Search

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with increased morbidity and mortality. We retrospectively analysed the perioperative anesthetic management in patients undergoing HIPEC surgery.

Background: Pediatric airway management requires careful clinical evaluation and experienced execution due to anatomical, physiological, and developmental considerations. Video laryngoscopy in pediatric airways is a developing area of research, with recent data suggesting that video laryngoscopes are better than standard Macintosh blades. Specifically, there is a paucity of literature on the advantages of the C‐MAC D‐blade compared to the McCoy direct laryngoscope. Methods: After Ethics Committee approval, 70 American Society of Anesthesiologists physical status 1 and 2 children aged 4–12 years scheduled for elective surgery under general anesthesia were recruited. Patients were randomly allocated to intubation using a C‐MAC video laryngoscope size 2 D‐blade (Group 1) and a McCoy laryngoscope size 2 blade (Group 2). The Intubation Difficulty Scale (IDS) for ease of intubation was the primary outcome, while Cormack–Lehane grades, duration of laryngoscopy and intubation, hemodynamic responses, and incidence of any airway complications were secondary outcomes. Results: Both groups were comparable in terms of patient characteristics. The median (IQR) Intubation Difficulty Scale (IDS) score was better but was statistically nonsignificant with C‐MAC (0 [0–0] vs. 0 [0–2], p =.055). The glottic views were superior (CL grade I in 32/35 vs. 23/35, p =.002), and the time to best glottic view (6 s [5–7] vs. 8.0 s [6–10], p =.006) was lesser in the C‐MAC D‐blade group while the total duration of intubation was comparable (20 s [16–22] vs. 18 s [15–22], p =.374). All the patients could be successfully intubated on the first attempt. None of the patients had any complications. Conclusion: The C‐MAC video laryngoscope size 2 D‐blade provided faster and better glottic visualization but similar intubation difficulty compared to McCoy size 2 laryngoscope in children. The shorter time to achieve glottic view demonstrated with the C‐MAC failed to translate into a shorter total duration of intubation when compared to the McCoy laryngoscope attributable to a pronounced curvature of the D‐blade. [ABSTRACT FROM AUTHOR]

Background: Existing literature lacks high-quality evidence regarding the ideal intraoperative positive end-expiratory pressure (PEEP) to minimize postoperative pulmonary complications (PPCs). We hypothesized that applying individualized PEEP derived from electrical impedance tomography would reduce the severity of postoperative lung aeration loss, deterioration in oxygenation, and PPC incidence. Methods: A pilot feasibility study was conducted on 36 patients who underwent open abdominal oncologic surgery. The patients were randomized to receive individualized PEEP or conventional PEEP at 4 cmH2O. The primary outcome was the impact of individualized PEEP on changes in the modified lung ultrasound score (MLUS) derived from preoperative and postoperative lung ultrasonography. A higher MLUS indicated greater lung aeration loss. The secondary outcomes were the PaO2/FiO2 ratio and PPC incidence. Results: A significant increase in the postoperative MLUS (12.0 ± 3.6 vs 7.9 ± 2.1, P < 0.001) and a significant difference between the postoperative and preoperative MLUS values (7.0 ± 3.3 vs 3.0 ± 1.6, P < 0.001) were found in the conventional PEEP group, indicating increased lung aeration loss. In the conventional PEEP group, the intraoperative PaO2/FiO2 ratios were significantly lower, but not the postoperative ratios. The PPC incidence was not significantly different between the groups. Post-hoc analysis showed the increase in lung aeration loss and deterioration of intraoperative oxygenation correlated with the deviation from the individualized PEEP. Conclusions: Individualized PEEP appears to protect against lung aeration loss and intraoperative oxygenation deterioration. The advantage was greater in patients whose individualized PEEP deviated more from the conventional PEEP. [ABSTRACT FROM AUTHOR]

Byline: Sukhminder. Singh Bajwa, Nishkarsh. Gupta, Shelly. Rana, Shikha. Sharma Intraoperative hypotension is a common occurrence in patients undergoing surgery under general and spinal anaesthesia and is associated with adverse [...]

