Intraoperative brain monitoring –thoughts for the near future

Intraoperative brain monitoring –thoughts for the near future

  • Issue 65

Jeroen Hermanides, Chiara Robba, Federico Bilotta*

*Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Rome, Italy, Chair of the Sub-Committee on Neuroanaesthesia of the European Society of Anaesthesiology

bilotta@tiscali.it

During the last ESA meeting in London the Neuroanaesthesia subcommittee organized and contributed to several activities, which included: pre-congress course on intraoperative brain monitoring, symposia, lectures, and business meeting. We would like to provide a brief overview of the different events and highlight some of the “multidisciplinary” activities and proposals for the future.

Pre-congress course on Intraoperative brain monitoring. The lectures and the practical sessions provided an important overview and update regarding current intraoperative neurophysiologic monitoring using a variety of neurophysiologic techniques, including EEG (electroencephalogram), SSEPs (somatosensory evoked potentials), and transcranial Doppler. During this session, we had more than 25 attendees from 10 different countries and 8 speakers from 7 countries.

In cooperation with the subcommittee on Ethics, the session “Consent and Ethics at the Boundaries of Neuroanaesthesia” offered insights concerning ethics and informed consent issues that we all encounter during clinical practice, including diagnostic modalities for patients in vegetative state, awake craniotomy, experimental tests, and withdrawal of treatment.

The session organized in collaboration with the paediatric anaesthesia subcommittee, “Neuroanaesthesia: are children different from adults?”, was a great success with the room filled to the brim. This session highlighted the main differences between paediatric and adult populations in the anaesthesiological management of intracranial surgery, pain management, as well as the management of children with mental disability, and offered many points of discussion among the participants.

We also had a large number of attendees during the session “Neurocritical Care”. During this interesting session, the topics ranged from the relevance of spreading depolarization after cardiac arrest to the prognostic role of MRI in the discrimination between favourable and unfavourable outcome in coma patients. Finally, the management of glucose after acute brain injury, especially with regard to micodialysis data, was discussed.

The session “Neuroanaesthesia and challenging cases” offered the possibility to discuss different and difficult scenarios that we can encounter in the context of neuroanaesthesia. In particular in the field of neurosurgical procedures in pregnant patients, where literature is lacking regarding the management strategies of this group of patients, and several considerations (including teratogenic risk of anaesthetics, foetal monitoring) should be taken into account. Moreover, the lectures regarding intraoperative management during general anaesthesia for brain tumour surgery and anaesthesia in neuroradiology offered the possibility to discuss new trials and management strategies that could modify our clinical practice.

The Neuroscience subcommittee business meeting was successful, with more than 30 attendees from all over the world. Many important topics were discussed.

1) European Neurofellowship Program

The idea is to develop a fellowship program in neuroanaesthesia and neurointensive care. The aim of this program is to give people extensive experience and special skills in the neuroscience field. Duration, location, and organization of the fellowship have been discussed, as well as the need for funding, considering that this program will not be part of the standard training. Several suggestions have been made with regard to the structure of the fellowship as a type of Diploma, Master’s, PhD program, thesis, or a mix of these options, possibly involving an online practical, teaching, and research module.

2) International Outreach Anaesthesia Education (IOAE) Program

The proposal of Alexander Zlotnik is to deliver knowledge and a training program to countries with limited resources to attend international conferences and education. The program should involve small groups of experts in neuroanaesthesia and neurointensive care who, in connection with the local societies of anaesthesia, will deliver a 3-day teaching program.

  1. Presentation – state of the art
  2. Changes in neuroanaesthesia (e.g., different clinical situations)
  3. Simulation, oral board exam, to help people get ready for the European diploma.

We believe that the neuroscience scientific program in London has been very relevant, interesting, and diverse, focusing on many aspects of neuroscience, neuroanaesthesia, and neurocritical care. We would like to thank all the presenters and members of the neuroscience subcommittee who worked hard to arrange scientific panels for all participants. We will continue to keep all those interested posted about the details of our ongoing events and would welcome involvement of more colleagues into the neuroscience activities.

We invite all those interested in this special clinical and research field to contact us for further cooperation.