ISBN No: 978-624-6024-02-4
39th ANNUAL ACADEMIC CONGRESS 2023 COLLEGE OF ANAESTHESIOLOGISTS & INTENSIVISTS OF SRI LANKA 21st & 22nd January 2023 at BMICH Colombo “Way Forward through Outcome Analysis and Resource Management” Main congress is accredited by the Royal College of Anaesthetists for 12 CPD Credits
COUNCIL – 2023 SEATED FROM LEFT TO RIGHT Dr Bimal Kudavidanage (Assistant Treasurer), Dr Chamila W Liyanage (Assistant Secretary), Dr Dilrukshi Perera (Secretary - Scientific Affairs), Dr Anushka Senevirathna (General Secretary), Dr Vinodini Wanigasekera (President Elect), Dr L A P Perera (President), Prof P T R Makuloluwa (Immediate Past President), Dr Sandya Somaweera (Treasurer), Dr M D Champika Sujeewani (Secretary - Education), Dr P Warusavithana (Trustee) STANDING FROM LEFT TO RIGHT Dr Lakmini Perera (Regional Representative – Northwestern), Dr D S Gunasena (Regional Representative – Western), Dr S S Ranasinghe (Council Member), Dr Nandika Wanigasinghe (Head – FCCM), Dr Mithrajee Premaratne (Chair – Resuscitation Council), Dr Lasman Dissanayake (Head – FPM), Dr Saliya Wijenayaka (Regional Representative – Southern), Dr Ramitha Jayasundara (RegionalRepresentative – Uva), Dr Piyusha Jayawardena (Regional Representative – Sabaragamuwa) ABSENT Prof Vasanthi Pinto (Editor), Dr Ashani Ratnayake (Assistant Editor), Prof Saman Nanayakkara (Council Member), Dr Champika de Alwis (Council Member), Dr Janaki Arulmoli (Council Member), Dr M T S Gayathri (Regional Representative – Central), Dr Vasumathy Devanesan (Regional Representative – Northern), Dr N M S Dammika Chandrasiri (Regional Representative – North Central), Dr Anupa Herath (Regional Representative – Eastern)
Message from the President, COAISL The year 2023 leaves a special note in the history of anaesthesia, intensive care and pain medicine in Sri Lanka. After two years of virtual events, we will be meeting in person at the BMICH Colombo on 21st- 22nd January 2023. You will be able to listen to many speakers of international repute in person. Despite severe economic restrains, the vacuum left by massive exodusof professionals and the persistent uncertainty of the future, the commitment and the perseverance of the council and the organising committee helped us to deliver a very comprehensive and a timely academic programme for the participants. While inviting all of you to join the congress and enjoy these two days of knowledge sharing and fellowship, I thank all resource personnel for sharing your time with us, and the council and the organizing committee for their dedication and support. . Dr Anoma Perera President COAISL
Message from the Vice President, RCOA Welcome to the 39 th Annual Academic Congress of the COAISL. I see a packed programme with fantastic speakers and it is going to be some excellent learning experience. I wish that I could be in your beautiful country at this moment. Last few years we all had our fair share of difficulties. I think Sri Lanka hashad an unfair share of these. I hope and believe that better times are ahead. Globally, No one can deny that climate change is a reality and a potentialcatastrophe for humanity. The UK recorded 2022 asits hottest year. My home country Iceland, experience more and more glacialmelting every year. I wish to draw your attention, towards the anaesthetists’ contribution to global warming and the way forward with our responsibility as anaesthetists in mitigating this catastrophe. Thank you very much and have a great conference.Dr Helgi Johannsson Dr Helgi Johannsson Vice President Royal College of Anaesthetists, United Kingdom
Message from Guest of Honour It is a great honor to be invited to the 39th Annual Academic Congress 2023 of the College of Anaesthesiologists and Intensivists of Sri Lanka with the topic “Way Forward through Outcome Analysis and Resource Management”. This exactly reflects the reality in Sri Lanka. As a country with limited resources, Sri Lanka impressed me already 10 years ago by their C-skills communication, collaboration, and consensus, which are essential for implementation of new concepts and improvement in patient outcomes. Accordingly, Sri Lanka reached in 2010 the WHO Millennium Goal #5 to reduce maternal mortality by 75%. Their strong motivation to use the limited resources in the best way made this possible. I am very happy to have good friends and colleagues in Sri Lanka since my first invitation in 2013, and I am proud that I may have contributed a little bit to their straight way forward to better patient care. Dr. Klaus Görlinger Consultant in Anaesthesiology and Intensive Care Medicine Germany
Message from Congress Chair and the General Secretary It has been a great pleasure and an honor serving as the Congress Chair and General Secretary of the COAISL. I am hopeful that this year’s congress will be a great success and on behalf of the collegeI would like to thank the renowned faculty of speakers contributingto our 39th annual academic congress for sharing their expertise toenhance patient care in Sri Lanka. Further, my sincere gratitude is extended to the organizing committee and our sponsors who were the pillars of strength behind this endeavor. Thank you Anushka Seneviratna General Secretary / Congress Chair COAISL
