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Background: Orthognathic surgery, a common corrective procedure for jaw abnormalities, requires precise anesthesia management to ensure patient stability and optimal recovery. This study compares the effects of total intravenous anesthesia (TIVA) and inhalational anesthesia on hemodynamics and recovery outcomes in patients undergoing orthognathic surgery. Materials and Methods: A prospective study was conducted at Pravara Rural Hospital, Pravara Institute of Medical Sciences, Loni, Maharashtra, over three years from July 2021 to July 2024. A total of 40 patients scheduled for orthognathic surgery were randomly assigned to either the TIVA group(Propofol + Fentanyl) (n=20) or the inhalational anesthesia group(Sevoflurane) (n=20). Hemodynamic parameters including heart rate, blood pressure, and oxygen saturation were monitored intraoperatively. Recovery outcomes, such as time to extubation, postoperative pain scores, and incidence of nausea and vomiting, were assessed in the postoperative period. Statistical analysis was performed using Student's t-test and Chisquare test. Results: The TIVA group demonstrated more stable intraoperative hemodynamics with significantly lower variability in heart rate (mean ± SD: 75 ± 5 bpm vs. 85 ± 8 bpm, p<0.05) and blood pressure (mean arterial pressure: 80 ± 6 mmHg vs. 90 ± 10 mmHg, p<0.05) compared to the inhalational group. The recovery profile was also superior in the TIVA group, with a shorter time to extubation (mean ± SD: 10 ± 3 minutes vs. 15 ± 5 minutes, p<0.05), lower postoperative pain scores (mean ± SD: 3 ± 1 vs. 5 ± 2 on a 10-point scale, p<0.05), and reduced incidence of nausea and vomiting (10% vs. 30%, p<0.05). Conclusion: Total intravenous anesthesia provides better hemodynamic stability and improved recovery outcomes compared to inhalational anesthesia in patients undergoing orthognathic surgery. These findings suggest that TIVA may be a preferable anesthesia technique for this patient population. [ABSTRACT FROM AUTHOR]

Cervical cancer continues to pose a significant global health burden, despite advancements in screening and early detection. In recent years, the integration of Artificial Intelligence (AI) technologies has emerged as a promising approach to enhance cervical cancer detection and diagnosis. The challenges associated with existing screening methods; AI-based approaches that have been developed to address these challenges are explored. Through a systematic review of the literature, we highlight the strengths and limitations of different AI algorithms and methodologies employed in cervical cancer detection, the role of machine learning, deep learning, and other AI techniques in improving the accuracy and efficiency of screening programs, as well as their potential impact on reducing disparities in cervical cancer outcomes. The integration of AI technologies into existing screening frameworks, including the use of automated systems for image interpretation, decision support tools for healthcare providers, and mobile health applications for patient education and engagement and the regulatory and ethical considerations surrounding the deployment of AI in cervical cancer detection are discussed. Review highlights future directions and emerging trends in AI-driven cervical cancer detection, the transformative potential of AI technologies in revolutionizing the future of cervical cancer detection and the importance of collaborative efforts among researchers, healthcare providers, policymakers, and industry stakeholders to realize this vision. [ABSTRACT FROM AUTHOR]

Anaesthesiology trainees, particularly those in interventional radiology settings, face elevated risks. Ionizing radiation is essential in medical practice, but even small doses can have severe consequences. This study seeks to gauge their knowledge and attitudes toward radiation hazards and safety measures. Materials and methodology: This questioner based cross-sectional study was conducted in two rural tertiary care units. A total of 65 anaesthesiology residents were included from two different institute in the study. The demographic data and answers pertaining to questions of radiation exposure was collected. Results: Out of 65 trainee, 35 (54%) were from the Maharashtra and 30 (46%) were from Karnataka. The males were 40 (61.5%) and females were 25 (38.5%). Among 65 trainees who responded 28 (43%) trainees were in first year, 12 (18.5%) were in second year and 25 (38.5%) were in third year. 60(92.3%) trainees responded that no one has trained or educated them about the radiation. All 65 (100%) trainees responded that they use the protective measure for the radiation in operation theatre. Conclusion: Anaesthesiology trainees in our institution exhibit a notable lack of awareness concerning the dangers linked to ionizing radiation. This research underscores the necessity for adequate protection measures among anaesthesiology trainees. It advocates for the integration of radiation dose, risks, and safety protocols into the fundamental curriculum of medical colleges. [ABSTRACT FROM AUTHOR]

