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Background and Aims: The diffusion of nitrous oxide (N2O) into the air-filled cuff of the classic laryngeal mask airway (LMA) may lead to an increase in cuff pressure (CP) and displacement of LMA affecting its performance. This study was conducted to evaluate the change in optimal position of LMA by fibre-optic bronchoscope, the changes in cuff pressure and oropharyngeal leak pressure (OLP), and post-operative laryngo-pharyngeal morbidity during N2O–oxygen (O2) anaesthesia in children. Methods: After ethics committee approval and written informed consent, 84 children, aged 2 to 8 years undergoing lower abdominal surgery using LMA were included. Anaesthesia was induced with sevoflurane and maintained with either 33% O2 in air (Group 1) or with 33% O2 in 67% N2O (Group 2) along with sevoflurane. The position of LMA using fibre-optic bronchoscope, CP and OLP were recorded at 30, 60 and 90 minutes and at the end of surgery. The incidence of post-operative sore throat, hoarseness of voice and dysphagia was assessed for 24 hours. Results: A mild (Grade 1) change in fibre-optic position of LMA was observed in 6 out of 42 children maintained with N2O–O2 anaesthesia. The cuff pressure was higher than baseline in group 2 at all three time points with the maximum at 90 minutes (93.23 ± 14.86 cm H2O vs. 39.78 ± 7.75 cm H2O; P < 0.05). The OLP was comparable between the groups during the initial 60 minutes and then increased in group 2. The incidence of post-operative sore throat was significantly higher in group 2 (P = 0.008). Conclusion: The diffusion of anaesthetic gases into the air-filled cuff does not change the fibre-optic position of the LMA significantly but increases the cuff pressure and incidence of post-operative laryngo-pharyngeal complications in children.

Anaesthesiology is a high-demand speciality of medicine in terms of long and unpredictable work hours, stressful work requirements, pressure for a cent per cent productivity in academics, clinical work and research. Higher stress levels can cause non-communicable diseases like hypertension, obesity and depressed immunity, among many others. In the journey as a trainee anaesthetist, vigorous and diligent efforts are needed to gain perfection in knowledge and skills ultimately. While this path is being transversed, it is essential to address physical and mental fitness by exercising it to the recommended benefits, to ward away stress and burnout. In this special article, the authors will discuss the barriers young anaesthesia trainees face to staying healthy and fit during their training and practical and appropriate measures to mitigate the same through intervention at various levels of hierarchy.

The quality of training is a major contributor to workforce proficiency in healthcare, and there is a definite need to achieve a uniform level of knowledge and skill in medical education programmes. There is a paucity of literature comparing postgraduate anaesthesia medical education training structure and requirements across the globe. In a zeal to achieve uniform competencies and technical skills, the strengths and scope of training programmes need to be identified. In this article, we describe the core elements of postgraduate training in various countries while proposing an amalgamation of strengths of each programme and providing a roadmap to evolve further the competency-based comprehensive curriculum proposed by the National Medical Commission of India.