Message from the Head of Faculty of Critical Care Medicine, COAISL On behalf of the Faculty of Critical Care Medicine (FCCM) of College of Anaesthesiologists and Intensivists of Sri Lanka (COAISL), it is my pleasure to welcome you all to the 39th Annual Academic Congress (AAC)of COAISL. The scheduled programme includes very informative sessions by high profile local and international speakers from which you can come along the latest developments in anaesthesia, critical care and pain medicine. We hope that the knowledge you gain would be benefited you to providesafe and quality patient care for enhanced patient outcome. There are many pre and post congress workshops, which would not only improve the knowledge of the participants, but also the skills they need for their day to day practice. I would like to thank the organizing committee of AAC, Members of the FCCM and the resource persons for their tremendous support given to conduct these workshops parallel to the AAC. I wish all the best for a successful Annual Academic Congress! Nandika Wanigasinghe Head Faculty of Critical Care medicine
Message from the Head of Faculty of Pain Medicine, COAISL It’s much satisfaction and fulfillment that I write this message for the 39th Annual academic session of the College of Anaesthesiologists and Intensivists in Sri Lanka on behalf of the faculty of painmedicine. The faculty of pain medicine is the mainbody addressing pain problems and training pain physicians in Sri Lanka. It is a part of the College of Anaesthesiologists and Intensivists since conception. The fact remains that pain continues to be a major health crisis and cannot be vaccinated. It is a leading cause of health care disability out of control health care cost and decrease in qualityof life in our patients. It is essential to find solutions to address acute and chronic pain effectively. Chronic pain is the main health burden that is not addressed adequately in Sri Lanka. The prevalence of chronic pain is about 10% in the population and rising day by day due to increasing age and change of lifestyle. We need to continue to develop and disseminate cost-effective alternatives to manage pain, especially chronic pain. It is essential to focus on different modalities in pain management and way forward with the rest of the world. The field of interventional pain management emerge as one of the most important disciplines in medicine today. Our mission as the faculty of pain medicine is to develop advance pain management options and disseminate pain knowledge among juniors in Sri Lanka. I am glad 2022 is behind and look forward to a very different pain-free 2023. You will enjoy and benefit from this multidisciplinary program and I am certain that it will enlighten the pain specialty as well. Finally, I wish to thank all working hard to make this event successful and to improve health care service in Sri Lanka. I look forward to welcoming all delegates and a very fruitful congress this year. Thank you Dr D A L Dissanayaka Head Faculty of Pain Medicine College of Anaesthesiologists and Intensivists of Sri Lanka
Message from Chair, Resuscitation Council Sri Lanka Council of the College of Anaesthesiologists & Intensivists of Sri Lanka, we take immensepleasure in welcoming all of you to the 39th Annual Academic congress. We are certain that all attendees will enjoy the top quality latest updates from the field of Anesthesia, critical care , pain medicine & resuscitation science . I addition to the main congress there willbe 10 workshops conducted by the renowned local & overseas experts in the field On behalf of the Resuscitation Dr Mithrajee Premarathna Chair, Resuscitation Council of Sri Lanka College of Anaesthesiologists & Intensivists of Sri Lanka
Scientific Committee Dr Anoma Perera Dr Harshani Liyanage Dr Chamila Liyanage Dr Nandika Wnigasinghe Dr Sandya Somaweera Dr Dilrukshi Perera Dr Champika de Alwis Dr Haritha Darmakeerthi Dr Vinodini Wanigasekera Dr Lakmini Perera Prof Vasanthi Pinto Dr Nadeesha de Fonseka Dr Nilmini Wijesuriya Dr Sagari Ranasinghe Dr Bimal Kudavidanage Dr Saman Nanayakkara Dr Lasman Dissanayake Dr Gayani Walpola Dr Mithrajee Premarathna Dr Chamil Perera Dr Thusitha Jayathilaka Dr Champika Sujeewani Dr Dimuthu Gunasena Dr Anushka Senevirathna Workshop – Coordinators Dr Bimal Kudavidanage Dr. Dilrukshi Perera Dr, Ashani Rathnayake Dr. Harshani Liyanage Dr. Anupa Herath Dr. Nilmini Wijesuriya Dr. Piyusha Jayawardana Dr. Nandika Wanigasinghe Dr. Chandana Karunarathne Dr. Thusitha Jayathilake Dr. Asitha Dassanayake Dr. Laksman Dissanayake Comperes of the congress Dr. U.A.I.K Thilakarathna Dr. A.E.U Jayawardena Dr.W.A.M.T.B Abeysekara Dr.N.T Wickramasinghe Book compiled by Dr. Ishan Deshika Fernando Medical Officer, Anaesthesia Unit, CNTH
