Report on the 4^th Neuroanaesthesia Symposium (2017) held at Kuching, Sarawak, Malaysia

The 4^th Neuroanaesthesia Symposium 2017 (NAS 2017), the biennial scientific meeting on Neuroanaesthesia and Neurocritical Care, was held from March 31^st to April 2^nd, 2017 at the Riverside Majestic Hotel, Kuching, Sarawak, Malaysia. It was organised by the Department of Anaesthesiology and Intensive Care, Sarawak General Hospital (SGH) in collaboration with the Neuroanaesthesia Special Interest Group, College of Anaesthesiologists and Academy of Medicine Malaysia. The organising committee under the leadership of Dr. Peter Tan Chee Seong (Organising Chairperson, NAS 2017) and Dr. Teo Shu Ching (Advisor, NAS 2017 and Head, Department of Anaesthesiology and Intensive Care, SGH) prepared an excellent scientific schedule. They facilitated involvement of 238 participants for this meeting from different parts of Malaysia; it also included delegates from India and Indonesia. Three renowned overseas faculty in the field of Neuroanaesthesia, namely, Prof. Mathew Chan Tak Vai, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong (CUHK), Prof. Girija Prasad Rath, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India, and Prof. Thomas Lew Wing Kit, Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital (TTSH), Singapore, were also invited to the meeting, and they delivered keynote lectures on various topics.

On the 1^st day (March 31^st, 2017), three pre-symposium workshops on ‘Anaesthetic Crisis Management’, ‘Bispectral Index (BIS) Titration Simulator/Target Control Infusion (TCI)’ and ‘Neuromonitoring’ were started at different venues. The workshop on ‘Anaesthetic Crisis Management’ was organised in the operating theatre of SGH coordinated by Dr. Teo Shu Ching (SGH, Kuching) along with the workshop faculty Dr. Rajeswary Kanapathipillai (Tuanku Ja’afar Hospital, Seremban) and Dr. Noorulhana Suharnakadi Hadzarami (Kuala Lumpur Hospital). The workshops on ‘BIS/TCI’ and ‘Neuromonitoring’ were coordinated by Dr. Peter Tan Chee Seong (SGH, Kuching) at the Riverside Majestic Hotel. Dr. Hui Mun Tsong (Tropicana Medical Centre, Kota Damansara) introduced the participants to the course on BIS Titration Simulator/TCI which was followed by demonstration of the technologies and skill stations by Drs Khoo Teik Hooi (Penang Hospital), Vanitha Sivanaser (Kuala Lumpur Hospital), Hui Mun Tsong (Tropicana Medical Centre, Kota Damansara), Loo Sun Yin (Kuala Lumpur Hospital), Lee Yan Wei (Pantai Hospital Ayer Keroh, Melaka) and Lim Siu Min (SGH, Kuching). After completion of the 2½ h programme on the BIS/TCI, the Neuromonitoring workshop was began with a problem-based learning discussion (PBLD) on ‘pitfalls in intraoperative neurophysiologic monitoring during spinal surgery’ by Dr. Hari Krshnan S. K. Puvaneswaran (Ramsay Sime Darby Ara Damansara). Overview on different neuromonitoring modalities was highlighted to the participants by different speakers such as ‘transcranial Doppler (TCD)’ and ‘near infrared spectroscopy (NIRS)’ by Dr. Girija Prasad Rath (AIIMS, New Delhi), ‘intracranial pressure monitoring (ICP)’ by Dr. Ravindran Vashu (SGH, Kuching) and ‘somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG)’ by Dr. Matthew Chan (CUHK, Hong Kong). It was followed by skill stations managed by Dr. Girija Prasad Rath for TCD and NIRS, Dr. Ravindran Vashu (SGH, Kuching) for ICP and brain tissue oxygenation monitoring and Dr. Matthew Chan (CUHK, Hong Kong) for SSEP, MEP and EMG.

