneously conducted  Problem Based Learning Discussions on acute ischemic stroke, SAH, awake craniotomy and anaesthesia for spine surgery. Experts carried forward the discussion smoothly, imparting lots of knowledge to the delegates. The experts who conducted these PBLD sessions were Drs. Shaheen Shaikh, H. Prabhakar, Irene Osborn, and Shobana Rajan. A neuroanesthesia review fun quiz was conducted by Dr. Rajan which turned out to be a big hit amongst the delegates.

The last session was on ‘Complication Avoidance’ in which venous air embolism, postoperative visual loss and postoperative cognitive dysfunction were discussed by Drs. V. Karne, Jayati Ghosh, and Sona Arora, respectively. The 19th ISNACC Annual Conference concluded successfully with warm response by the faculty and delegates. The valedictory function was presided over by Dr. Shashi Srivastava (incoming President of ISNACC) and Dr. Rajshree Deopujari, the organizing secretary of ISNACC 2018. The 2019 ISNACC is scheduled at Gurugram, and given the incredible standard of knowledge and expertise that ISNACC has always maintained, the next conference is also bound to be a roaring success.