Opening Ceremony 07:30 Guests take their seats 07:45 Ceremonial procession 07:55 National anthem and lighting of oil lamp 08:05 Welcome address by Dr Anoma Perera President, College of Anaesthesiologists andIntensivists of Sri Lanka 08:15 Address by the Chief Guest, Dr Helgi Johannsson, Vice President Royal College of Anaesthetists, UK (Joining virtually) 08:25 Address by the Guest of Honour, Dr Klaus Goerlinger Consultant in Anaesthesiologyand Intensive Care Medicine – Germany 08:30 Launch of the new website. 08:35 Award ceremony 09:00 BS Perera oration A Quest for Enhanced Recovery after Liver Transplant the Colombo North Center for Liver Disease - The first decade OratorBhaagya Gunetilleke Senior Lecturer in Anaesthesia and Consultant Anaesthetist Department of Surgery,Faculty of Medicine University of Kelaniya 10:00 Fellowship
College of Anaesthesiologists & Intensivists of Sri Lanka 39th Annual Academic Congress Day 1 21st January 2023 Time IST-Colombo “Way forward through outcome analysis and resource management” 07.45 -09.00 Opening ceremony 09.00- 10.00 Introduction of the Orator Dr B.S.Perera Oration – Dr Bhaagya Gunetilleke A Quest for Enhanced Recovery After Liver Transplant at the Colombo North Center for Liver Disease – The first decade 10.00-10.30 TEA 10.30-11.30 Symposium 1 Perioperative care in paediatrics Way forward in paediatric resuscitation PALS Dr Ryan Morgan (USA) Forgotten area – Paediatric burn management Prof J Martyn (USA) Titrating postoperative pain relief Prof Saman Nanayakkara (SL) 11.30-12.30 Symposium 2 Perioperative care in obstetrics HELLP! It is an emergency Dr Chamil Perera (SL) Challenges in maternal critical care Dr Sunil T. Pandya (India) Anesthesia & maternal mortality -Now and the future in Sri Lanka Dr Upul Ranjith (SL) 12.30-13.00 Plenary 1 Dr Helgi Johannsson Vice President-RCOA Sustainability in anaesthesia and its association with climate change 13.00 - 13.30 LUNCH 13.30 – 14.30 Symposium 3 Way forward with perioperative care Navigation of perioperative care Prof Ramani Moonasinghe (UK) New developments in perioperative care Dr Bernadette Rathnayaka (UK) Harnessing quality improvement in perioperative medicine Dr Samantha Warnakulasuriya (UK) 14.30-15.00 Plenary 2 Prof Richard Langford Acute pain update and recent innovations 15.00-15.20 TEA 15.20-16.20 Symposium 4 Patient blood management-Way forward–Dr Nilmini Wijesuriya & Dr Ramani Pallemulla Panel discussion on PBM programme-Case scenarios Dr Ajay Gandhi (India) Dr Klaus Gorlinger (Germany) Dr Janaki Dissanayaka (SL) 16.20-17.20 Symposium 5 Trauma management Pelvic fractures – which pathway? Dr Sandro Rizoli (Quatar) Concept of team training in trauma- ATLS Vs ETC Dr Joachim Schlieber (Austria) Prof Arnold Suda (Austria)
College of Anaesthesiologists & Intensivists of Sri Lanka 39th Annual Academic Congress Day 2 22nd January 2023 Time IST-Colombo “Way forward through outcome analysis and resource management” 08.00- 08.30 Plenary 3 Dr Wayne Morriss President -WFSA Anaesthesia work force-strengthening the most valuable resource 08.30-09.30 Symposium 6 Perioperative care for neuro surgery Challenges for anaesthesiologist in neuro radiological interventions Dr Gowri de Zylva (UK) Anaesthesia for epilepsy surgery Dr Bimal Kudavidanage (SL) Fatal love between brain and heart: A block-busterstory Dr Tumul Chowdhury (Canada) 09.30-10.30 Symposium 7 Pain- Recent advances in chronic pain management Chronic pain-its all in the head Dr Victor Mendis (UK) Vitamin D supplements in chronic pain management Dr Suboda Thanthulage (UK) 10.30- 10.50 TEA 10.50-11.20 “Way forward” Challenge the crisis- Value added ECG rhythm generator Dr Indika Withanage (SL) Beyond a conventional anaesthetist – Perioperative family care Dr Ramitha Jayasundara (SL) 11.20-12.20 Symposium 8 Health and economics Sri Lanka, Economic crisis and way forward Dr Dileep De Silva (SL) GRIFT-Get it Right for the first time – Recommendations for day surgery Dr Michael Swart (UK) 12.20-13.20 Symposium 9 Perioperative care in anaesthesia What is new and why-perioperative care in diabetes mellitus Dr Nicholas Levy (UK) Blood pressure - what is the target? Why? Prof Simon Howell (UK) Cardiac output monitoring why and how? Dr Frederick Michard (Switzerland) 13.20 -13.55 LUNCH 13.55 -14.55 Symposium 10 Perioperative care in cardiac anaesthesia Vasoplegia following CPBP Dr Zied Ltaief (Switzerland) Diastolic dysfunction and anaesthetic challenges Dr Marcus Peck (UK) IABP – the lifeline - LV supportive devices Dr Muralidhhar Kanchi (India) 14.55-15.25 Plenary 4 Professor M. Nirmalan (UK) 15.25- 16.25 Symposium 11 Critical care – perioperative fluid therapy Force, volume or flow- what matters in perfusion Prof Monty Mythen (UK) Fluid Stewardship in ICU Prof Manu Malbrain (Belgium) Dialysisin ICU how when & whom Prof Marlies Osterman (UK) 16.25-17.25 Symposium 12 – Critical care- ensuring continuous care How to ventilate a lung donor Prof Luciana Mascia (Italy) Hemodynamic management of brain-dead donors Dr M.A. Arshad (UK) Overall management of the donor Dr Murali Krishna (India) 17.25 TEA
