Report of AIIMS neuroanaesthesia update 2013, New Delhi, India

The AIIMS Neuroanaesthesia Update 2013 was held at New Delhi on 19th and 20th October 2013. The Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi organised the first Neuroanaesthesia Update under the leadership of Prof. Parmod K Bithal (Organising chairman). It was organised with the aim to update the delegates with the recent advances and developments in the field of Neuroanaesthesiology and also to give the young budding anaesthesiologists a platform to share their knowledge and gain from the vast experience of the esteemed faculties from India and abroad. Over 120 delegates from various parts of the country assembled to participate in the event.

The event started with the preconference workshop on 19^th Oct 2013, at 8.30 a.m. This included the live demonstration (audio-visual relay from AIIMS Neurosurgery operation theatres) of anaesthetic techniques and discussion on anaesthetic management of three different cases by Dr. Sergio Bergese (Director of Neuroanaesthesia at Ohio State University, CO, USA). The three cases discussed were anaesthetic management of posterior fossa tumour in sitting position, cervical spine surgery in prone position and surgery for pituitary adenoma using trans-nasal trans-sphenoidal (TNTS) approach. Initially, there was discussion regarding preoperative assessment followed by anaesthetic plan and management of each case. The techniques of induction, maintenance using desflurane and extubation were demonstrated live on the patients from the operation theatre. Besides this, technique of fibre optic intubation, central venous cannulation, trans-esophageal echocardiography (TEE) and positioning of patients for surgery in sitting and prone positions were also demonstrated. The audience actively participated in the discussion regarding various aspects of anaesthetic management in these patients and shared their experiences in such cases.

Post-lunch session began with the lecture on “Balanced use of anaesthetic agents in neuroanesthesia: Pharmacological bases and principles” by Dr. Sergio Bergese (USA) who elaborately discussed about various anaesthetic agents in neuroanaesthesia practice. This was followed by a panel discussion on “Improving competence in neuroanaesthesia for patient well being?” moderated by Prof. Rajiv Chawla (New Delhi). The panellists included Prof. H H Dash (Gurgaon), Prof. GS Umamaheswara Rao (Bengaluru), Prof. P K Bithal (New Delhi), Dr. Sergio Bergese (USA) and Dr. K J Choudhury (New Delhi). After this there was a session on interactive case discussions moderated by Dr. Gyaninder P Singh (New Delhi), Dr. Virendra Jain (Gurgaon) and Dr. Keshav Goyal (New Delhi). The cases discussed were “Anaesthetic management of an infant with crouzon syndrome posted for craniosynostosis surgery”, “Anaesthetic management of a patient of pituitary adenoma with acromegaly posted for TNTS surgery” and “Anaesthetic management of an irritable child with Tetralogy of Fallot posted for drainage of brain abscess in emergency”. There was an extensive discussion in the house on various important aspects in each and every case. Prof. P K Bithal (New Delhi), Prof. L D Mishra (Varanasi) and Prof. M Tandon (New Delhi) were the experts for each case, respectively, who gave their opinion and expert comments at the end. The day ended with the dinner at the conference venue.

The second day of the conference began with the lecture of Prof. P K Bithal (New Delhi) who delivered a talk on “Postoperative blindness after surgery in prone position” and discussed in detail the causes, management and preventive strategies of this rare but important complication of prone position surgeries. Prof. G S Umamaheswara Rao (Bengaluru) elaborately discussed on “How close are we to the ideal to the ideal neuro anaesthetic agent?” and Dr. Sergio Bergese (USA) spoke on “Impact of the anaesthetics in the brain: the young and the elderly”. He highlighted upon the effects of various anaesthetic agents on the young and elderly brain. This session was chaired by Prof. L D Mishra (Varanasi) and Mukul Jain (New Delhi).

The morning session was followed by a formal inauguration ceremony. The chiefguest Prof. M C Misra (Director, AIIMS, New Delhi) presided over the meeting. The event was conducted in presence of several dignitaries on the dais - Prof. S S Saini (Director, Neuroanaesthesia, Paras Hospital, Gurgoan), Prof. H H Dash (Director, Anaesthesia and Pain Management, Fortis Memorial Research Institute, Gurgaon), Prof. P K Bithal (Organising Chairman, AIIMS Neuroanaesthesia Update 2013), Prof. Arvind Chaturvedi (Co-organising Chairman, AIIMS Neuroanaesthesia Update 2013) and Dr.. Mihir P Pandia (Organising Secretary, AIIMS Neuroanaesthesia Update 2013). After the lamp-lighting ceremony and the inaugural address by the dignitaries, the CME book was released by the chief guest. The ceremony was followed by high tea.

The second session started with lecture on very important and relevant topic by Prof. H H Dash (Gurgaon). His talk highlighted the “Research studies that have influenced the practice of neuroanaesthesia in recent years”. The next two lectures touched upon important issues in neurocritical care units. Prof. Mary Abraham (NOIDA) discussed “Controversies in neurocritical care” while Prof. Pragati Ganjoo (New Delhi) talked on “Weaning and extubation in neuropatients.”

The next session comprised two symposia. The first symposium was on “ICU management of neurology patients with respiratory muscle dysfunction”. Dr. Virendra Jain (Gurgaon) discussed about airway management and ventilation, Dr. Kapil D Soni (New Delhi) about nutrition and Dr. Zulfiqar Ali (Srinagar) about analgesia and sedation in these patients. The session was moderated by Prof. G S Umamaheswara Rao (Bengaluru). The second symposium was on “Recent advances in head injury management” moderated by Prof. Rajiv Chawla (New Delhi). The issues discussed were “Initial approach and management in the emergency room” by Dr. Kavita Sandhu (New Delhi), “Anaesthetic management” by Dr. Girija P Rath (New Delhi) and “Postoperative care and ICU management” by Dr. Hemant Bhagat (Chandigarh).

The post-lunch session was an interactive case discussion moderated by Dr. Ashish Bindra (New Delhi) and Dr. Nidhi Gupta (Gurgaon). There was in depth discussion of cases such as “Emergency room management of head injured comatose patient with facial trauma presenting with shock to the emergency department”, “Anaesthetic management of a patient with large parafalcine meningioma with hypertension and raised ICP posted for tumor resection” and “Anaesthetic management of a newborn requiring urgent repair of leaking meningomyelocele”. The experts with wide experience in the field Prof. H H Dash (Gurgaon), Dr. K J Choudhury, (New Delhi) and Prof. Dilip Pawar (New Delhi) gave their expert opinion and views in the management of such cases.

The last session of day 2 began with the lecture on “Difficult airway in neuroanaesthesia” by Dr. M Radhakrishnan (Bengaluru) who discussed extensively on the expected difficult situations in neurosurgical patients and the management strategies in such patients particularly highlighting the use of newer gadgets available. Dr. Zulfiqar Ali (Srinagar) in depth discussed the “Interventional pain management in lower back pain”, highlighting the various modalities available to treat such pain and the future prospective. Dr. Keshav Goyal (New Delhi) delivered a talk on “Hyponatremia in neurosurgical patients” emphasising the various conditions, approach to diagnosis and management of these conditions.

The meeting concluded with the valedictory function and prize distribution to the residents who actively participated in the interactive case discussions. The delegates came forward to share their experiences and suggestions and congratulated the organisers for organising a great academic treat. The organising secretary, on behalf of his team thanked everyone for their active participation during the conference. The delegates cheered and applauded for the host and wished to make it a regular event. Everyone enjoyed the evening with light music and dinner.