The 1^st day of the symposium (April 1^st, 2017) was started with a plenary lecture on ‘application of improvement science in neuroanaesthesia and neurocritical care’ by Prof. Thomas Lew Wing Kit (TTSH, Singapore); it was chaired by Dr. Vanitha Sivanaser (Kuala Lumpur Hospital). It was followed by a formal opening ceremony with the welcome address by Dr. Teo Shu Ching. After a tea break, the Mini-Symposium 1 was started with the moderator being Dr. Mohd Fahmi Lukman (Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur). During this session, Dr. Lim Wee Leong (Sungai Buloh Hospital, Selangor) discussed the ‘cerebral autoregulation and anaesthesia-an update’, Dr. Thomas Lew Wing Kit (TTSH, Singapore) discussed ‘current perspectives on neurotoxicity of general anaesthesia’, Dr. Vanitha Sivanaser (Kuala Lumpur Hospital) talked on ‘anaesthesia for complex spinal surgery’ and Dr. Athena Tang Mee Yee (Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan) talked about ‘pain management after major spinal surgery-current evidence’. There was a lunch symposium by Merck Sharp and Dohme (Malaysia) on ‘fine tuning neuromuscular block in neuroanaesthesia’ discussed by Dr. Loh Pui San (Department of Anaesthesiology, Faculty of Medicine, University of Malaya). The post-lunch Mini-Symposium 2 was moderated by Dr. Wan Mohd Nazaruddin Wan Hassan (School of Medical Sciences, Universiti Sains Malaysia, Kelantan). In this session, Dr. Teo Shu Ching (SGH, Kuching) discussed ‘paediatric neuroanaesthesia for occasional anaesthetists’, Dr. Girija Prasad Rath (AIIMS, New Delhi) explained about ‘anaesthetic concerns for specific paediatric neurosurgical procedures’, Dr. Hari Krshnan S. K. Puvaneswaran (Ramsay Sime Darby Ara Damansara) shared his ‘experience from a private hospital on epilepsy surgery’ and, finally, Dr. Girija Prasad Rath (AIIMS, New Delhi) elaborated on ‘awake craniotomy-the current and future challenges’.

The 2^nd day (April 2^nd, 2017) began with a plenary session on ‘research in neuroanaesthesia: What have we learnt so far?’ by Dr. Matthew Chan (CUHK, Hong Kong) and it was chaired by Dr. Lim Wee Leong (Sungai Buloh Hospital, Selangor). It was followed by a small tea break and booth visit. The Mini-Symposium 3 was started after that moderated by Dr. Hui Mun Tsong (Tropicana Medical Centre, Kota Damansara). Three very important topics were discussed by the renowned faculty in the field of Neuroanaesthesia. Dr. Wan Mohd Nazaruddin Wan Hassan (Universit Sains Malaysia, Kelantan) highlighted on ‘scalp block-how useful is it?’, Dr. Vanitha Sivanaser (Kuala Lumpur Hospital) discussed on ‘complications during neurosurgery’ while Dr. Matthew Chan (CUHK, Hong Kong) talked on ‘specialised training in neuroanaesthesia-is there a need?’ This session was followed by a lunch symposium by Fresenius Kabi Malaysia on ‘anaesthesia choice and cancer recurrence’ discussed by Dr. Lim Wee Leong (Sungai Buloh Hospital). The last session, Mini-Symposium 4, was moderated by Dr. Teo Shu Ching (SGH, Kuching). In this session, Dr. Tang Ing Ping (Universiti Malaysia Sarawak, Kota Samarahan) talked about ‘present and future of endoscopic skull base surgery’, Dr. Mohd Fahmi Lukman (National Defense University of Malaysia, Kuala Lumpur) explained about ‘cervical immobilisation during airway management: Comparison of different techniques’, and Dr. Hui Mun Tsong (Tropicana Medical Centre, Kota Damansara) presented the ‘highlights on the 2016 guidelines for the management of adult traumatic brain injury’. The event ended with cheers and applauds for the host. It was followed by tea and bon voyage.