INTERNATIONAL NEUROANESTHESIA NEWS

A Treatise on 1st Neurocritical Care Society of India (NCSI) Conference and 3rd Annual Neurocritical Care Update (ANCU) 2020

- An event of many firsts with a motto “Back to Basics…Eyes on Future!”

Seema Lachala, MD, IDCCM
Senior Consultant, Department of Neuroanaesthesia and Neurocritical Care

Saurabh Anand, MD
Chief, Department of Neuroanaesthesia and Neurocritical Care
Artemis Hospital
Gurugram, India

Seema Lachala, MD, IDCCM
Seema Lachala, MD, IDCCM
Saurabh Anand, MD

With a frisson of excitement, the ANCU 2020 presented the virtual 1st conference of NCSI, which was held on October 2-4, 2020. It was organized by Artemis Agrim Institute of Neurosciences under the aegis of Neurocritical Care Society (NCS) and Indian Society of Neuroanaesthesiology and Critical Care (ISNACC). Dr. Saurabh Anand being the Organizing Chairman and Dr. Seema Lachala was the Organizing Secretary. Keeping participants' safety in mind in the tough COVID times, turning the challenge into a new opportunity was made by changing the in-person conference to a unique virtual-learning experience that got a roaring inordinate response from the prestigious participants transforming the event into a grand one. The essence of the event was an erudite discussion after each and every session to make it interactive and engaging to clarify the key issues with the experts. At the same time, however, it was also an event of many firsts: first NCSI conference, first virtual event of ISNACC & NCSI, first virtual Acute Neurocritical Care Course Workshop with full interactive sessions with the delegates.

An array of renowned international and national faculty, more than 400 delegates from all over India and abroad converged on this virtual platform for the knowledge network to contribute to each other in innovating, invigorating, and evolving. Every session was recorded and was available online to re-watch for two weeks.

Workshops on Mechanical-ventilation and Electroencephalogram (EEG), with interesting case discussions, were conducted by Drs. Jeetendra Sharma and Chaturbhuj Rathore. The delegates got enthusiastically engaged in learning, interacting, clarifying and evolve to accomplish more. Transcranial Doppler (TCD) workshop was conducted by the stalwarts in the TCD field (Figure 1), Drs. Andrei Alexandrov (USA), Vijay Sharma (Singapore), Arvind Sharma, and Amit Batra (India); by including interesting case-discussions, they successfully unraveled the concepts and the clinical applications of this non-invasive tool in neurocritical care.

Figure 1

Figure 1: Virtual Transcranial Doppler (TCD) Workshop.

Acute Neurocritical Care (ANC) Course (Figure 2) with a focused motto on the first golden hours’ management of neurological emergencies to improve the functional outcome witnessed enthusiastic, interactive participation of the delegates, fulfilling the aim of the course. It was well coordinated by Drs. Keshav Goyal and Saurabh Anand.

Figure 2

Figure 2: Acute Neurocritical Care (ANC) Course.

The scientific program, diligently formulated to encompass the important topics impacting neurocritical care today, comprised lectures, case discussions, panel discussions, debate sessions, case reports, and paper presentations.

On the first day, there were sessions on “Trauma: Let’s See the Finer Print," which included lectures on “Target Temperature Management in TBI” by Prof. Yashiro Kuroda (Japan) and “High PEEP: Is it a Deterrent in Raised ICP?” by Dr. Sanjith Saseedharan, and a case discussion on “Critical Care Management of Cervical Spine Injury”, moderated by Dr. Ranadhir Mitra. After that was an interesting session on “Pharmacology, It’s Not Always Boring” that included elucidative lectures and discussion on “Tranexamic Acid in Neuro ICU: Current Status” by Dr. Indranil Ghosh and “Antiplatelet & NOAC Reversal” by Dr. Rajsrinivas Parthasarthy. A session on sepsis with a talk on “Choosing Antibiotics in Neuro Critical Care” by Dr. Subramanian S. and a case discussion on “ Meningoencephalitis’’ where three different cases were discussed, was much appreciated and was moderated by Dr. Sumit Singh with the panelists Drs. Namita Jaggi, C. S. Narayan, Tapesh Bansal, and Subramaniam S. followed by the session pressing on “Guidelines for NCC in COVID-19” by Dr. Masao Nagayama (Japan). The conference was inaugurated formally by the welcome speech by Dr. Saurabh Anand, the Organizing Chairman, followed by an address by NCSI president Dr. Shashi Srivastav and NCSI secretary Dr. V. Ponniah followed by an inaugural address by the Honorble Chief Guest, Dr. Pramod Bithal, and thank-you address by Dr. Seema Lachala (Figure 3). The last session of the afternoon was “Pot Pouri” that comprised assorted issues in Neurocritical Care like “Research Gaps in TBI Guidelines” by Dr. Sriganesh Kamath, “Role of Neurophysiological Monitoring in Neurocritical Care” by Dr. Dheeraj Masapu, and “Nutrition in Neuro ICU: Is it Any Different?” by Dr. Subhal Dixit, that ended with an insightful discussion.

Figure 3

Figure 3: Virtual Inauguration Ceremony of the First NCSI National Conference.

