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Background and Aims: Exposure to ionising radiation to Anaesthesiology consultants, residents, technicians and nurses (Anaesthesiology personnel) is steadily increasing as a consequence of growing usage of imaging technology for diagnostic and therapeutic purposes. We conducted a questionnaire-based survey of Anaesthesiology professionals (consultants, residents, technicians and nursing staff) working in three major tertiary care medical institutes in northern India regarding the existing knowledge, attitudes and practices of radiation safety at their workplaces., Methods: A printed and validated 30-point questionnaire was distributed. Questions were graded into the domains of demographics (6 questions), knowledge (9 questions), attitude (4 questions) and practice (11 questions). Data obtained from the responses was collated and analysed statistically., Results: Out of the 403 questionnaires distributed, 222 were returned completed (55%). Majority of the respondents were residents (53.60%) and males (57.20%). Many were unaware of the principle of As Low As Reasonably Achievable (ALARA), (70.7%) regarding collimators (65.85%) and their usage (41.9%). Maximum respondents stressed on the necessity of knowing the exposure dosage of radiations (89.2%) and were concerned regarding the same (87.8%). Lead apron was the commonest protection equipment and 97.3% of them were not using dosimeters. Highest levels of knowledge, attitude, and practices were demonstrated by the consultants. In terms of practices, the technicians fared better than the residents., Conclusion: Knowledge, attitude and practices regarding radiation protection issues and doses of radiological procedures is limited. Although all the cadres scored high on their attitude scores, the practice sector requires improvement., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Anaesthesia.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Background and Aims: Anaesthesiologists have been in the forefront of managing patients of the novel coronavirus disease 19 (COVID-19) globally. The rearrangement of duties of anaesthesiology professionals and trainees along with the enforced containment measures like cessation of gatherings (for classroom teaching), cancellation of large number of elective cases and restricted number of procedures that are being performed have adversely affected the training of anaesthesiology postgraduate students across the country., Methods: An electronic survey to assess the effect of the measures taken by hospitals due to COVID-19 on postgraduate teaching was undertaken using a validated questionnaire. We used snowball sampling, and the survey invitation with the web link was shared through freeware WhatsApp. The participation in the survey was voluntary and anonymity was maintained. Data obtained from the responses was collated and analysed., Results: A total of 595 anaesthesiology postgraduate students (males = 298, females = 297) responded to the survey. Majority of the participants reported a steep depreciation (>50%) in the quality and quantity of academic activities (57.47%), major changes or cessation of clinical rotations (73.61%) and inability to conduct thesis-related cases (55.29%). In total, 56.97% of the students reported the rise in usage of online platforms like "Zoom" for conduct of routine academic activities., Conclusion: Teaching and training schedules of anaesthesiology postgraduate students have undergone major modifications following the COVID 19 pandemic. Resourcefulness and ingenuity in teaching methods is the need of the hour to sustain the desired standards of training courses and to maintain the quality of the budding anaesthesiologists., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Anaesthesia.)

Aims: A significant incidence of Posterior Vessel Wall Puncture (PVWP) was reported during ultrasound guidance (USG) for internal jugular vein (IJV) catheterization. We studied a new technique of USGIJV cannulation to minimize or avoid PVWP, thereby decreasing overall complication rate, irrespective of the operators' experience level., Materials and Methods: After ethical approval, a prospective study was conducted on adult patients of either gender between 18-65 years of age, belonging to the American Society of Anesthesiologists Physical Status I-III, undergoing general anesthesia and requiring USG-guided IJV cannulation. After induction of general anesthesia and intubation, USG-guided IJV cannulation was done using technique of "proximal pen-holding method" in patients placed in supine position with neck rotated in 15° rotation to the opposite side. The primary outcome was defined as success rate of USG-guided IJV cannulation and incidence of PVWP. The secondary outcome was the incidences of complications such as arterial puncture, adjacent tissue damage, and performer's ease of the procedure (0-10 scale; 0 denoting no ease and extreme difficulty and 10 denoting extreme ease and no difficulty)., Results: In 135 patients, right IJV puncture, guidewire, and central line insertion were achieved in single attempt without any PVWP by nine operators which included two anesthesia consultants and seven senior registrars. No complications were reported and ease of procedure were rated as median (interquartile range) of 10 (10)., Conclusions: The "proximal pen-holding method" for real-time USG-IJV cannulation helped in avoiding PVWP with lesser complication rate and greater performer's ease.

Competing Interests: There are no conflicts of interest.

Background and Aims: Central venous cannulation (CVC) through right internal jugular vein (IJV) route is routinely performed in paediatric patients undergoing major surgery and in those admitted to intensive care units. A novel technique (modified short-axis out-of-plane [MSA-OOP]) to improve first pass success rate of ultrasound-guided IJV CVC in neonates and infants is being compared with conventional SA-OOP method., Methods: A total of 120 patients were enroled in the study over a period of 6 months. All paediatric patients with age <1 year and weight <10 kg who underwent a major surgery requiring CVC were included. Patients were randomised to either of the two approaches of ultrasound-guided IJV cannulation; SA-OOP and modified SA-OOP (MSA-OOP). In modified approach, the midline of probe footprint was marked with a radio-opaque barium wire that casted a central acoustic shadow on ultrasound screen., Results: In MSA-OOP group, 83.1% of patients were cannulated in the first attempt as compared to 49.2% patients in group SA-OOP. Patients in MSA-OOP group required significantly fewer attempts for successful CVC as compared to patients in the SA-OOP group ( MSA-OOP: median = 1, interquartile range [1-1]; SAOOP: median = 2, interquartile range [1-2], P < 0.001, Mann-Whitney U-test)., Conclusion: The use of MSA-OOP ultrasound technique for IJV CVC cannulation results in a higher first-attempt success rate and reduces the number of cannulation attempts., Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Hyperglycaemia following surgical and anaesthetic stress is a well-established entity which might have undesirable clinical consequences in known diabetics. We encountered a rare event where an undiagnosed diabetic patient developed ketoacidosis in the immediate post-operative period which was her initial presenting symptom of deranged glucoregulation. Presumably, the stress induced by surgery and anaesthesia lead to the genesis of this event. We discuss the management of this case. In addition, we highlight the importance of glycosylated haemoglobin as a subject of future research in identifying such "at risk" patients and for stratifying the risk of hyperglycaemic complications in perioperative settings.

Intra Aortic Balloon Pump (IABP) is conventionally used to support coronary perfusion and weaning from cardiopulmonary bypass. IABP in situ has its own share of complications. We present a case where a patient on IABP support who had reduced peripheral pulsations of the ipsilateral limb and was initially misdiagnosed as IABP catheter associated thromboembolism. A negative embolectomy ruled out the same. Further looking for the cause of reduction of ipsilateral pulses it was found that the tight compressive bandage at saphenous vein conduit harvesting site had led to development of compartment syndrome (CS).

Malaria-leptospira co-infection is rarely detected. Emergency surgery in such patients has not been reported. We describe such a case of a 24-year-old primigravida at term pregnancy posted for emergency caesarean delivery who developed pulmonary haemorrhage, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Here, we discuss the perioperative management, pain management (with transverse abdominis plane block), intensive care management (special reference to management of pulmonary haemorrhage with intra pulmonary factor VIIa) and the role of plasmapheresis in leptospira related jaundice with renal failure.