One of the aims of anaesthesia is to provide unconsciousness during procedures or surgery but only a small part of the curriculum of the general anaesthetist is spent in understanding the principles and tools available to interpret how to monitor the brain function during anaesthesia.
Two Scientific Subcommittes (General Anaesthesia and Neuroanaesthesia) launched the “Course on Intraoperative Monitoring” for the first time during the ESA annual meeting in Berlin. The course was chaired by Dr. Massimo Lamperti and Dr. Federico Bilotta and hosted speakers from Europe and oversease covering the basics for interpreting data from the most commonly available cerebral monitors used in the theatres and in the perioperative period as electroencephalogram, spectral electroencephalogram analysis, celebral oxymetry, transcanial doppler and evoked potentials.
Out of the 66 registered attendees 40 part in both the theoretical and practical sections.
The course started on May 29th afternoon. Dr. Honorato started the course with an introduction on electroencephalogram and gave practical examples of how the anaesthestist can easily be trained in interpreting the electroencephalogram raws during general anaesthesia and titrate the depth of anaesthesia correctly. Dr. Pandit, from Oxford University, presented an interesting lecture on the different levels of sedation and how consciousness could be evaluated during general anaesthesia. He also explained that there is an alternative “third state” of consciousness somewhere between sleeping and waking that patients under general anaesthetic can and do experience, the so called “dysanaesthesia” state. The course continued with the lecture by Prof. Rafi Avistian from Cleveland Clinic Ohio, who presented the mechanism of near-infrared spectoscopy and its actual application for the anaesthetist in the operating room with the benefits and the limitations of this technique. Dr. Velly from Marseille discussed the different commercial tools for depth of anaesthesia monitoring and offered an evidence-based approach on how to correctly interpret the numbers coming from these monitors. An overview of the different pharmacokinetic models available to deliver intravenous anaesthesia was presented by Prof Absalom from Groningen. The course was concluded by Prof. Czosnyka from Cambridge, who illustrated the basic functions and parameters measurable with transcranial Doppler and presented the different applications of transcranical Doppler both in the operating room and in the ICU; Dr. Pandin concluded the first part of the course with a presentation on the basics on evoked potentials, how to interpret the results from this monitor and how to titrate the different anaesthetic drugs in case of need for intraoperative neuromonitoring.
The second part of the course was completed on May 30th morning with a 4 hour session of problem based learning discussions (PBLD). The attendees rotated between 4 tables where 2 faculty members presented and commented on 4 clinical cases. Participants are asked to comment and ask questions. For each of the discussed scenario, the possible role of the neuromonitoring devices and methods of providing anaesthesia presented in the course were evaluated along with different therapeutic options.
The course was an opportunity to create a link between experts and anaesthetists not routinely involved in neuroanaesthesia, to improve the knowledge on how to interpret the signals coming from patients’ brains and how to deliver and titrate the level of anaesthetics accordingly.
Given the high interest between the anaesthesia community, the course will be presented even during Euroanaesthesia 2016 in London.
Hope to see you there.