New appearance of the COAISL website Designed by KOKIINC PVT LTD Mr Jewaka Michael Fernando and Mr Dinith Ishan Co-ordinated by: Dr Champika Sujeewani and Dr Roshana Mallawaarachchi
39th ANNUAL ACADEMIC CONGRESS OF COAISL PLENARY SPEAKERS: 1. Dr Helgi Johannsson Vice President of the Royal College of Anaesthetists United Kingdom Associate Medical Director for medical education atImperial College Health Care and Clinical Director of anaesthesia for MSI choices. Sustainability in anaesthesia and its association with climate change 2. Prof Richard Langford MBBS, FRCA, FFPMRCA Lead Consultant, In-patient Pain Service The London Clinic Acute pain update & recent innovations 3. Dr Wayne Morriss MBChB (Otago) Dip Obst (Otago) FANZCA(President WFSA) Anaesthesia workforce – Strengthening the most valuable resource. 4. Professor M. Nirmalan MD, FRCA, PhD, FFICM Patient and public involvement and engagement in health care : a personal journey B.S.PERERA ORATION Dr Bhaagya Gunetilleke MBBS MD FRCA Consultant Anaesthetist with a Special interest in Intensive Care Senior Lecturer and Head, Division of Anaesthesia, Critical care and Pain management Department of Surgery,Faculty of Medicine, University of Kelaniya Sri Lanka
SYMPOSIUM 1 - PERIOPERATIVE CARE IN PAEDIATRICS 1 Professor Ryan W. Morgan ( USA) MD, MTR Paediatric intensivist Children’s Hospital of Philadelphia (CHOP)Assistant Professor of Anesthesia, Critical Care, and Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia Way forward in paediatric resuscitation PALS 2 Prof J Martyn (USA) MBBS . MD Professor of Anesthesiology, Harvard Medical School, Anesthetist-in-Chief, Shriners Hospital for Children, Boston Forgotten area – Paediatric burn management 3 Prof Saman Nanayakkara (SL) MBBS, MD(Anaesthesiology), B.Ac. Postgraduate Diploma inSociology Professor in Anaesthesiology Department of Anaesthesiology & Critical care, President of Sri Lanka Association for the Study of Pain andcancer care service, University of Peradeniya Titrating postoperative pain relief SYMPOSIUM 2 - PERIOPERATIVE CARE IN OBSTETRICS 1 Dr Chamil Perera MBBS, MD, FRCA Consultant Anaesthetist at Base Hospital, Elpitiya, HELLP! It is an emergency 2 Dr Sunil T. Pandya MD, Post Doctorate Fellowship (Cardiac & Neuro Anaesthesia)Post Doctorate Fellowship (Ob. Anaesthesia) Challenges in maternal critical care 3 Dr Upul Ranjith MBBS, MD(ANAESTHESIOLOGY) Consultant anaesthetist, Special interest in Gynaecology & Obstetrics Teaching Hospital, Mahamodara. Anesthesia & maternal mortality - Now andthe future in Sri Lanka
SYMPOSIUM 3 - WAY FORWARD WITH PERIOPERATIVE CARE 1 Prof Ramani Moonasinghe (UK) MD FRCP FRCA FFICM Consultant in anaesthesia and intensive care at UCL Hospitals, UK Navigation of perioperative care 2 Dr Bernadette Rathnayaka (UK) MBBS, DA, FRCA, FFPMRCA Diploma in Leadership & Management Consultant Anaesthetist at Kingston Hospital NHS FT, UKVisiting Consultant EOC New developments in perioperative care 3 Dr Samantha Warnakulasuriya (UK) FRCA MSC MA (OXON) BMBC consultant in anaesthesia and perioperative medicine qualityimprovement lead for anaesthesia, University college London hospital. Harnessing quality improvement in perioperative medicine SYMPOSIUM 4 - PATIENT BLOOD MANAGEMENT-WAY FORWARD 1 Dr Ajay Gandhi (India) MD (Pathology) Consultant Hematopathology and Hemostasiology. Associate Director, Clinical Affairs of Werfen, India and SouthAsia, Custodian of the Werfen Academy India. Case based Panel discussion to include importance, implementation, obstacles and present position of PBM programme in Sri Lanka 2 Dr Klaus Gorlinger (Germany) MD Senior Consultant at the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, Germany, particularly in the field of Trauma, Liver Transplant, and Cardiac Surgery. Essen, Germany Medical Director of TEM Innovations GmbH, Munich, Germany, 3 Dr Janaki Dissanayaka (Sri Lanka) MBBS MD Consultant Transfusionist Colombo North Teaching Hospital, Ragama, Sri Lanka
SYMPOSIUM 5 - TRAUMA MANAGEMENT 1 Dr Sandro Rizoli (Qatar) MD PhD FRCSC FACS Trauma medical Director Hamad General Hospital. Doha, Qatar Pelvic fractures – which pathway? 2 Dr Joachim Schlieber (Austria) MD Consultant Anaesthesiologist AUVA – Trauma center Salzburg, Austria Medical director - HEMS base- ÖAMTC Flugrettung –“CHRISTOPHORUS 7”, Nikolsdorf, Officer of Military Medical Service Prehospital EmergencyMedicine, Resuscitation, Trauma Care Concept of team training in trauma- ATLS Vs ETC 3 Prof. Arnold J. Suda (Austira) AUVA Trauma Center Salzburg, Austria Academic Teaching Hospital of Paracelsus Medical University · Department of Orthopaedics and Trauma Surgery.
