28th Annual Meeting of the Society of Neurosurgical Anesthesia and Critical Care.NASan Francisco, California. October 13, 2000.

Tod B. Sloan, M.D., Ph.D.

The scientific meeting began with John C. Drummond, M.D., F.R.C.P.C., who moderated a pro–con session called “Neuro-monitoring: What is the Role of the Anesthesiologist.” The discussion that followed was stimulated by comments by Mark H. Zornow, M.D., and Michael E. Mahla, M.D. They agreed that the anesthesiologist is positioned properly to play a critical role in the minute-to-minute integration of neurologic monitoring into the pharmacologic, physiologic, anesthetic, and surgical environments during surgery. Problematic areas of reimbursement, training, liability, credentialing, and resources (including nonclinical time) were mentioned as potential limitations. However, all agreed that this was clearly an area of special contribution of neuroanesthesiologists and an important area of contribution to a team effort for optimal patient outcome.

Masahiko Kawaguchi, M.D., received the Young Investigator Award for his paper entitled “Effect of Isoflurane on Neural Apoptosis in Rats Subjected to Focal Ischemia.” This work builds on earlier observations that isoflurane seems to reduce ischemia-induced neural injury. He stated that the protective efforts may result from effects on acute injury (such as mediated by excitotoxins) and effects on apoptosis. He noted a significant increase in short-term neural survival after isoflurane, which was not sustained for longer periods of time. He suggested that this might imply a delay of apoptotic death, creating a window of opportunity for other potentially protective agents. This presentation was followed by a walk-around discussion-and-viewing session of 42 posters of original work presented at the meeting.

The highlight of the meeting was a luncheon meeting of the Society of Neurosurgical Anesthesia and Critical Care with the Society of Pediatric Anesthesiology and the American Society of Critical Care Anesthesiology. Dr. Jeffrey Kirsch, M.D., introduced Dr. Louis J. Ignarro, Ph.D., winner of the 1998 Nobel Prize in Medicine, for his work on nitric oxide. He presented a light-hearted and reflective recount of his research journey that led to a better understanding of the mechanism of this important mediator. The first part of his presentation was described as an abbreviated version of his Nobel lecture. He then shared his personal reflections about hearing about his award and the ceremony that followed when he received the award.

A forum about central nervous system ischemia and injury followed this discussion. Rona Giffard, M.D., discussed methods and considerations for gene therapy, focusing squarely on studies attempting to enhance gene expression that may confer neuroprotective efforts for ischemia.

Christian P. Werner, M.D., followed with a discussion of the continued controversy regarding the mechanisms of neuroprotective benefits of anesthetic agents. He stated that differences in models, end points, and confounding variables (such as temperature) may explain some of the inconsistencies seen.

David S. Warner, M.D., followed with a discussion of clinical trials, including the stroke trials directory, the National Institutes of Health hypothermia trial, glycerin antagonist trials, and the International Hypothermia for Aneurysm Surgery Trial 2. He men-tioned that a valuable summary of the trials could be found at http://stroke.wustl.edu/trials/index.htm.

This was followed by a second walk-around discussion of 72 additional posters. The program concluded with a forum moderated by Sulpicio G. Soriano, M.D., about various issues, including the unstable cervical spine (e.g. , head injury, rheumatoid arthritis, Down syndrome), visual loss after spine surgery, and peripheral nerve injury, the second most common cause of liability in the American Society of Anesthesiologists closed claims database (27% of cases).

The proceedings, including the scientific abstracts from this meeting, are published in the October issue of the Journal of Neurosurgical Anesthesiology . The society will reconvene at the 2001 annual meeting in New Orleans, Louisiana, October 12, 2001.