AIIMS Neuroanaesthesia Neurocritical Care Update 2019

Ashish Bindra, MD, DNB, DM
Additional Professor, Department of Neuroanesthesiology and Critical Care
All India Institute of Medical Sciences (AIIMS),
New Delhi, India

Arvind Chaturvedi, MD
Professor and Head, Department of Neuroanesthesiology and Critical Care
All India Institute of Medical Sciences (AIIMS)
New Delhi, India

Tatang Bisri, MD, PhD
Ashish Bindra, MD, DNB, DM
Arvind Chaturvedi, MD
Arvind Chaturvedi, MD

The best way of learning is the coming together of thinking minds! With the vision of promoting neuroanaesthesia-neuro critical care across the country, the AIIMS Neuroanaesthesia Update is held each year at All India Institute of Medical Sciences (AIIMS), New Delhi, India. The meeting has seen a spectacular growth with constant and untiring efforts of its faculty and enthusiastic participation from across the country. From October 18-20, 2019, more than 200 super specialty neuroanaesthesiologists/intensivists gathered to discuss recent advances and the future of management of critically ill neuro patients. In addition, more than 100 nurses and operating room (OR) technicians participated in preconference workshops. The three-day conference was hosted by the Department of Neuroanaesthesiology & Critical Care, AIIMS, New Delhi, and is one of the largest conferences of its kind. The event was accredited with 20 CME points by the Delhi Medical Council. Dr. Ashish Bindra was the Organising Secretary for the event. The organising team, under the able leadership of Dr. Arvind Chaturvedi (Organising Chairman), was all geared up to put on a great show. The seventh edition of the Update saw a change in the name of the event, with the addition of the term Neurocritical Care, to accurately reflect the increasing contributions of neuroanesthesiologists in optimising patient outcomes throughout the hospital course. This year, the three-day event, with one day each dedicated to the modern practice of neuroanesthesiology as well as to neurocritical care, hosted eminent speakers, who shared their expertise and knowledge. Apart from scientific content, our ‘go green’ initiative aimed to reducing single use plastics during our conference.

Hands-on training was offered to residents/trainees, neuro-nurses and OR technicians during five different workshops held on October 18, 2019 (Figures 1&2). Workshops on Point of Care Ultrasound in Critical Care, Intraoperative Neuromonitoring, and Cadaveric Airway for resident doctors were coordinated by Drs. Puneet Khanna, Ashok Jaryal, and Niraj Kumar, respectively and provided useful insights to residents and clinicians alike. The neuro-nurses workshop, where in case-based training and discussion were carried out, was coordinated by Dr. Gynaninder Pal Singh. OR technicians enthusiastically participated during hands-on training for chest-compressions and interactive case discussions.

The scientific program for the meeting was meticulously designed to cover important topics consisting of talks, case discussions, case reports and panel discussions (Figure 3). A recent literature review “update” was included at the end of each session. Trainees/students of the department prepared a quiz for all from their own interesting clinical data. A question or two was asked after each session to keep the audience engaged. The first session, “The Good, Bad and Ugly in Neurosciences” included talks titled, “Is There Anything Known as Clinical Neuroprotection?”, “Anesthesia and Neurotoxicity: The Questions Unanswered” and “Update: Year Under Review” elaborated by Drs. VJ Ramesh, Hemant Bhagat, and Gaurav Kakkar, respectively. The second session, “A Vascular Fable” included four talks, “Moyamoya Disease : Perioperative Concerns”, “Plastic/Metal in Brain: Implications and Complications”, “Special Scenarios During Aneurysm Clipping: Adenosine-induced Flow Arrest and Hypothermic Circulatory Arrest in Current Practice” and “Update on Cerebral Vasospasm” by Drs. Girija P. Rath, Saurabh Anand, Joseph Monteiro, and Charu Mahajan, respectively. Both the sessions were appreciated by the audience and generated great discussion.

The session, “Pediatric Pinnacle” included a talk on “Pediatric Fluid Therapy in Neuroanaesthesia and Neurocritical Care” by Dr. Swethashree KR. This was followed by an interesting case discussion on “Congenital Heart Disease for Craniotomy” presented by Drs. Kiran Kiro and Ashoo Wadhera was moderated by Dr. Monica Tandon. The next session, “Zero In at Intracranial Pressure” was meticulously designed by Dr. Mihir Prakash Pandia and moderated by Dr. Keshav Goyal. The panelists, Drs. Ponniah V, Virendra Jain, Saurabh Anand, and Vasudha Singhal hooked the audience and gave good take-home messages. At the same time, nearly 50 research topics were presented as e-posters on five different screens and moderated by an eminent panel of judges.