SYMPOSIUM 6 - PERIOPERATIVE CARE FOR NEURO SURGERY 1 Dr Gowri de Zylva (UK) MD FCARCSI Consultant Neuroanaesthetist King’s College Hospital , London, UK Challenges for anaesthesiologist in neuro radiological interventions 2 Dr Bimal Kudavidanage (SL) MBBS. MD, Consultant Anaesthetist Epilepsy Centre National Hospital, Colombo, Sri Lanka Anaesthesia for epilepsy surgery 3 Dr Tumul Chowdhury (Canada) MD, DM, FRCPC Faculty anesthesiologist Toronto Western Hospital, University of Toronto,Canada.Chair of the Neuroanesthesia Section of the Canadian Anesthesiologists'Society. Fatal love between brain and heart: A block -buster story SYMPOSIUM 7 – PAIN – RECENT ADVANCES IN CHRONIC PAIN MANAGEMENT 1 Dr Victor Mendis (UK) MD. MD. FCARCS. FRCA. FFPMRCA Consultant in Pain Medicine and Anaesthetics, Mid and South Essex University Hospitals NHS Trust Chronic pain-its all in the head 2 Dr Suboda Thanthulage (UK) MD, FRCA, FFPMRCA, FIPP consultant in Pain Medicine and AnaestheticsBroomfield hospital. Vitamin D supplements in chronic painmanagement
Way forward 1 Dr Indika Withanage (SL) Consultant Anaesthetitst Base Hospital, Homagama Challenge the crisis- Value added ECG rhythm generator 2 Dr Ramitha Jayasundara (SL) Consultant Anaesthetist District General Hospital Monaragala Beyond a conventional anaesthetist – Perioperative family care SYMPOSIUM 8 - HEALTH AND ECONOMICS 1 Professor Dileep De Silva (SL) BDS(Peradeniya), MSc (Colombo), MBA (Colombo), MD -Com Dent (Colombo), PhD-Health Management (UK), AIB (Sri Lanka), FCMA(UK),FRSPH(UK), FDS RCPS(Glasgow) Chair Professor of Community Dentistry at the Faculty ofDental Sciences, University of Peradeniya. Sri Lanka Chartered Banker, Cost & Management Accountant and aSpecialist in Health Finance and Health HR. Sri Lanka, Economic crisis and way forward 2 Dr Michael Swart (UK) MBBS, FRCA, EDICM, FICM GIRFT - Get it Right for the first time --Recommendations for day surgery
SYMPOSIUM 9 - PERIOPERATIVE CARE IN ANAESTHESIA 1 Dr Nicholas Levy (UK) MBBS FRCA Consultant Anaesthetist West Suffolk Hospital. UK What is new and why-perioperative care In diabetes mellitus 2 Prof Simon Howell (UK) Consultant anaesthetist Lead of the Division of Gastroenterology and Surgical SciencesUniversity of Leeds UK Blood pressure - what is the target? Why? 3 Dr Fredrick Michard (Switzerland) MD PhD The founder of MiCo (MichardConsulting.com) Consulting & research firm Cardiac output monitoring why and how? SYMPOSIUM 10 - PERIOPERATIVE CARE IN CARDIAC ANAESTHESIA 1 Dr Zied Ltaief (Switzerland) Senior physician. Special interest in hemodynamics extracorporealassistance and heart failure, Switzerland, specifically to the University Centre of Lausanne, Vasoplegia following CPBP 2 Dr Marcus Peck (UK) MAAS FRCA Consultant in anaesthesia and intensive care medicineFrimley Park Hospital Surrey, UK, chair of the Focused Intensive Care (FUSIC) committee Diastolic dysfunction and anaestheticchallenges 3 Dr Muralidhhar Kanchi (India) MD, MBA, PhD Senior Consultant –Anaesthesia & Director (Academic) atNarayana Hrudayalaya, India Dean of “Indian College of Anaesthesiologists” Vice Chancellor of India College of Cardiac Anaesthesiologists IABP – the lifeline - LV supportive devices
SYMPOSIUM 11 - CRITICAL CARE – PERIOPERATIVE FLUID THERAPY 1 Prof Monty Mythen (UK) MBBS MD FRCA FFICM FCAI (hon) Emeritus Professor of Anaesthesia and Critical Care Division Surgery and Interventional Science University College London, UK Force, volume or flow- what matters in perfusion 2 Prof Manu Malbrain (Belgium) MD, PhD CMO of Medaman, an Ehden certified SME, professor of Critical Care Research at the First Department ofAnesthesiology and Intensive Therapy Fluid Stewardship in ICU 3 Prof Marlies Osterman (UK) Professor of Intensive Care and Nephrology Guy’s & St Thomas Hospital London.UK Dialysis in ICU how when & whom SYMPOSIUM 12 - CRITICAL CARE- ENSURING CONTINUOUS CARE 1 Prof. Luciana Mascia (Italy) Director of Residency program in anesthesia and critical care-University of Bologna, Italy. How to ventilate a lung donor 2 Dr M.A. Arshad (Uk) MBBS FRCA Consultant Intensivist and Liver Transplant Anaesthetist in University Hospitals Birmingham. Hemodynamic management of brain-dead donors 3 Dr. Murali Krishna (India) MD Senior consultant Cardiac anesthesia and critical care MGMHealth care, Chennai. India Overall management of the donor
