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Author(s): Rohan Magoon [1]; Arindam Choudhury (corresponding author) [2] Dear Editor, Jose et al. [sup.[1]] recently outlined the utility of opioid-free anaesthesia (OFA), employing dexmedetomidine and lignocaine infusions for haemodynamic [...]

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]

Total cavopulmonary connection (Fontan) without using cardiopulmonary bypass (CPB) may be superior to Fontan on CPB. In the experience of many, a Fontan operation without CPB may be associated with a reduced need for inotropic support, improved outcomes in the postoperative phase including faster time to termination of mechanical ventilatory support, reduced intensive care unit stay, lower volume of pleural and peritoneal effusions, and decreased hospital stay, thereby rendering it more cost-effective. However, the operation is technically more difficult to perform than Fontan on CPB and requires significant modifications of surgical technique and alteration in overall management strategy. In this article, an alternative technique of performing total cavopulmonary connection without CPB is described. Its advantages are briefly discussed. [ABSTRACT FROM AUTHOR]

Despite conventional entity such as opioids and non-steroidal anti-inflammatory drugs, post-operative pain management, and poor pain control is still inevitable. Thus, generating the need for other modalities of postoperative pain control. Moreover, fast-tracking and enhanced recovery after anesthesia requires opioid-free multimodal analgesia. Newer, lesser invasive regional nerve blocks such as bilateral erector spinae (ESP) nerve blocks and bilateral pectoral nerve blocks are increasingly used nowadays. The use of ultrasound has made these blocks to be performed with utmost safety. A novel, interfascial plane block (namely, subpectoral interfascial plane block), has been used in pain management of rib fracture, sternal fracture, and mastectomy. We hereby want to share our experience in the institution of subpectoral interfascial plane block and ESP plane block in combating post-operative pain management following coronary artery bypass graft surgery. We have reported the efficacy of bilateral ESP block and bilateral subpectoral interfascial block in patients undergoing cardiac surgery. Both ESP block and SPIF block provided effective and long-lasting analgesia. Numeric rating scale scores were substantially low for significant duration post-surgery. As far as the consumption of rescue analgesia is concerned, its requirements were very less in all four cases. All the patients were discharged from the intensive care unit early. We want to emphasize here these regional blocks have immense potential in early recovery from what is called MAJOR cardiac surgery. However, more trials are required to know the adjact duration of action, and their efficacy and to compare between ESP block and subpecto-interfascial block. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vascular resistance, an important determinant of shunting across ventricular septal defects (VSD), rises at both extremes of lung volume. Aims: We sought to determine the effect of changes in tidal volumes (VT) on pulmonary blood flow (Qp), systemic blood flow (Qs), and shunt (Qp/Qs) in children with VSD. Setting: Single-center teaching hospital. Design: Prospective observational study. Methods: Thirty children with a mean age of 11.8 ± 5 months undergoing surgical closure of VSD were studied. Hemodynamics and shunt-related parameters were assessed using transthoracic echocardiography measured at three different VT i.e. 10, 8, and 6-ml/kg keeping the minute ventilation constant. Results: Reduction in VT from 10 to 8 to 6 ml/kg led to a reduction in gradient across VSD measuring 23.5, 20 and 13 mmHg respectively (P < 0.001). Similarly, right ventricluar outflow tract (RVOT) diameter, RVOT velocity time integral, Qp (57.3 ± 18.1, 50.6 ± 16.9, 39.9 ± 14.7 mL; P < 0.001), Qs (24.1 ± 10.4, 20.0 ± 8.7, 15.3 ± 6.9 mL; P < 0.001) and peak airway pressure (17.2 ± 1.5, 15.8 ± 1.3, 14.5 ± 1.2 cmHg; P < 0.001) showed progressive decline with decreasing VT from 10 to 8 to 6 ml/kg, respectively. However, Qp/Qs (2.4 ± 0.4, 2.6 ± 0.4, 2.6 ± 0.4) demonstrated a minor increasing trend. Conclusion: Lower VT reduces the gradient across VSD, the pulmonary blood flow, and the peak airway pressure. Hence, ventilation with lower VT and higher respiratory rate maintaining adequate minute ventilation might be preferable in children with VSD. Further studies are required to confirm the findings of this pilot study. [ABSTRACT FROM AUTHOR]

Byline: Arindam. Choudhury, Sambhunath. Das, Usha. Kiran Galactosaemia is an autosomal recessive metabolic disorder that occurs due to galactose-1-phosphate uridyl transferase enzyme deficiency that leads to hepatic, ophthalmic, neural and [...]