INTERNATIONAL

ISNACC 2021 Conference Report

Ankita Dey, MD

Ankita Dey, MD
Division of Neuroanaesthesia, Department of Anaesthesiology and Critical Care
JIPMER, Puducherry, India

Prasanna Udupi Bidkar, MD, DM
Division of Neuroanaesthesia, Department of Anaesthesiology and Critical Care
JIPMER, Puducherry, India

Ponniah Vanamoorthy, MD, DNB
Department of Neuro Anaesthesia & Neuro Critical Care
MGM Health Care, Chennai, India

Gyaninder Pal Singh, MD. DM
Department of Neuroanaesthesiology and Critical Care
AIIMS, New Delhi, India

The 22nd Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC-2021) was conducted in a virtual platform, owing to the ongoing COVID-19 pandemic. The theme for this year's conference was “Innovation and Evolution”. It was organized over three days from January 24-26 which started with a welcome address by the ISNACC Secretary, Dr. V. Ponniah. Insightful scientific talks were delivered by seasoned clinicians and researchers.

The first speaker, Dr. Lakshmi Venkatraghavan (Canada), shed light on the nuances of the relationship between carbon-dioxide and steno-occlusive disease, followed by riveting lectures on management of cerebral vasospasm and acute kidney injury in neurosurgery by Dr. Kiwon Lee (USA) and Dr. Channanait Paisansathan (USA), respectively. The second session of scientific talks resumed after the inaugural ceremony, which included deliberations on jugular venous oximetry, NIRS guided therapeutic interventions, and the choice of anesthetic agents in head injury. The next session was dedicated to debates on anesthetic agents being neuroprotective or neurotoxic and intraoperative goal-directed fluid therapy was the road to adopt, with convincing arguments both for and against. Video presentations on pupillometry and USG assessment of DVT brought the pre-lunch sessions to a close.

The post-lunch session commenced with an insightful talk on telemedicine in neuroanesthesia followed by the pros and cons of using prognostic calculators in neuroanaesthesia and a panel discussion on the current status of multimodality monitoring in TBI. The enthusiasm of the moderator and the panelists was tangible.

The next session saw Dr. Basil Matta (UK) delivering an engaging talk on lessons learned from the COVID pandemic with respect to monitoring the brain and optimizing sedation and oxygenation. Dr. Martin Smith (UK) elaborated on the pitfalls of incorporating perioperative research into clinical practice. This was followed by a comprehensive overview of the role of neurointensivists in the management of large vessel stroke, delivered succinctly by Dr. Wade Smith (USA). Dr. Jeffrey Pasternak (USA) and Dr. Manu Malbrain (Belgium) were the next session's esteemed speakers. While Dr. Pasternak enlightened us on significant research in the field of perioperative neuroscience in the year 2020, Dr. Malbrain dealt with the complex subject of fluid therapy with inimitable ease.

The prestigious Dr. Hariwir Singh oration was delivered by Dr. Andrew Kofke (USA). He deliberated on the layered and complex subject of intracranial hypertension at length and opened new horizons for all. This was followed by the SNACC panel, one of the most admired sessions of every ISNACC conference. This year’s theme was “Harnessing Technological Innovations for Patient Safety in Neuroanesthesia”. Dr. Kate Rosenblatt (USA) provided her insights on cerebral autoregulation guided therapy to improve sepsis outcomes. Dr. Dinesh Pal (USA) delivered on processed EEG and states of consciousness, and Dr. Deepak Sharma (USA) spoke about his inspiring work on a simulation-based TCD innovation to improve patient safety.

The last session on the first day was a problem-based learning discussion (PBLD) on airway management in cervical spine injury for trainees in neuroanesthesia. This was moderated by Dr. Verghese Cherian (USA). Even though it was intended for trainees, it was a learning experience for everyone. Day one also witnessed 25 enthusiastic neuroanesthesia residents from all over the country participating in the preliminary round of the quiz conducted by Drs. Shobana Rajan (USA) and Tumul Chowdhury (Canada).

Day two commenced with the PG symposium, which provided an excellent platform for residents to share their experiences and interact with eminent and established neuroscientists. It was followed by Drs. Claude J Hemphill (USA), talking about perioperative management of direct anticoagulants in neurosurgeries, Tumul Chowdhury is providing an interesting perspective on the impact of anesthetic agents on the survival of brain cancer patients, and Chitra Venkat (USA) discussing the myriad neurological complications of COVID-19.

The third session began with the lucid talk on the prevailing concepts of perfusion pressure breakthrough after AVM surgery, followed by a concise presentation on TEG. The next session started with an insightful talk by Dr. Sujoy Banik (Canada) on optimization of intraoperative electrocorticography followed by discussions on the anesthetic management of patients with prior stroke for non-neurological surgery, and perioperative risk stratification in neurosurgical patients. There were informative lectures on airway challenges in acromegalics, brain death certification, and perioperative management of endoscopic neurosurgical procedures.