Pre Congress Workshops
Pre Congress Workshops Sponsored by – Kings Hospital Colombo
Sponsored by – Sunshine Healthcare
Sponsored by – B Braun Lanka Pvt Ltd
Sponsored by – Edwards Lifesciences
Sponsored by – Medtronic with A J Medichem
Sponsored by – Phillips
Sponsored by – Nextgen Healthcare
Post Congress Workshops
Sponsored by – Sanofi
Sponsored by – Sunshine healthcare & Medexholdings
B. S. PERERA ORATION 2023 Delivered by Bhaagya Gunetilleke, MBBS MD FRCA Consultant Anaesthetist with Special interest in Intensive care Senior lecturer and Head, Division of Anaesthesia, Critical care and Pain management Department of Surgery, Faculty of Medicine, University of Kelaniya Sri Lanka
A QUEST FOR ENHANCED RECOVERY AFTER LIVER TRANSPLANT at Colombo North Center for Liver Disease : The first decade Dr Bhaagya Gunetilleke MBBS MD FRCA Sri Lanka is facing a rapid rise in the prevalence of metabolic syndrome and its hepatic component - nonalcoholic fatty liver disease (NAFLD). The spectrum of NAFLD extends from Nonalcoholic fatty liver (NAFL) to cirrhosis. Cirrhosis progresses relentlessly punctuated by episodes of acute liver failure and decompensation. The only cure for end stage liver disease is liver transplant. Perioperative care of a patient with end stage liver disease with severe of liverfailure, multiple organ dysfunction and the dynamics ofsurgery is complex and impacts on early postoperative outcome after liver transplant. The concept of Enhanced Recovery After Surgery (ERAS) encompasses multiple evidencebased perioperative interventions aimed at minimizing surgical stress response and improving short term outcome. The adoption of ERAS in liver transplant has been slow compared to specialties such as colorectal and hepato-biliary surgery. This oration focuses on a few evidence based interventions adopted since 2016 by the team at the Colombo North Center for Liver Disease (CNCLD) in a Quest for enhanced recovery after liver transplant (ERALT). A comprehensive set of consensus recommendations on Enhanced recovery for liver transplantation has been recently published by the International Liver Transplantation Society.
Professor Ryan W. Morgan MD, MTR Professor Ryan Morgan is a pediatric intensivist at the Children’s Hospital of Philadelphia (CHOP) and an Assistant Professor of Anesthesia, Critical Care, and Pediatrics at the University of Pennsylvania Perelman School of Medicine in Philadelphia, United States. His research focus is on pediatric cardiac arrest and cardiopulmonary resuscitation, with an emphasis on cardiac arrest physiology and the tailoring of resuscitation therapies to individual patients. He conducts both translational laboratory and clinical studies in pediatric resuscitation with grant support from the National of Institutes of Health. Within the American Heart Association Emergency Cardiovascular Care Committee, he chairs the Pediatric Emphasis Group and sits on the Science Subcommittee and Pediatric Advanced Life Support Writing Group.
The Way Forward in Pediatric Resuscitation: Physiology-Directed Cardiopulmonary Resuscitation - Professor Ryan W. Morgan Thousands of children suffer cardiac arrests within and outside of the hospital each year. Current cardiac arrest treatment paradigms call for cardiopulmonary resuscitation (CPR) according to standardized algorithms. This algorithmic care facilitates training and consistency and has resulted in great improvements in CPR quality and outcomes. In some settings, particularly monitored locations within the hospital, the actual physiologic response of the patient can be taken into account during CPR. Established physiologic indicators of CPR quality include coronary perfusion pressure, diastolic blood pressure, and end-tidal carbon dioxide. This presentation will discuss evolving evidence on physiologic targets during CPR and share novel studies regarding how these indicators of CPR quality can be used to enhance pediatric resuscitation outcomes.
