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Byline: Rohini. Dattatri, Nishkarsh. Gupta Thoracotomy is considered as the most painful of all surgical procedures with complex multifactorial pathophysiology. Both nociceptive and neuropathic mechanisms have been implicated. Following skin [...]

Byline: Anuja. Pandit, Nishkarsh. Gupta, Vinod. Kumar, Sachidanand. Bharati, Rakesh. Garg, Karan. Madan, Seema. Mishra, Sushma. Bhatnagar Introduction: Early integration of palliative interventions in patients with central airway obstruction (CAO) [...]

Byline: Kinshuki. Jain, Nishkarsh. Gupta, Mukesh. Yadav, Sanjay. Thulkar, Sushma. Bhatnagar Airway management forms the foundation of any anaesthetic management. However, unanticipated difficult airway (DA) and its sequelae continue to [...]

Background and Aims: Electrical defibrillation is the most important therapy for patients in cardiac arrest. The audit was aimed to assess awareness among residents with respect to routine preuse checking of cardiac defibrillators. Materials and Methods: The audit was conducted at a multispeciality tertiary care referral and teaching center by means of a printed questionnaire from anaesthesiology residents. A database was prepared and responses were analyzed. Results: Eighty resident doctors participated in the audit. Most (97.8%) of the residents were sure of the presence of a defibrillator in the operation room (OR); 70% of postgraduates (PG)s were aware of the location of the defibrillator in the OR as compared to 83.7% of the senior resident (SRs). Also, 32.1% residents routinely check the availability of a defibrillator. The working condition of the defibrillator was checked by 21.7% of the residents; 25.3% ensured delivery of the set charge. Further, 8.2% of residents ensured availability of both adult and paediatric paddles. About 27.8% of residents ensured the availability of appropriate conducting gel and 53.8% residents were of the opinion that the responsibility of checking the functioning and maintenance of the defibrillators lies with themselves. Some 22% thought that both doctors and technical staff should share the responsibility, while 19.5% opined that it should be the responsibility of the technical staff. Conclusion: All medical equipment is to be tested prior to initial use and periodically thereafter. An extensive, recurring training program, and continued attention to the training of clinical personnel is required to ensure that they are proficient in the operation and testing of specific defibrillator models in their work area. We conclude that apart from awareness of the use of the equipment we are using, its preuse testing is must. All resident doctors should be aware of the presence and adequate functioning of the defibrillator in their ORs and this audit reinforces the need for training of all resident doctors.

The article explores the potential of artificial intelligence (AI) to enhance palliative care for cancer patients and healthcare providers. Topics discussed include AI's role in improving clinical decision-making and patient education, the ethical and legal challenges of relying on AI in sensitive healthcare settings, and the need for cautious integration of AI tools like ChatGPT and Google Gemini into routine clinical practice.

Background: An unwavering availability of opioids is crucial for effective pain and palliative care and for managing opioid dependence. This study aims to study the pattern of morphine consumption and the use of safety protocols for prescribing opioids in a tertiary cancer hospital in India. Patients and methods: The medical and pharmacy records were studied retrospectively to investigate the pattern of oral Morphine consumption and distribution from 2008 to 2020. Results: The number of new cancer patients visiting the hospital, the number of re-visits of these patients, and inpatient admissions to palliative care services increased unswervingly from 2008 to 2019 with a sharp fall in 2020 owing to the COVID pandemic. Annual oral morphine consumption showed a steady increase from 4.89 kg in 2008 to 11.53 kg in 2019 with a fall to 5.68 kg in 2020. However, the trend for oral morphine dispensed per patient per visit showed a mild increase from 1.1 grams in 2008 to 2.06 grams in 2012, followed by a gradual decline to 0.89 grams in 2020. Opioid diversion incidence was found to be zero. Conclusions: Comprehensive interventions alongside safety protocols for prescriptions of opioids and effective integration of palliative care can help prevent opioid use disorders. [ABSTRACT FROM AUTHOR]

Objective: Several interfascial interfacial plane blocks have been described in patients undergoing modified radical mastectomy. We conducted this study to evaluate the analgesic efficacy of ultrasound-guided serratus anterior plane block and erector spinae plane block in patients undergoing modified radical mastectomy. Methods: Totally, 80 female patients (18-70 years) undergoing modified radical mastectomy were randomised into 2 groups of 40 each and were given ultrasound-guided serratus anterior plane block or erector spinae plane block with 0.4 mL kg−1 of 0.375% ropivacaine in this prospective double-blind control trial. The groups were compared for the time to request of first dose of rescue analgesic, requirement of rescue analgesics, and patient satisfaction score. Results: The time to request of the first rescue analgesia was comparable in both groups (P =.056). Postoperative pain scores at rest at 0 minute were significantly lower in serratus anterior plane group as compared to erector spinae plane group (P =.03). The intraoperative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable between the 2 groups. The number of patients requiring rescue doses of fentanyl intraoperatively and rescue analgesics postoperatively was similar in both groups. The mean patient satisfaction score was also comparable in both groups. Conclusion: Ultrasound-guided serratus anterior plane block and erector spinae plane block have comparable postoperative analgesic efficacy after modified radical mastectomy [ABSTRACT FROM AUTHOR]

Byline: Kritika. Agrawal, Satyajit. Majhi, Nishkarsh. Gupta, Rakesh. Garg A 62-year-old hypertensive woman with a diagnosis of primary central nervous system lymphoma (PCNSL) was planned for chemotherapy with high-dose methotrexate [...]

