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Abstract Background Limiting the preoperative fasting period positively impact surgical patient outcome. In tertiary care hospitals, preoperative fasting instructions are mostly implemented by postgraduates. This study was conducted to evaluate the knowledge, attitude, and practice of postgraduate trainees of surgical specialties and anesthesiology regarding preoperative fasting. This observational study was conducted at a tertiary care hospital in May 2020. Consenting 166 postgraduate trainees of anesthesiology and surgical specialties was asked to respond to a questionnaire consisting of nine questions. The primary outcome was the knowledge status of postgraduate trainees regarding preoperative fasting guidelines and secondary outcomes being their attitude and practice of the same. Categorical data were presented as numbers and percentages. Results Out of 166 respondents, 149 (89.8%) and 94 (56.6%) respondents could not correctly describe the practice guidelines published by the American Society of Anaesthesiology pertaining to preoperative fasting in adult and pediatric patients respectively. Of the total respondents, 146 (87.9%) and 108 (65.1%) gave incorrect preoperative fasting instructions to adult and pediatric patients, respectively. The source of information regarding fasting guidelines was seniors amongst 89 (53.6%) respondents. Fifty-one (30.7%) respondents were unaware of the benefits of limiting preoperative fasting. Conclusions There is an imminent need for change in the knowledge, attitude, and practices of residents with regards to preoperative fasting practices. A holistic approach with formal teaching and development of SOP can achieve the change of practice of “NPO after midnight.”

Background and Aims: COVID-19 infection has the potential to spread exponentially during aerosol-generating procedures like intubation. The aim was to find the compliance toward the actual practice as well as the existing knowledge gap and adherence to the guidelines among the medical professionals while attempting intubation in a known or suspected COVID-19 patients. Materials and Methods: A cross-sectional web-based survey format was planned using English questionnaire in an online form (Google® Forms). One hundred and forty valid responses for 27 questions were received. Maximum participation was received from Indian anesthesiologists working in government, semi-government, and private health facilities, performing the intubation routinely. All the valid responses were statistically analyzed by calculating the significant difference in means and proportions, with P < 0.05 being considered statistically significant. Results: Eighty percent of the respondents received training for donning and doffing and regularly wore personal protective equipment for the airway procedure. Scarce simulation training (22.1%), minimum screening before entering into a intubation scene (37.9%), frequent use of bag-mask ventilation (18.2%) or high flow nasal cannula (19.7%) use for preoxygenation, confirmation of the depth of endotracheal tube by auscultation (34.5%), and having no plan B in case of unanticipated difficult airway (27.9%) make the knowledge gap evident. The survey pointed out toward the infrastructural requirement of negative pressure intubation rooms, availability of waveform capnography, and widespread use of videolaryngoscope. Conclusion: This survey gives us an insight into the compliance with existing lacunae and nonuniform practices of the recommended guidelines for the airway management during COVID-19 pandemic with its pragmatic solution.

Background: Recovery from neuromuscular blockade is commonly assessed by clinical signs. There exists wide disparity in what is recommended to monitor neuromuscular blockade and routine clinical practice by anesthesiologists. The objective signs of train-of-four (TOF) ratio of >0.9 and double burst stimulation (DBS) ratio of 1.0 indicate adequate neuromuscular function. This study was planned at a tertiary care hospital to evaluate the ongoing practice of assessing neuromuscular recovery employing clinical signs and comparing with simultaneous TOF and DBS values. Design: A cross-sectional analytical study. Methodology: A total of 100 consecutive patients undergoing surgical procedures lasting more than 1-h duration under general anesthesia with intermediate acting muscle relaxant were enrolled and data of 60 patients analyzed. After extubation, an independent observer recorded simultaneous TOF and DBS ratio using acceleromyography as the clinical signs of neuromuscular recovery (eye opening, tongue protrusion, head lift, sustained bite, hand grip strength, and ability to cough) were attained. Statistical Analysis: Statistical analysis was done utilizing SPSS version 20 (SPSS Inc., Chicago IL, USA) software. Continuous variables are expressed as mean (standard deviation) and Pearson's correlation coefficient was applied to study the correlation between the clinical parameters and quantitative measures of neuromuscular recovery. Results: There was a significant association between ability to retain tongue depressor (sustained bite), absent double vision and ability to cough effectively and TOF and DBS ratios (P < 0.05). None of the clinical signs correlated with TOF ratio >0.9 or DBS ratio of 1.0. Conclusion: Clinical signs of recovery fail to reliably predict postoperative residual paralysis compared to objective neuromuscular monitoring.

Pediatric unanticipated difficult airway in cases of subglottic stenosis (SGS) is always a challenge. We present two cases of SGS which were managed according to the pediatric difficult intubation protocols where supraglottic device was used as secondary intubation plan successfully. Airway management in these cases depends on the urgency of the surgery; if the surgery is nonemergent, the case can be postponed and both surgical and nonsurgical modalities of treatment can be offered; however, in wake of emergency surgery, surgical airway is indicated. Strategies of the pediatric airway management have evolved over the years, but the risk and morbidity associated with the adverse airway events loom larger.

The anesthetic management of a patient with dilated cardiomyopathy (DCM) for noncardiac surgery is challenging due to associated congestive heart failure, malignant dysrhythmias, sudden cardiac arrest, implanted rhythm devices, and thromboembolism. We report successful conduct of a case of DCM on cardiac resynchronization device with Cauda equina syndrome (CES) under general anesthesia in prone position. The anesthetic concerns specific to the pathophysiology of DCM are also discussed.

Context: Intraoperative hypothermia is a leading cause of morbidity in the perioperative period. This retrospective audit study was planned to assess the efficacy of three different active warming devices used in maintaining euthermia in patients who underwent lower segment cesarean section (LSCS). Aims: Audit of the three different fluid warming techniques in maintaining euthermia in patients who underwent cesarean sections. Settings and Design: A retrospective audit. Materials and Methods: In total, 698 patients were included in the study who underwent LSCS and were divided on the basis of the warming technique used into Group 1 (n = 241, blood warming bath), Group 2 (n = 238, cabinet), and Group 3 (n = 219, inline warmer). The preoperative core body temperature was compared in each group with the intraoperative body temperature as well as with core body temperature measured 20 minutes after shifting the patient in the postoperative room as per the entries made in the central anesthesia registry. The incidence of the shivering was also noted from the data for each group separately. Statistical Analysis Used: One-way analysis of variance was applied for comparing the mean (SD) between the three groups and unpaired t-test was used to compare two mean (SD) values.P value

Spinal anesthesia (SA) is utilized as an effective means of anesthesia and has an impressive safety record but it is not devoid of complications, and sometimes, the complications are as fatal as cardiac arrest. Although many factors are involved in etiology of cardiac arrest under SA, the vagal responses to the decreased preload are the most common culprits. We report two cases of cardiac arrest under SA; which happened despite our patient being adequately preloaded utilizing the ultrasonography-guided targeted volume therapy. The patients were successfully resuscitated with no neurological deficit.