In the ever-evolving landscape of medical technology, the integration of artificial intelligence (AI) has emerged as a transformative force in various specialties, including anaesthesia. Cardiothoracic anaesthesia, a critical domain within cardiovascular medicine, stands to benefit significantly from AI's capabilities. This abstract delves into the burgeoning intersection of cardiothoracic anaesthesia and AI, exploring the manifold applications, challenges, and potential outcomes. AI's capacity to analyze complex data streams swiftly and accurately has paved the way for personalized patient care in the digital age. In the context of cardiothoracic anaesthesia, AI's potential spans preoperative risk assessment, intraoperative monitoring, and postoperative care optimization. Algorithms trained on extensive patient datasets can predict patient-specific responses to anaesthesia, aiding clinicians in tailoring interventions. Furthermore, real-time AI-driven monitoring systems can detect subtle changes in hemodynamic and oxygenation, enabling timely intervention and improving patient safety during surgery. However, this symbiotic relationship between AI and cardiothoracic anaesthesia faces challenges, including data privacy concerns, algorithm interpretability, and integration with existing healthcare systems. Ensuring that AI models are trained on diverse and representative datasets is essential to mitigate biases and promote equitable patient care. [ABSTRACT FROM AUTHOR]

Introduction: Anesthesiologist plays an important role in intensive care units, trauma centers, pain clinics, and as a member of resuscitation team all over the world. Due to the lack of public awareness about anesthesia as a medical discipline, many patients assume an anesthesiologist to be an assistant of the surgeon and do not recognize the role played by the anesthesiologist in preoperative, perioperative, and postoperative periods. With the changing health-care environment and advancement in anesthesiology, the patients and general public need to be educated. Aims and Objectives: This study aimed to assess the knowledge of patients regarding anesthesia and anesthesiologist at rural tertiary care hospital. Design: This is a descriptive cross-sectional study done at a rural tertiary care hospital. Materials and Methods: After approval of the institutional ethical committee, the study was conducted in the form of a questionnaire for patients coming to preanesthetic checkup outpatient department (OPD) for elective surgery. Results: This study involves 602 (312 male; 290 females) for preanesthetic checkup OPD, of whom only 403 (67%) of them recognized anesthesiologists as doctors, while 401 (66.7%) knew that anesthesia is required prior to any surgical procedure and 209 (41.4%) of them knew anesthetists play a role in intraoperative and postoperative patient care. Conclusion: We can conclude that there is unawareness among the rural population regarding the role played by anesthesiologists; hence, initiatives are to be taken for educating the population. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac arrest is a substantial public health problem. The American Heart Association recommends that those whose daily work requires knowledge and skills in advanced cardiovascular life support (ACLS) should not only be trained in ACLS but also be given a refresher course at least every 2 years. We conducted a study to find out how much knowledge and skill was improved in the participants following the workshop and also how much of it they retain after 6 months. Materials and Methods: The study, a prospective repeated measures quasi-experimental design, was done to test the knowledge and skill about basic life support (BLS) and ACLS among MBBS Interns at the entry to internship before training, posttraining and 6 months after training. This was done using a structured questionnaire containing 25 knowledge and practice questions and a checklist containing 15 points was used to assess the skills was also assessed using the Laerdal CPRQ Manikin with skill guide using parameters compression score, ventilation score, and compression fraction. Results: Knowledge mean total score for pretest, immediate posttest, and 6 months posttest was 10.9, 23.54, and 15.77, respectively, and skill mean score for pretest, immediate posttest, and 6 months posttest was 3.55, 12.99, and 9.06, respectively. Knowledge and skill assessed for immediate posttest was significantly higher than the pretest score. Six months posttest total score was significantly higher than the pretest total score but was significantly lower than posttest score in regard to both knowledge and skills. Conclusion: We found that there is gross lack of knowledge and skills among interns, which needs to be looked at with proper BLS and ACLS training and periodic reinforcement of the same with trainings as there is a significant decrease in both knowledge and skills at 6 months. The skill guide can be considered for skill assessment. [ABSTRACT FROM AUTHOR]

