ASA MEETING REVIEW
SNACC - Upholding Its Mission At ASA
Christopher Fjotland, MD
Assistant Editor of SNACC Newsletter
For the first time in 47 years, the SNACC Annual Meeting was held at a different time and in a different location than the ASA Annual Meeting. While breaking away from the ASA led to a well-received, more intimate, educational and networking experience, SNACC remained to be very well represented at ASA in October.
SNACC members served in many different capacities this past October in Orlando, Florida. Many members served as speakers and moderators for both topics in the neurosciences as well as general topics. They served as representatives of SNACC while holding seats on committees and they served as neuroanesthesia ambassadors. To quote our SNACC President, Dr. Deepak Sharma, “Our mission at SNACC is to advance the art and science of care in the neurologically impaired patient through education, training and research in perioperative neuroscience. We aim to do this through all possible venues and the ASA Annual Meeting is an important venue for us.” As a society, our goals and mission were strongly upheld this year at the ASA, despite this big change.
One of the most talked about neuroscience panels was entitled, “The Transparent Brain” hosted by Dr. Ines Koerner from the Oregon Health & Sciences University and member of the SNACC Board of Directors. This panel featured speakers Drs. Laura Hemmer, Monica Vavilala, Nicolai Goethe and Max Kelz. This panel discussed ways to use advanced monitoring in the perioperative period to improve outcomes in brain heath. Dr. Laura Hemmer, from Northwestern University, began the panel with an overview of current intraoperative neuromonitoring techniques that can reduce the risk of intraoperative brain injury. Dr. Hemmer discussed the use of motor and sensory evoked potentials during aneurysm surgery. She explained how the eloquent cortex can be protected during tumor resection through the use of mapping and she described ways to reduce the risk of major functional deficit in brainstem surgery through the utility of brainstem mapping and auditory evoked potentials. Dr. Monica Vavilala, from the University of Washington, spoke about ways to monitor the integrity of autoregulation in both injured brain tissue and brain tissue which is at-risk of injury. She did so by describing a spectrum of monitoring techniques, from the utility of those which are well-established, such as jugular venous saturation, to those which are relatively new, including the use of near-infrared spectroscopy and brain tissue oxygen saturation. Dr. Nicolai Goettel, from the University of Basel, discussed the role of advanced imaging and how it can be used in the prediction and possibly even the prevention of postoperative neurocognitive disorder. He did so by presenting early evidence which suggested that brain atrophy, particularly that of the hippocampus, may increase the risk of postoperative delirium. He sparked the audience’s interest in multiple on-going studies, which aim to further support this evidence and hopefully provide more answers, by methodically eliminating conflicting results which have been seen in more recent studies on this topic. Dr. Max Kelz, from the University of Pennsylvania, wrapped up this fascinating panel discussion with his talk on EEG monitoring. He described how patterns of suppression of brain activity, which can be detected using processed EEG monitoring [a widely available tool to the anesthesiologist] may be a predictor of brain frailty which ultimately can be a predictor of postoperative cognitive disfunction and delirium. This panel’s host, Dr. Koerner, described the talk as a “stimulating discussion by the panelists [which] provided hope that future research and development of monitoring techniques will indeed improve the anesthesia provider’s ability to optimize management to the individual patient’s risk profile.”
Patient monitoring and perioperative brain health were hot topics this year. Drs. Alex Proekt, Max Kelz and Seun Akeju presented, “The Squiggle-ology Primer: An Anesthesiologist’s Guide to Recognizing and Interpreting EEG Signals.” This talk gave a brief history of EEG and its role in anesthesia. Elements of EEG analysis were discussed including conventional spectral analysis with emphasis on the different time-frequency decomposition techniques and connectivity analysis with focus on phase-based analysis of connectivity including phase lag index and phase amplitude coupling. Other talks on these topics included Drs. Antoun Koht, Laura Hemmer, Leslie Jameson and Ferene Rabai who presented, “Interactive Intraoperative Evoked Potential Monitoring” and Drs. Katie Schenning, Deborah Culley and Miles Berger who presented, “Delirium Across the Perioperative Spectrum.”
Stroke and neurotrauma were also covered in depth at this year’s ASA Annual Meeting. For stroke, Dr. Jess Brallier presented, “Cerebral Aneurysm Coiling in the Interventional Radiology Suite: The Headache of a Lifetime!;” Drs. Kate Rosenblatt and John Bebawy presented, “Acute Ischemic Stroke: Addressing the Continuum of Care from Neuro IR to Neuro ICU;” Dr. Matthew Whalin presented, “Anesthetic Management During Endovascular Stroke Treatment;” and Dr. Laurel Moore presented, “Perioperative Stroke in Noncardiac Surgery.” Neurotrauma talks included Dr. S. Camellia Baldridge who presented, “Ever Evolving Perioperative Management of Patients with Traumatic High Spinal Cord Injury: The Critical Role of the Anesthesiologist” and a panel discussion with Drs. Monica Vavilala, Letha Mathews and Audree Bendo on “Perioperative Management of Traumatic Brain and Spinal Cord Injury.”
As stated by Dr. Sharma “The entire neurotrack was very educational.” Another highly notable talk was “The Neuroanesthesia Editors Editorialize - The Best Perioperative Neuroscience” which was a session moderated by Dr. Adrian Gelb with the editors from Anesthesia and Analgesia, and the Journal of Neurosurgical Anesthesiology and Anesthesiology, Drs. Greg Crosby, Martin Smith and Deborah Culley. High quality articles from each journal were presented and discussed followed by insightful discussion with interesting insights into the future of neuroanesthesia research.
SNACC President, Dr. Deepak Sharma, delivered a highly educational talk, “Neuroanesthesia for the Occasional Neuroanesthesiologist” and Drs. Chanannait Paisansathan, Jeffery Pasternak, Peter Goldstein joined Dr. Sharma in an interesting panel discussion entitled, “Evidence-Based Mythbusting in Neuroanesthesia.” Both of these talks appealed not only to the dedicated neuroanesthesiologist, but to the “occasional neuroanesthesiologist,” further upholding to SNACC’s mission of education in the art and science of caring for the neurologically impaired patient.