Professor J A. Jeevendra (Jeeva) Martyn Professor Martyn, is a graduate of the University of Colombo Medical Faculty, Sri Lanka. He trained in Anesthesiology, Pain Medicine and Intensive Care was at Columbia UniversityPresbyterian Hospital, New York, NY and continued specialized training in pediatric anesthesiaand critical care medicine at the John Radcliffe Hospitals, University of Oxford, England. From England, he was recruited to the faculty at Harvard Medical School, Massachusetts General Hospital and Shriners Hospital for Children Boston and currently serves as Professor of Anesthesiology, Harvard Medical School, Director, Clinical & Biochemical Pharmacology Laboratory, Massachusetts General Hospital (MGH) and Anesthetist-in-Chief, Shriners Hospital for Children, Boston and holds the Judith Hellman Endowed Chair in Anesthesia at MGH
Abstract: Pediatric Burn Management Professor J A. Jeevendra (Jeeva) Martyn Pediatric burn injury patients pose a myriad of challenges during the acute resuscitative phase and in the perioperative period. Major burn injury results in pathophysiologic changes affecting virtually all organs from the onset of injury until burn wounds are healed. Despite significant advances in therapeutic strategies, such as improved fluid resuscitation methods, enhanced wound coverage techniques, new drugs to control infection and treat inhalation injury, severe burns remains a devastating injury leading to significant morbidity and mortality. Anesthesiologists are often called to care for burn injury patients throughout their hospitalization including acute airway management and resuscitation, intraoperative anesthetic care, intensive care, and management of postoperative pain. Optimal care for this challenging patient population requires understanding, appreciation and anticipating the unique preoperative, intraoperative and postoperative issues and problems of burn injured patient that predisposes them to increased morbidity and mortality. Perioperative concerns for the burn-injured patient include 1. airway abnormalities, 2. impaired lung function, 3. difficulties in vascular access, deceptively large and rapid blood loss, 4. hypothermia and altered pharmacology Management of burn injury pain is extremely challenging and may change in intensity and quality over time through multiple stages of healing. Anesthesiologists should assume an essential role in developing and refining analgesic guidelines, coordinating the multidisciplinary pain management team and aid in the education of burn unit staff. .
Professor Saman Nanayakkara MBBS, MD (Anaesthesiology), B.Ac. Postgraduate Diploma in Sociology • Professor in Anaesthesiology • Head of the Department of Anaesthesiology & Critical care, Faculty of Medicine, Universityof Peradeniya, Sri Lanka • Visiting lecturer -Faculty of Dental Sciences & Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka • Consultant Anaesthetist- Teaching Hospital Peradeniya, Sri Lanka • President of Sri Lanka Association for the Study of Pain (Sri Lankan chapter of IASP) • President, Cancer Care Service • Past Head of Faculty of Pain Medicine, COAISL 2017- 2020 Areas of special interest Pain medicine, paediatric anaesthesia, post-operative care, difficult airway, labouranalgesia, acupuncture and alternative medicine
Titrating postoperative pain relief - Professor Saman Nanayakkara - Principles of post-operative analgesia for paediatric patients are similar to that of adults. Successful management of pain needs a multimodal and multidisciplinary approach. If analgesic management is to be efficient, it needs objective assessment of pain using an appropriate pain scale with frequent and repeated assessments and fine titration of analgesics. Different tools have to be employed for assessment of pain in paediatric patients of different age groups due to the variation in growth, development and maturity. Optimal pain care has to be offered to the entire spectrum of paediatric patients; from day surgeries to patients who are admitted to intensive care units, from neurosurgery- cardiothoracic surgeries to dental extractions and from operating theatre room through recovery area to procedures done outside the operating theatres. Excellent pain care will facilitate early mobilisation, earlier resumption of feeds and early discharge of children. Acceptable pain management has to be extended to home and should be supervised by community nurses. Pain management methods could be pharmacological and non-pharmacological. Paracetamol, NSAIDs, opioids and regional/local anaesthetics, nurse or patient controlled infusions are the main pharmacological means whilst reassurance, explanation, splinting, comfortable positioning and distraction with games, toys and videos are the main non pharmacological methods. Expeditious pain relief would negate multiple adverse consequences of pain.
Dr Chamil Perera MBBS, MD, FRCA Dr Chamil Perera is a Consultant Anaesthetist at Base Hospital, Elpitiya, in the Southern Province of Sri Lanka. He gained his MBBS, with Honors at the Faculty of Medicine, University of Colombo in 2004. He then obtained his MD in Anaesthetics in 2015, from the Post Graduate Institute of Medicine, University of Colombo. From 2016 to 2018, he worked at North Middlesex University Hospital NHS Trust, in London UK, for 2 years before returning back to Sri Lanka. He obtained HIS FRCA in 2017. Since coming back to Sri Lanka, he worked as a Consultant in Moneragala and Kaluthara districts. He has a passion for teaching. He is an active member of the Faculty of Pain Medicine, COAISL and is an ALS Instructor.
HELLP: It is an Emergency - Dr Chamil Perera! HELLP syndrome is a rare, but potentially life-threatening illness in the pregnant, or post-partum mother. It is considered a severe form of preeclampsia (PE), but in up to 20%, there is no evidence of ongoing PE, leading to a dilemma, should it be a stand-alone diagnosis? The syndrome is characterized by the triad of microangiopathic hemolytic anaemia, with elevated liver enzymes and thrombocytopenia. Nearly all patients are seen after 28 weeks of gestation, up till 7days postpartum. Once a mother goes into HELLP syndrome, the progression into life-threatening situations is extremely rapid. These include, anaemia, Thrombocytopenia (reduction in platelet counts by 40% per day) leading to DIC, bleeding and spontaneous intracranial hemorrhages, and rapid deterioration in liver functions due to intrahepatic bleeds which may rupture leading to massive torrential bleeding. Early symptoms of this syndrome include mid epigastric colicky abdominal pain {90%}, nausea, vomiting, {90%} generalized malaise {90%}, headache, visual changes, jaundice, and ascites. They may also present with complications such as placental abruption, AKI, pulmonary edema, liver hematoma or retinal detachment. Therefore, early identification of HELLP syndrome, stabilisation of the mother with blood pressure control and magnesium sulphate as seizure prophylaxis, admission to tertiary care units with involvement of Liver trauma teams form the cornerstones of managing such mothers. Early identification and delivery of the baby, will reduce maternal mortality and morbidity to 1%.