Background and aim: Oral care contributes significantly to the patients' health outcome in a critical care unit. Nurses play a vital role in maintaining good oral health. However, there remains a dearth of literature regarding oral care practices among nurses working in an Indian critical care unit. In this descriptive cross sectional study, we assessed the level of awareness and the existing practices of patients' oral care among our critical care unit (CCU) nurses. Methodology: After obtaining approval from the institutional ethics committee, 64 CCU nurses, having work experience of atleast 6 months in the CCU, were enrolled in this descriptive cross sectional study. A self-structured questionnaire was used to assess the awareness and practice of the nurses. The data collected was analyzed using descriptive statistics and results were expressed as percentages. Result: Of the 64 nurses enrolled in the study, there were no dropouts. It was found that 62 (96.87%) nurses provided oral care to all the CCU patients. 60 (93.7%) nurses claimed that a standard oral care protocol has been provided to them. Documentation of the oral care was carried out by 54 (84.37%) nurses. Although 50% of the nurses had been trained to provide oral care, 54 (84.37%) nurses felt the need of fresh training. 60 (93.7%) nurses preferred using toothbrush in conscious patients. Chlorhexidine was the most commonly used solution. Bleeding, extubation and biting were among the few complications that they faced during routine oral care. Conclusion: Despite working in a rural set up with limited resources available, oral care was provided by most of the nurses. Following a standard protocol and documentation of the same, has helped maintain consistency in oral care of all critical care patients. Key words: Oral health; Awareness; Critical care; Nursing; Rural. [ABSTRACT FROM AUTHOR]

It is not uncommon to see in developing and underdeveloped countries, where the anesthesiologist who is untrained in cardiac specialty takes care of cardiac catheterization centers. The service in cardiac catheterization laboratories (CCL) in developed countries and some of the developing countries is mainly provided by the cardiac anesthesiologists. The scenario is not same in some part of developing countries or in underdeveloped countries which are mainly due to increase in number of CCL (catheterization laboratory) when compared to the number of cardiac anesthesiologists working outside the operation theater. It is also important for training the postgraduate in this field as to make them capable and competitive in managing such cases during emergency situation as it may save the life of a patient. Many a times, CCL is built as per the need of cardiologist ignoring the basic needs of cardiac anesthesiologist. It is important to note that anesthesiologist should be competent enough to provide complete, integrated anesthetic care outside the operation theater with available resources. It is challenging for the anesthesiologist to provide sedation or general anesthesia in such critical area where he/she will be dealing with life-threatening situations. In the modern era, the interventional techniques are advancing and treating complex heart diseases is more often. Days are not far where the CCL procedures may reduce the requirement of major surgeries. A careful and dedicated approach by the anesthesiologist with thorough knowledge and skills decreases morbidity and mortality rate. This article helps both cardiac and noncardiac anesthesiologists to improve their knowledge and to approach the patient systematically. [ABSTRACT FROM AUTHOR]

Background: World Health Organization has estimated that 3 million cases of pesticide poisoning are registered every year .Southern states of India have high prevalence rate of organophosphorus poisoning (OPP) due to many factors, including accidental, suicidal or homicidal intentions. Various clinical and laboratory tests are used to assess severity of the poisoning, but with conflicting results. This study aimed to correlate the serum acetylcholinesterase levels with morbidity, ventilation need, ICU stay and the final outcome of the ailment. Methodology: This retrospective study was conducted in rural tertiary care of Maharashtra, India. The patients admitted from 1st January 2016 to 31st December 2016 with definitive diagnosis of OPP requiring mechanical ventilator support were included. Parameters like age, sex, serum acetylcholinesterase levels, ventilator days, ICU stay days and outcome were collected. Patients with unknown compound poisoning, referred from other hospital or brought dead were excluded. The statistical analysis was done by using Graph Pad software. Unpaired t test was used for parametric values. Pearson's correlation test was used for correlating the values of serum cholinesterase levels with ventilator hours and ICU stay. Results: Out of a total of 257 patients, 32 fulfilled inclusion criteria; 25 (78%) were males of whom 10 (40%) patients died, and 7 (22%) were females of whom 2 (28.5%) could not be saved. The male to female ratio was 3.6:1.The lowest and highest recorded serum acetylcholinesterase level was 178 and 6358 U/L respectively. The average ventilator hours were 66.56 ± 44.73, age distribution was 43.28 ± 16, average number of ICU stay was found to be 10.4 ± 19.68 days. Conclusion: The prediction of morbidity or outcome, ICU stay and ventilator days cannot be made based on the levels of serum acetylcholinesterase. [ABSTRACT FROM AUTHOR]

