2017 NACCSGBI and SNACC Annual Scientific Meeting Report.

  The 2017 meeting was held in London, at the Institute of Electrical Engineers, a magnificent building overlooking the river Thames. A record number of 324 delegates from 22 countries were present. For the first time the annual meeting was organised by a pan London group of anaesthetists, representing each of the Neuroscience units in the capital and for the second (or possibly third time) it was co-hosted by SNACC. With this in mind Andrew Kofke got us off to a great start with his entertaining introduction and report on the history of SNACC. The next session saw Tim Wigmore from the Royal Marsden Hospital outline how our choice of anaesthesia, TIVA versus volatile, may have implications for tumour recurrence. A topic felt pertinent by many in view of the increasing number of neuro-oncological cases presenting for surgery. Rupert Pearse then discussed the use of “big data” as a tool to help answer those questions that we remain unable to tackle with small scale institutional studies. This session was followed by George Mashour and Katie Warnaby who provided us with a fascinating symposium on Neural mechanisms of anaesthetic induced unconsciousness. This was an excellent session which provided food for thought even before the break for lunch. After lunch we reconvened for a symposium on enhanced recovery which discussed processes of care and allowed us to consider possibilities for the future. Jeff Pasternak discussed the difficulties presented in developing enhanced recovery programmes for the diverse spinal surgery population. Lashmi Venkatraghaven gave a comprehensive overview of their ERAS programme for craniotomy in Toronto. Finally Mike Grocott explored the role of prehabilitation and enhanced recovery for Critical Care. We then enjoyed a debate between Rafi Avitsian (pro) and Mike Nathanson (con) on the motion “A formal Neuroanaesthetic fellowship does it make a difference?Both debaters vigorously defended their positions and, despite a starting vote in favour of the motion, Dr Nathanson managed to swing a few voters and so, despite an overall win for the motion, it was not as overwhelming as might have been expected. The final session of the day was an overview of optimal trauma care straight through from the Battlefield with Surg Cdr Kate Prior, via the ED with Matt Wiles and on to Critical Care with Luke James. This was an excellent and entertaining session which provoked much discussion. Parallel workshops with discussions on EEG monitoring in neuroanaesthesia and the UK-USA transatlantic approaches to challenging cases ran throughout the day. The first day finished with the President’s Drinks Reception on Rooftop Terrace which was enjoyed by all despite the rain! The second day began with a fascinating session on Reducing Perioperative Complications with Rafi Avitsian talking on perioperative visual loss and Adrian Gelb on perioperative stroke. As might be expected there were many questions to both speakers on best practice and issues of consent. Andrew Kofke then summarised the current literature on anaesthesia for thrombectomy including some “hot off the press” results. If the audience reaction is anything to go by it looks as if the debate on best practice especially for thrombectomy is set to continue. After coffee the Free Paper and Trainee prize session got underway. There were 6 excellent presentations. Parallel workshops on Dexmedetomidine in neuroanaesthesia and advances in Neuromonitoring ran throughout the morning. The afternoon session was dedicated to the topic of Controversies in Neurocritical Care. Martin Smith began with Controversies in brain death which lived up to its title and resulted in much discussion. David Menon followed with the aptly titled What do we aim for, and how do you get there: a manifesto for rational critical care in TBI in the face of unfavourable RCTs. The final session of the day was the wonderful Baroness Susan Greenfield CBE, an Oxford neuroscientist, accomplished author and member of the House of Lords who entertained us with her thoughts on Perceptions of Consciousness. The final session saw the Trainee Prize presentations: Harvey Granat (note joint winners) 1 = Felicity Avann Experience of 302 Cases of Intra-arterial Thrombectomy at the University Hospitals of North Midlands (UHNM) Trust 1 = Richard Haddon Propofol alters functional connectivity in the endogenous sleep-wake system 3 = Payashi Garry Using arterial spin labelling to estimate cerebral blood flow after severe subarachnoid haemorrhage The poster prizes were awarded to: 1 = Sriganesh Kamath Cerebral oxygenation changes after decompressive craniectomy in patients with malignant cerebral venous thrombosis 2 = Hannah Wong Intra-arterial thrombectomy for acute ischaemic stroke at the Wessex Neurological Centre, University Hospital Southampton (UHS) 3 = Sarah Taylor Effects of Trendelenburg and head rotation on blood volume and its asymmetry, assessed by Cerebrotech, in healthy volunteers     The day was brought to a close with a preview of next year’s meeting which will be held in Bristol. In addition, there were thanks to all the speakers and especially our co-hosts in SNAACC. The meeting has had fantastic delegate feedback and we hope that this will be the beginning of many more combined meetings.