Dr Sunil T Pandya MD, Post Doctorate Fellowship (Cardiac & Neuro Anaesthesia) Post Doctorate Fellowship (Ob. Anaesthesia) Dr. Pandya currently heads the lead Quaternary care AIG multispecialty hospitals at Hyderabad and is a visiting consultant at Fernandez Hospitals, Hyderabad, India. He headed a tertiary care perinatal center, Fernandez Hospital from Feb 1997 until Dec 2014, where he pioneered in establishing 24 x 7 “On demand” Labour Epidural Services for the first time in India. In 1999, his team established the first dedicated “Obstetric Critical Care Unit” in India. They also was initiated established the process of providing National guidelines for labour Analgesia, Maternal Critical Care, ECMO in pregnancy and Maternal Cardiac Arrest. Patient safety protocols, newer research with safe innovations and Dashboard clinical audits were introduced for the first time by him. The team runs several training programmes and post-doctorate fellowship in obstetric anaesthesia, Post-Doctorate Fellowship in Regional Anaesthesia and International fellowship programmes. The team conduct several live and interactive workshops and courses. Live workshop on labour analgesia, Obstetric Critical Care Course, Critical Incidents in Obstetric Anaesthesia, ABG for Obstetricians are just to name a few. He is an internationally recognized speaker, has several publications to his credit and contributed several chapters and edited books in Obstetric Anaesthesia and Obstetric Critical care. He is also a peer reviewer of several indexed journals. He was the immediate past president of Association of Obstetric Anaesthesiologists, India and the Founder, Past National Secretary of Society of Obstetric Medicine, India, Executive member, Obstetric anaesthesia Society Asia Oceania and several other National societies. He enjoys travelling, photography and playing keyboard.
Challenges in Maternal Critical Care -Dr Sunil T Pandya There has been a paradigm shift in types of obstetric patients getting admitted in maternal critical care unit over last three decades. Infertility treatment related ovarian hyperstimulation syndromes, advanced maternal age-related issues of chronic hypertensive disorders, diabetics, coronary artery diseases, GUCHDs (Grown Up patients with congenital heart disease), obese parturients, the evergrowing incidence of placenta accrete spectrum related massive obstetric hemorrhage, plethora of auto immune disorders etc. just to list a few. South East Asia still have seasonal cases of tropical disease complicating pregnancy like dengue hemorrhagic fever, leptospirosis, malaria etc. just to name a few. Current Covid pandemic again has exposed the vulnerability of hospital infrastructure and protocolized approach in the management of parturients needing critical care support, thus furthering the concept of having dedicated Maternal critical care units. Pregnant women are exposed to dual jeopardy, the immunological and physiological / anatomic changes clubbed with disease conditions can compromise vital organ functions and they often, rapidly deteriorate. Due to the physiologic changes, the parturient have high reserves and do not have classic tell-tale signs of sickness. Further, the common physiological signs and symptoms like breathlessness, pedal oedema, mechanical discomfort etc., the underlying true pathology can be easily masqueraded. Pregnant women breathe more, pump more and clot more. Experience and wisdom of medical personnel is crucial to differentiate between physiological and pathological signs. The classic risk scores like APACHE II, SAPS II over predict maternal mortality. However recent pregnancy specific scores have been developed likeObstetric SOFAin Sepsis(Truncated versionof SOFA Scores), MOEWS give some directions to recognize a critically ill parturient. The Pregnancy Physiology Pattern Prediction (4P) study aimed to develop a database of prospective vital sign measurements (blood pressure; heart rate; oxygen saturation; temperature; and respiratory rate) in pregnant women fromearly gestation through to the postpartum period. The study provides evidence-based, gestationspecific centiles for vital signs during pregnancy Complications of hypertensive disorders, massive haemorrhage, sepsis, thrombosis and thromboembolism, cardiac ailments are the leading causes of maternal critical care unit admissions globally. The therapeutic scores for organ support are often high compared vis a vis to non-pregnant patients with similar cohorts. However, once delivered, the recoveries are faster too! Criticality in a parturient, if recognized early, they recover promptly with conventional organ supports like NIV, invasive ventilation, minimal invasive monitoring. However, if recognized late or if they present in a fulminant manner, they do require advanced critical care supportive therapy like advanced cardiac out monitoring, prone ventilation, IABP support, Cath lab interventions, VV ECMO, VA ECMO, RRT etc. Outcomes of these interventions are best done in units who have a regular exposure, as trained staff with stringent HIC and various standard protocols are essential for better outcomes.