Background: There is an upward surge in the use of laparoscopic surgeries due to various advantages when compared to open surgeries. Major advantages are, due to small incisions which are cosmetically acceptable and most of them are now daycare procedures. Problem of economic burden and hospital bed occupancy has been overcome with laparoscopic surgeries. All these advantages are not free from disadvantages, as hemodynamic changes such as hypertension; tachycardia and other surgical-related complications are commonly observed intraoperatively. Dexmedetomidine is one of the α2 agonist drugs which acts at both supraspinal and spinal level and modulate the transmission of nociceptive signals in the central nervous system. The basic effect of dexmedetomidine on the cardiovascular system is to decrease the heart rate and systemic vascular resistance with additional feature of opioid sparing effect. This drug has become an ideal adjuvant during general anesthesia, especially when stress is expected. Hence, the drug was studied in laparoscopic surgeries. Aims and Objectives: (a) To study the effect of dexmedetomidine on hemodynamic parameters during perioperative period in patients undergoing laparoscopic surgery. (b) To study the postoperative sedation score and analgesic requirement. (c) To study the side effect profile of dexmedetomidine. Settings and Design: Randomized double blind controlled trial. Subjects and Methods: After obtaining the Institutional Ethical Clearance, the study was conducted. Forty patients of American Society of Anesthesiologists Class I and II were enrolled in this randomized study. The patients were randomly divided into two groups; group normal saline (NS) and group dexmedetomidine. Patient received either NS or dexmedetomidine in group NS and group dexmedetomidine, respectively, depending upon the allocation. The infusion rate was adjusted according to; loading dose (1 µg/kg) over 10 min and maintenance dose (0.5 µg/kg/h) and perioperative hemodynamics was recorded. Routine general anesthesia was administered in all the patients with conventional technique without deviating from institutional protocols. Postoperatively, Rasmsay sedation score, time taken for request of first analgesic dose, and side effects if any were recorded. Statistical Analysis Used: The categorical factors are represented by the number and frequency (%) of cases. The continuous variables are represented by measures of central frequency and standard deviation. The statistical analysis was done by using unpaired t-test and Chi-square. P < 0.05 was considered statistically significant. Results: Significant hemodynamic changes are observed in NS group during laryngoscopy, intubation, during pneumoperitoneum formation, and during extubation. Hemodynamic stress response in dexmedetomidine group was significantly attenuated. Analgesic requirement during postoperative 24 h were much less in dexmedetomidine group when compared to NS group. No significant side effects were noted except for bradycardia; which was observed in two cases of dexmedetomidine group. Conclusion: Dexmedetomidine infusion in the dose of 1 µg/kg body weight as bolus over 10 min and 0.5 µg/kg/h intraoperatively as maintenance dose controlled the hemodynamic stress response in patients undergoing laparoscopic surgery. Use of dexmedetomidine extends the pain free period postoperatively and thereby reducing total analgesic requirement. Thus, dexmedetomidine can be utilized as an ideal anesthetic adjuvant during laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

Carotid body tumor (CBT) is a rare tumor, which arises at bifurcation of carotid artery from chemoreceptor cells. These cells sense the partial pressure of oxygen and carbon dioxide from the blood. Hence, carotid body plays an important role in the control of ventilation during hypoxia, hypercapnia, and acidosis. The tumor arising from these cells is benign and has tendency to turn out malignant. This tumor is found in persons who live at high altitudes. Removal of tumor poses several anesthetic challenges and perioperative morbidity or mortality. We report successful anesthetic management of CBT excision. [ABSTRACT FROM AUTHOR]

Non-obstetric diseases during pregnancy are not uncommon. The presence of systemic disease may further insult the pregnancy leading to alteration in the normal function of other system. Hence, it is important to treat the disease depending upon the severity and type of urgency. Several systemic diseases in pregnancy and management have been reported earlier but it is necessary to report a rare pathology, treatment option and its anesthetic management. We report anesthetic management of a rare case of pseudo pancreatic cyst in a pregnant lady operated for cysto-gastrostomy and also highlighting the recent guidelines for non-obstetric surgery in pregnancy. [ABSTRACT FROM AUTHOR]

Many anti-emetics are used in clinical practice. Palonosetron hydrochloride is one of them. It is a novel, centrally acting antiemetic, and anti-nausea agent. This drug is an antagonist of serotonin receptor subtype 3 (5-HT3). This drug has longer duration of action which makes it useful in the prevention and treatment of acute and delayed onset of nausea and vomiting. This drug was initially used for chemotherapy induced nausea and vomiting. Federal drug agency (FDA) has approved it for prevention and treatment of post-operative nausea and vomiting. The literature search for this article was done using Google scholar and Pubmed using the terms ''Palonosetron,'' ''longer duration of action,'' ''nausea,'' ''vomiting,'' and ''postoperative''. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to the role of decision support system and technological advancements in anesthesia practice.