Meanwhile, eminent judges Drs. Nitin Manohar and Suparna Bhardwaj moderated interesting case-reports’ presentations, and the best three were awarded out of fourteen case-reports. The conference’s second day of the scientific program started with commemorative Dr. G. S. Umamaheswara Rao (NIMHANS) Oration, presented by Dr. J. J. Rouby on “Use of High Flow Nasal Cannula in Intensive Care Unit”. Simultaneously, Free-Paper Presentation of studies had started in the other virtual hall, judged by Drs. HH Dash, Pramod Bithal, and Virendra Jain and awards to the best three winners were announced; a total of 33 delegates participated in the paper presentation.

Up next was the session "Seize the Day" with a panel discussion on “Practical Points about Antiepileptics - Are We Ready to Change Our Practice?” moderated by Dr. Ashish Bindra. After this was the session  “Addressing the Grey Area” clarifying the controversial topics impacting neurocritical care, wherein Dr. Vijay Sharma delivered a lecture on "BP Control in AIS," and Dr. Andrei V. Alexandrov talked about “Acute Stroke Management: What is New?” followed by another interactive case discussion on “Management of Cerebral Edema in Neurocritical Care” moderated by Dr. Saurabh Anand with the eminent panelists Drs. Jose Suarez, Aditya Gupta, Yashiro Kuroda. The next session, "All White is Not Bright" included lectures on “Haematoma Expansion in ICH: Can We Really Predict & Prevent It?” by Dr. Jose I Suarez (USA) and “Future of Minimally Invasive Surgery in ICH” by Dr. Aditya Gupta. The succeeding session “Seeing is Believing” wherein “Hyponatremia & Central Pontine Myelinosis” was presented by Dr. Unnikrishnan and “Cerebral Haemodynamic Assessment: Is TCD a Reliable Tool?” by Dr. Andrei V. Alexandrov and “DCI: What Should be an Ideal Management Protocol: Is there anything new?” by Dr. Jose Suarez were followed by wonderfully Clear and Rationale Conversation." Dr. Rajsrinivas Parthasarthy moderated the discussion on “Management of Cerebral Venous Thrombosis” with the eminent panelists Drs. Andrei V. Alexandrov, Arvind Sharma, Vipul Gupta, and Radhakrishnan M. (Figure 4). The last session of the second day, being “EVD: Gain or Pain, "Panel Discussion on “EVD –The Practice Guidelines” was moderated by Dr. V. Pooniah, and the prominent panelists were Drs. Jose I. Suarez, Ines Koerner (USA), Drs. HH Dash, and Anurag Sharma (India) (Figure 5).

Figure 5

Figure 4: Panel Discussion on Management of Cerebral Venous Thrombosis.

Figure 4

Figure 5: Panel Discussion on EVD Practice Guidelines.

The third day of the conference began with the edifying debate-session with esteemed Jury: Drs. B. K. Das, Arvind Chaturvedi, Hemangi Karnik with a pre-debate and post-debate poll to evaluate the impact of the debate on the delegates' views. Debates included “TEG Based Transfusion Strategy in Patient on Antiplatelet and Anticoagulants in Neuro ICU” by Dr. Manish Marda vs. Dr. Ajay Prasad Hrishi, “Is IVC Measurement Good Enough for Fluid Management?” by Dr. Obaid Siddiqui vs. Dr. Durgesh J. Satalkar,  “Multimodal Monitoring Makes a Difference in TBI” by Dr. Ankur Luthra vs. “ICP Monitoring is Enough in TBI” by Dr. Sucharita Chakravarti. The lined-up session “Holding the Bull by Its Horns" had a panel discussion on “Ethical and Legal Issues in Neuro ICU,” moderated by Dr. Jeetendra Sharma with the panelists Drs. Arvind Arya, Umamaheswara Rao, Dhruva Choudhary and Geetender Sharma. The second debate-session with Jury Drs. M. M. Mehndiratta, Pramod Bithal and Rajiv Chawla had pre-and post-debate poll and witnessed enriching dialogues on “Should Treatment be Repeated in GBS Patients Who Do Not Improve?” by Dr. Anshu Rohtagi vs. Dr. Sumit Singh , “Is cCipping a Dying Art?” debated by Dr. Vipul Gupta vs. Dr. Aditya Gupta, “Should We Go Ahead with Intraventricular Thrombolysis in ICH with IVH?” debated by Dr. Pawan Goyal vs. Dr. Subba Reddy. The next session, "When Going Gets Tough” included talks on “Management of ICH in Decompensated Chronic Liver Disease” and “Decompressive Craniotomy in TBI and Stroke” by Drs. Manikandan S. and Karanjit Singh, respectively. Session “Busting the Clot” with Interactive Case-Discussion on “DVT Management in Neurocritical Care“ was moderated by Dr. Bidkar Prasanna. The last session on “Current Affairs” included “Current Status of Stress Ulcer Prophylaxis in ICU” by Dr. Dalim Kumar Baidya, and “Five Landmark Trials in Neurocritical Care” by Dr. Zulfiqar Ali.

Overall, the event received an overwhelming and praiseworthy response and proved to be a feast of intensive knowledge exchange that would hopefully help maintain and improve the daily clinical practices of the participants. Finally, we wrapped up the conference hoping that the learning, the evolving and the efforts will not cease.

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