Byline: Nishkarsh. Gupta, Vinod. Kumar, Rakesh. Garg, Sachidanand. Bharati, Seema. Mishra, Sushma. Bhatnagar Introduction: There is enough evidence to suggest that early introduction to palliative care (PC) for patients with [...]

Byline: Nishkarsh. Gupta, Sidharth. Puri, Vinod. Kumar, Rakesh. Garg, Sachidanand. Bharati, Seema. Mishra, Sushma. Bhatnagar The patients often present to palliative care with intractable nausea and vomiting. This may reduce [...]

Byline: Prashant. Sirohiya, Vinod. Kumar, Rakesh. Garg, Nishkarsh. Gupta Sir, Head and neck cancer patients have potentially difficult airways. The degree of difficulty in intubating the trachea depends on the [...]

Byline: Nishkarsh. Gupta, Rohini. Dattatri, Sachidanand. Bharati, Sushma. Bhatnagar Oral cancers are one of the most common cancers in India. These patients have pain during the course of the disease. [...]

Background: While long-term studies on the correlates of protection, vaccine effectiveness, and enhanced surveillance are awaited for SARS-CoV-2 vaccine, studies on breakthrough infections help understand the nature and course of this illness among vaccinated individuals and guide in public health preparedness. This study aims to compare the differences in the hospitalization outcomes SARS-CoV-2 infection of fully vaccinated individuals with with those of unvaccinated and partially vaccinated individuals. Materials and Methods: Single institution observational cohort study. This study compared the differences in clinical, biochemical parameters and the hospitalization outcomes of 53 fully vaccinated individuals with those of unvaccinated (1464) and partially vaccinated (231) individuals, among a cohort of 2,080 individuals hospitalized with SARS-CoV-2 infection. Descriptive statistics and propensity-score weighted multivariate logistic regression analysis adjusting for clinical and laboratory parameters were used to compare the differences and to identify factors associated with outcomes. Results: Completing the course of vaccination protected individuals from developing severe COVID-19 as evidenced by lower proportions of those with hypoxia, abnormal levels of inflammatory markers, requiring ventilatory support, and death compared to unvaccinated and partially vaccinated individuals. There were no differences in these outcomes among patients who received either vaccine type approved in India. Conclusions: Efforts should be made to improve the vaccination rates as a timely measure to prepare for the upcoming waves of this highly transmissible pandemic. Vaccination rates of the communities may also guide in the planning of the health needs and appropriate use of medical resources. [ABSTRACT FROM AUTHOR]

Objective: Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients' exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing. Methods: Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality. Results: Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO2 peak) was 1128.39 ± 202.79 mL min-1 (19.46 ± 3.06 mL kg-1 min-1) which declined to 1010.33 ± 195.56 mL min-1 (17.24 ± 2.55 mL kg-1 min-1) in the postchemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min-1 (15.54 ± 2.24 mL kg-1 min-1) which declined to 764.76 ± 158.79 mL min-1 (13.01 ± 2.22 mL kg-1 min-1) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien-Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien-Dindo grade =3 was 693.33 ± 140.99 mL min-1 (11.2 ± 1.17 mL kg-1 min-1) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg-1 min-1 (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg-1 min-1. Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery. [ABSTRACT FROM AUTHOR]

Objective: Intubation is a highly aerosol-generating procedure. Recent airway management guidelines advocate the use of appropriate personal protective equipment, videolaryngoscope, and "intubation box" while intubating a suspected or infected coronavirus patient. We undertook a study to compare C-MAC videolaryngoscope with McGrath videolaryngoscope for tracheal intubation using an intubation box by donned anaesthesiologists. Methods: The patients were randomly allocated to 2 groups by computer-generated random numbers, depending upon the videolaryngoscope used. In group C, C-MAC videolaryngoscope (n = 30) was used, whereas McGrath videolaryngoscope was used in group M (n = 30). The primary outcome was the total time required for successful intubation. The secondary outcomes included the number of attempts required, Cormack and Lehane grade, the percentage of glottis opening score, the difficulty faced while using the device, and the user's preference. Results: The time to intubation was 57.17 ± 19.98 seconds with C-MAC videolaryngoscope as compared to 57.93 ± 14.92 seconds with McGrath. Both the devices had a good percentage of glottis opening score. Twelve patients in each group were found to have a Cormack and Lehane grade of 1. The time to glottis visualization was more with McGrath than with C-MAC although not significant (23.8 ± 14.03 vs 20.10 ± 10.78 seconds). Both the devices were easy to use. Conclusions: Both C-MAC and McGrath videolaryngoscopes are equally effective devices for intubation by a donned anaesthesiologist using an intubation box. McGrath with a disposable blade should be preferred for intubation in these conditions. [ABSTRACT FROM AUTHOR]