The post-lunch session on “Perioperative Pharmacology” included talks on “Total Intravenous Anaesthesia Versus Inhalational Anaesthesia”, “Updated Pharmacological Armamentarium” and an update on “Best of Old with a Promise of New” by Drs. Srilata M. Ajay P. Hrishi, and Navdeep Sokhal, respectively. The speakers, Drs. Subrata Singha, Unnikrishna, and Priyanka Gupta talked on “I Am Establishing a New Neurocritical Unit: Which Monitors to Buy?”, “Measuring the Depth: Burst Suppression MAC and Burst Suppression CP50” and “Confused Mind: Postoperative Cognitive Dysfunction”, respectively during the session “Monitoring the Injured Brain.” This session was followed by an inauguration of the event by Prof. Randeep Guleria, Director, AIIMS, New Delhi. The guest of honour was Prof. GS Umamaheswara Rao. Among others, the distinguished guests included Prof. Rajesh Malhotra, Orthopedician and Chief, Jai Prakash Narain, Apex Trauma Centre, and Prof. Shailesh Gaikwad, Interventional Neuroradiologist at AIIMS.

The post inauguration session, “Clinical Pearls”, was based on commonly encountered complications in neurosciences. The topics included were “Soaked Lung: Neurogenic Pulmonary Edema” by Dr. Suparna Bhardwaj, “Finding Balance: Management of Anticoagulants and Antiplatelets” by Drs. Manish Marda and Shiwani Jain, and “Sodium Imbalance” by Drs. Pallav Kumar and Narendra Kaloria. Unparalleled enthusiasm was seen during late evening Quiz for Residents conducted by Dr. Ankur Luthra. A gala dinner followed the long academic day.

Dr. Kavita Sandhu touched the hearts of many by her mesmerising talk on “Work-Life Balance” during the first session on “Taming the Demon” on day three of the conference. This was followed by a talk on “Initial Approach to Patients with Status Epilepticus” by renowned neurologist Dr. Manjari Tripathi. Dr Ankur Luthra talked on “Treatment Options for Super-Refractory Status Epilepticus”. This was followed by a panel discussion on stroke management by Dr. Ponniah V and a group of eminent panelists, Drs. Rohit Bhatia, Anuj Prabhakar, and Priyanka Khurana. All aspects of stroke management were dealt with a case vignette moderated by Dr. Deepti Vibha, along with Drs. Sarita Mahapatra and Sunil Garg, minutely covered infections of the central nervous system and their management.

This year, the update featured the inaugural ‘Prof. Saini-Dash-Bithal Oration’ which was delivered by Prof. GS Umamaheshwara Rao, in honour of the first three stalwart neuroanesthesiologists at AIIMS, New Delhi who founded and nurtured the subspecialty in its infancy in India. A panel discussion on “Proliferation of Certification Courses in Neuroanaesthesia and Neurocritical Care: Productive or Counterproductive,” was moderated by Dr. Rajiv Chawla. The panelists, Drs. Parmod Bithal, Anil Parakh and Venkatesh highlighted the advantages and disadvantages of changing trends and professional concerns associated with upcoming certification courses in neuroanaesthesia and neurocritical care. The post-lunch session witnessed interactive talks on “Fever as a Symptom of Suffering Brain”, and “Perioperative Management of Deep Vein Thrombosis” by Drs. Rahul Yadav and Varun Jain, respectively. A brief clinical case presentation on obstructive sleep apnea was illustrated by Drs. Sweetha Mohan and Parul. The concluding session was a panel discussion on “Massive Intraoperative Blood Loss in a Patient with Large Meningioma.” The clinical discussion of great significance was moderated by Dr. Surya Dube and panellists: a brigade of passionate neuroanaesthesiologists included Drs. Bhavna Hooda, Vanitha Rajagopalan, Nitasha Mishra and Ritesh Lamsel.

Valedictory function was held at the end of the conference and awards for best paper presentation and quiz winners were distributed. The huge success of the event motivated the organisers to start working already for next year!

Figure 1

Figure 1: Glimpses of workshops for neuro-nurses and OR technicians

Figure 2

Figure 2: Glimpses of workshops for Point-of-Care Ultrasound in Neurocritical Care, Intraoperative Neuromonitoring and Cadaveric Airway

Figure 3

Figure 3: Glimpses of the two-day meeting

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