The meeting after the lunch commenced with sharing tips and tricks of cerebral protection during aneurysm surgery, management of an intraoperative ‘angry brain’, and intraoperative evoked potential monitoring in a neonate scheduled for MMC repair. The coming sessions were a medley of interesting and contentious subjects such as the feasibility of thromboprophylaxis in neurosurgical patients, perioperative challenges in the management of a new-born with a vein of Galen malformation, hemodynamic monitoring in neurosurgery in a sitting position, weaning strategies in tetraplegics, anesthesia and cognitive outcomes in the elderly, and the vasopressors of choice in neurosurgical patients.

In the following session, Dr. Vijay Sharma (Singapore), enthralled the audience with his talk on the use of TCD in neurocritical care. Thereafter, the presentations on the strengths and limitations of big data research in clinical neurosciences and differences in outcomes of emergent neurosurgical procedures when performed during the day against those performed at night generated good discussion. The prestigious Dr. Malathi oration was delivered by Dr. David Menon (UK), who highlighted rational approaches to the management of a traumatic brain injury in a brilliant, well-rounded session. Dr. Lara Prisco (UK) discussed the use of intravenous anesthetics in the management of refractory and super-refractory status epilepticus, while Dr. Umamaheshwar Rao (India) delivered a riveting talk on neural inertia during anesthesia.

The day concluded with a PBLD session on awake craniotomy, which was meticulously planned and very informative. Three workshops were also conducted on the second day of the conference. These workshops on research methodology, EEG in anesthesia practice, and neuroradiology for neuroanesthesiologists generated significant enthusiasm among the delegates and were seamlessly conducted by the organizers.

The virtual conference's final day began with another PG symposium session, which saw three neuroanesthesia residents from various institutes delivering presentations on important clinical topics. Next, Dr. David Wright (US) discussed the perioperative considerations of advances in endovascular neurosurgeries in an engaging presentation. Other talks during this session included the hemodynamic targets before, during and after interventions for acute stroke and the perioperative temperature management in neurosurgical patients.

Dr. Kavita Sandhu (India) delivered the prestigious Dr. Gode oration on lessons learned and unlearned in the neuroanesthesiology practice in the last decade. The next session saw speakers discussing contentious topics during the debate on opioid-free anesthesia versus balanced anesthesia in neuroanesthesia practice. Another debate on the age-old controversy about normal saline and balanced salt solutions in the setting of neurosurgeries resulted in an absolutely riveting session. Thereafter, the panel discussion by erudite panelists on why and when elective neurosurgery should be deferred was thought-provoking and fruitful.

The post-lunch sessions commenced with discussions on an interesting topic such as evolving options for postoperative pain management in spine surgeries, targeted perfusion therapy in spinal cord injury, management of neurogenic shock beyond fluids, use of nitrous oxide in neuroanesthesia practice, common problems associated with intraoperative neuromonitoring and their troubleshooting, and finally an eye-opening lecture on artificial intelligence in anesthesia and intensive care unit delivered by Dr. Massimo Lamperti (UAE).

Next in line was a video session that meticulously demonstrated the steps of sitting position in neurosurgery and Dr. Ashley Miller (UK) preciously explained about ONSD measurement using video clips. This was followed by a panel discussion featuring senior neuroanesthesiologists from across the country, who deliberated on how the COVID-19 pandemic affected teaching and training in neuroanesthesia. Involving trainees to provide their inputs was a nice touch.

The final session of the day and the conference saw three seasoned speakers who provided a fitting conclusion to the conference by their excellent talks on the use of volatile agents for sedation in the ICU, cross-talks between inflammation and coagulation in sepsis, and neurosurgeons perspective on decompressive craniectomy.

On the last day of the conference, the valedictory ceremony announced the winners of the final round of the quiz and in various paper and poster presentations. The paper presentation was spread over two days which received an overwhelming response.

Since it was for the first time the ISNACC conference was conducted on the virtual platform, this was a challenge for the organizers who had no previous experience of this kind. It warranted a smooth and flawless streaming of the event and required close coordination among organizers who were present at different locations of the country. Moreover, it required adjusting the timings for international faculties based on the different time zones. However, this virtual platform had distinct advantages also, like, people from every corner of the world could join the meeting without traveling to the venue. This benefited trainees the most who were able to participate in large numbers from all over the country. The scientific meeting proceeded smoothly and provided an excellent academic platform for novices and experienced neuroanesthesiologists alike.

ISNACC fig 1 Figure 1: Virtual Inauguration Ceremony of ISNACC 2021: Upper row (Lt-to-Rt): Prasanna Bidkar (Org. Secretary), Ponniah V (Org. Chairman), Nidhi Panda (President, ISNACC) and Deepak Sharma (Past President, SNACC); Lower row (Lt-to-Rt): Roger Lightfoot (NACCS President), Wade Smith (NCS President), Chanannait Paisansathan (SNACC President) and Amna Goswami (Chief Guest).