Byline: Anju. Gupta, Nishkarsh. Gupta Sir, We read with great interest the article by Zilberman et al .[1] regarding modification of the LMA® GastroTM airway(LGA). We commend them for their [...]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim and background: High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. Methods: It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. Results: A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). Conclusion: There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles. [ABSTRACT FROM AUTHOR]

Byline: Ruchi. Singh, Anju. Gupta, Nishkarsh. Gupta, Vinod. Kumar Introduction The concept of enhanced recovery after surgery (ERAS) was introduced in the mid-90s by Kehlet et al .[1] The comprehensive [...]

Background: The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. Methods: After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco-surgery were recruited. The patients were randomly allocated to group I [1 mg/kg of bolus propofol over 15 minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2--4] or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 µg/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient's satisfaction were noted. Results: Total fentanyl required was 0.56 ± 0.13 µg/kg/hour in group II and 0.58 ± 0.18 µg/kg/hour in group I (P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic-related adverse effects were 41.67% in group II and 11.11% in group I (P = 0.006). Conclusion: The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco-surgeries. [ABSTRACT FROM AUTHOR]

Byline: Anju. Gupta, Nishkarsh. Gupta Surgical incision and related trauma stimulate the endocrine and inflammatory response and result in metabolic stress. This occurs due to an increase in release of [...]

Byline: Anju. Gupta, Riniki. Sarma, Nishkarsh. Gupta, Rakesh. Kumar Introduction Throat pack (TP) is commonly used during oral and-maxillofacial surgeries to prevent aspiration of blood and tissue debris intraoperatively as [...]

Byline: Abhity. Gulia, Anju. Gupta, Prateek. Sharma, Nishkarsh. Gupta The coronavirus disease 2019 (COVID-19) pandemic has imposed a major burden on the already limited health services across the world. The [...]

Byline: Sourav. Burman, Rakesh. Garg, Sushma. Bhatnagar, Seema. Mishra, Vinod. Kumar, Sachidanand. Bharati, Nishkarsh. Gupta Introduction: Awareness of end-of-life care (EOLC) has been at grass root level in our country. [...]

Byline: Parmanand. Jain, Kalpana. Balkrishanan, Sukdev. Nayak, Nishkarsh. Gupta, Shagun. Shah Global cancer burden is on the rise and many more patients present for surgery or other oncological diagnostic or [...]

Byline: Vinod. Kumar, Nishkarsh. Gupta Coronavirus disease 2019 (COVID-19) epidemic has resulted in patients with varying severity of respiratory problems. Anesthetists are frequently involved in patient's airway management, resuscitation, and [...]

Byline: Vinod. Kumar, Deepti. Ahuja, Nishkarsh. Gupta, Sachidanand. Bharati, Rakesh. Garg, Seema. Mishra, K. Haresh, Subhash. Gupta, Sushma. Bhatnagar Background: Prostate cancer is a common cancer found in men worldwide. [...]

Byline: U. Raveendra, Anju. Gupta, Swagata. Biswas, Nishkarsh. Gupta Airway emergencies are among the life-threatening events that are encountered in the operating room, emergency department or intensive care unit. They [...]

Byline: Ruparna. Khurana, Mohit. Varshney, Seema. Mishra, Nishkarsh. Gupta, Rakesh. Garg, Sachidanandjee. Bharti, Vinod. Kumar, Sushma. Bhatnagar Introduction: During the current COVID-19 crisis, striking a balance between adequate pain relief [...]

Byline: A. Karthik, Kanika. Rustagi, Seema. Mishra, Rakesh. Garg, Nishkarsh. Gupta, Sachidanand. Bharati, Vinod. Kumar, Sushma. Bhatnagar Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has affected all the aspects [...]

Byline: Swagata. Biswas, Shreya. Adhikari, Nishkarsh. Gupta, Rakesh. Garg, Sachidanand. Bharti, Vinod. Kumar, Seema. Mishra, Sushma. Bhatnagar Background and Aims: With the COVID-19 pandemic, lockdown, and fear from contagion, the [...]

Byline: Riniki. Sarma, Saurabh. Vig, Puneet. Rathore, Deepam. Pushpam, Seema. Mishra, Nishkarsh. Gupta, Rakesh. Garg, Vinod. Kumar, Sachidanand. Bharati, Sushma. Bhatnagar Context: The coronavirus pandemic has put an unprecedented burden [...]