Report of AIIMS Neuroanaesthesia Update 2018

Gyaninder Pal Singh, MD, DM,
Associate Professor
Department of Neuroanaesthesiology and Critical Care
Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Arvind Chaturvedi, MD

Department of Neuroanaesthesiology and Critical Care
Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India

The 6th Annual “AIIMS Neuroanaesthesia Update” was held on 2-4 November 2018, at All India Institute of Medical Sciences, New Delhi (India). The meeting was a great success and was attended by over 300 participants mainly from India. The untiring efforts of Dr. Gyaninder Pal Singh (Organizing Secretary) and the members of organizing team under the leadership of Prof. Arvind Chaturvedi (Organizing Chairman) were appreciated by all participants for organizing yet another excellent academic event. The meeting was accredited by Delhi Medical Council and was awarded 17 credit hours.

The highlights of the meeting included six different workshops with ample interactions and hands-on training for each participant. The workshop on “Transcranial Doppler (TCD)” was organized by Prof. Girija Rath, with emphasis on basics of TCD, isolation of cerebral vessels and clinical implications of TCD. A workshop on “Ultrasonography in Neurocritical Care” was organized by Prof. M Radhakrishnan and Dr. K Gopalakrishna as a case scenario-based approach to critically ill patients. Dr. Akanksha Singh conducted the workshop on “Neurophysiologic Monitoring”; she elaborated in depth about this modality of monitoring during cerebral and spinal surgeries as well as associated anesthetic concerns. Dr. Leve Joseph conducted a very informative workshop on “Neuroimaging for Neuroanesthesiologists”. There were also workshops for nurses and anesthesia technicians working in neurosurgical ORs and neurocritical care units. These workshops included important topics in management and care of patients relevant to nursing and technical staff, as well as hands-on training on airway management and cardiopulmonary resuscitation. All the workshops were attended by large numbers of participants and were highly appreciated.

The second day started with a series of lectures that covered a wide range of topics in neuroanesthesia and neurocritical care, starting from molecular research to current evidence in clinical management. Prof. V.J. Ramesh delivered an excellent talk on “Molecular Research in Neuroanesthesia – What Does the Future Hold?” and Dr. Rahul Yadav discussed “ERAS and Neurosurgery”. “EcoG Guided Epilepsy Surgery - Anesthetic Concerns and Management” was comprehensively discussed by Dr. Sujoy Banik (London Ontario, Canada). Dr. Shobana Rajan (Cleveland Clinic, USA) delivered a very interesting talk on the challenges and management of “Awake Craniotomy in an Intraoperative MRI Suite.” A Panel discussion on “Should Every Neurosurgical Case be Done by a Neuroanesthesiologist?” was a highlight of the meeting. Prof. Rajeev Chawla moderated the discussion and a panel of experts included renowned neuroanesthesiologists (Prof. HH Dash, Dr. V Ponniah), general anesthesiologists (Prof. Anju Bhalotra and Prof. Nikki Sabharwal), and a neurosurgeon (Prof. S.S. Kale). All the panelists emphasized the need for trained neuroanesthesiologists to conduct neurosurgical procedures and that we should strive for it. There were sessions on brain and spine trauma that focused on intraoperative and ICU management of trauma patients. The talks included “Blood Transfusion in TBI Patients” by Dr. Ashish Bindra, “Management of Brain Trauma Patients Posted for Extracranial Injuries” by Dr. Sriganesh Kamath, “Non-operative Acute Cervical Spinal Cord Trauma - Challenges in Management” by Dr. Hemangi Karnik and “Current Status of Neuroprotection for Spinal Cord Injury” by Dr. Surya Dube.

Different workshops conducted with hands-on training sessions.
Different workshops conducted with hands-on training sessions.

In the afternoon session Prof. M. Radhakrishnan delivered a very informative talk on “Blood Transfusion Practice in Pediatric Neurosurgical Patients” and Dr. Prasanna Bidkar on “Goal-Directed Fluid Therapy in Neurosurgery.” There was a very interesting interactive case discussion on difficult airway management in a case of chin-chest syndrome which was presented by Dr. Keshav Goyal, followed by two very relevant and interesting pros and cons debates. The topic of the first debate was “Clinical Field or Thromboelastography - What Should Decide the Intraoperative Transfusion Strategy in Neurosurgery”, and the second debate was on “Transfusion of Cell Saver Autologous Blood in Malignant Brain Tumor Surgeries - Is It Safe?” All the speakers (Drs. Vanitha Rajagopalan, Ajay Hrishi, Kiran Jangra and Pallav Kumar) argued either in favor or against the topic and aptly justified their statements with scientific evidence from literature. The day ended with an interesting quiz competition which was conducted by Dr. Shobana Rajan (USA). Twenty-two participants took the preliminary round and the top nine participants were selected for the finals. Winners were awarded the prizes during the valedictory function.

The third day of the event began with a session on cerebrovascular conditions and included talks on current understanding on delayed cerebral ischemia, management of patients with acute ischemic stroke and role of neurointensivist in hyper-perfusion after carotid stenting by Drs. H.K. Venkatesh, V. Ponniah and Saurabh Anand, respectively. There were video lectures demonstrating techniques of ICP monitoring and USG guided percutaneous tracheostomy. There was also a panel discussion on “Brain and Organ Donation - Ethical and Legal Implication in India” moderated by Prof. S. Manikandan. Experts in the field of organ donation (Prof. Aarti Vij, Prof. M.V. Padma, Prof. Sanjeev Lalwani, Prof. Deepak Gupta and Dr. H. Sapra) meticulously answered the queries of the audience. The lecture by Prof. Parmod Bithal (Riyadh) on contrast-induced nephropathy in neurological patients was fascinating and so was the talk by Prof. Monica Tandon who highlighted on the implications of NOAC for neuroanesthesiologists.

Thereafter, a session on infection and sepsis in neurocritical care unit included informative and eye-opening talks on “Immunotherapy for Sepsis: A Good Idea or Another Dead End?” (Dr. Ankur Luthra), a sepsis guidelines update (Dr. Navdeep Sokhal), causes and management of fever in neuro-ICU (Dr. Nidhi Gupta), and optimization of antimicrobial prescription through drug dosing and MIC (Dr. Sarita Mohapatra).

In the subsequent session, Dr. Vasudha Singhal talked on management of cerebral venous thrombosis in pregnancy and Dr. Varun Jain on acute intermittent porphyria. At the end, there were few didactic lectures on current evidence in management of patients in neuro-intensive care. These talks included current evidence on glycemic control in neuro-ICU, DVT prophylaxis, Seizure prophylaxis, and sedation in Neuro ICU by Drs. Ranadhir Mitra, Priyanka Gupta, Barkha Bindu, and Gaurav Tomar, respectively. Moreover, the poster session on the third day was a big attraction with large attendance. Ten research papers were selected for award category and the three best papers were selected for awards.

The three-day long event concluded with a valedictory function. The winners of the quiz and best research papers were awarded. The delegates appreciated the scientific content of this academic meeting and congratulated the organizers for the huge success of this event.

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