Introduction: With the advent of ultrasound (US) guidance, this technique saw resurgence in the late 1990s. As US guidance provides real-time view of the block needle, the brachial plexus, and its spatial relationship to the surrounding vital structures; it not only increased the success rates, but also brought down the complication rates. Most of the studies show use of US guidance for performing brachial plexus block, results in near 100% success with or without complications. This study has been designed to examine the technique and usefulness of state-of-the-art US technology-guided supraclavicular brachial plexus block and compare it with routine nerve stimulator (NS)-guided technique. Aim: To note block execution time, time of onset of sensory and motor block, quality of block and success rates. Settings and Design: Randomized controlled trial. Materials and Methods: A total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and NS (Group NS). Both groups received 1:1 mixture of 0.5% bupivacaine and 2% lignocaine with 1:200000 adrenaline. The amount of local anaesthetic injected calculated according to the body weight and not crossing the toxic dosage (Inj. bupivacaine 2 mg/kg, Inj. lignocaine with adrenaline 7 mg/kg). The parameters compared between the two groups are block execution time, time of onset of sensory and motor block, quality of sensory and motor block, success rates are noted. The failed blocks are supplemented with general anesthesia. Statistical Analysis: The data were analyzed using the SPSS (version 19) software. The parametric data were analyzed with student "t" test and the nonparametric data were analyzed with Chi-square test A P < 0.05 was considered significant. Results: There was no significant difference between patient groups with regard to demographic data, the time of onset of sensory and motor block. Comparing the two groups, we found that the difference in the block execution time and success rates is not statistically significant. A failure rate of 10% in US and 20% in NS group observed and is statistically insignificant (P = 0.278). No complication observed in either group. Conclusions: US and NS group guidance for performing supraclavicular brachial plexus blocks ensures a high success rate and a decreased incidence of complications that are associated with the blind technique. However our study did not prove the superiority of one technique over the other . The US-guided technique seemed to have an edge over the NS-guided technique. A larger study may be required to analyze the advantages of using US in performing supraclavicular brachial plexus blocks, which could help justify the cost of purchase of the US machine. [ABSTRACT FROM AUTHOR]

Sugammadex (ORG 25969) is a unique neuromuscular reversal drug; a novel cyclodextrin, the first in a new class of selective relaxant binding agents, which reverse neuromuscular blockade (NMB) with the aminosteroid non-depolarizing muscle relaxants rocuronium and vecuronium. Sugammadex can reverse moderate or deep NMB. The clinical use of sugammadex promises to eliminate many of the shortcomings in current anesthetic practice with regard to antagonism of rocuronium and other aminosteroid muscle relaxants. [ABSTRACT FROM AUTHOR]

Tapentadol is a novel, centrally acting analgesic with dual mechanism of action, combining mu-opioid receptor agonism with noradrenaline reuptake inhibition in the same molecule. It has an improved side effect profile when compared to opioids and nonsteroidal anti-inflammatory drugs. The dual mechanism of action makes Tapentadol a useful analgesic to treat acute, chronic, and neuropathic pain. [ABSTRACT FROM AUTHOR]

The ventilator solution for COVID -19 patient at rural tertiary care hospital. [Extracted from the article]

Huntington's chorea (HC) is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia, and psychiatric disturbances. There are only a few case reports regarding the anesthetic management of a patient with HC and the best anesthetic technique is yet to be established for those patients which are at higher risk of perioperative complications. We report the anesthetic management of a 64-year-old patient with HC admitted for cataract surgery. [ABSTRACT FROM AUTHOR]

Holt-Oram syndrome also known as heart and hand syndrome, first reported in 1960. It is a rare, inherited, an autosomal dominant disorder with mutation in TBX5. As the name suggests, the feature involves skeletal abnormality mainly involving upper limb, that is, upper-extremity malformations involving radial, thenar, or carpal bones; congenital heart diseases like, atrial-septal defect and ventricular septal defect and conduction problems. This syndrome may also involve other part of skeletal structure. We hereby report a case of a patient who was suffering from this syndrome scheduled for right radial head excision. [ABSTRACT FROM AUTHOR]

Laurence-Moon-Biedl Syndrome is primarily a rare, recessively inherited genetic disorder. The cardinal features are polydactyly, obesity and retinitis pigmentosa, mental retardation, genital hypoplasia and cardiac anomalies. This spectrum may extend and may also involve renal anomalies. Here, we report a rare case of 15-year-old boy who was overweight and suffering from Laurence Moon Biedl syndrome scheduled for closure of atrial septal defect. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 4-year-old female child suffering from hematuria and abdominal pain with a history of abdominal distention. Topics include observation of mentally retardedness in the child, mallampatti grade I revealed through airway examination, and tenderness in iliac region observed through abdominal examination. It mentions normal intraocular pressure and nystagmus observed through eye examination and rare genetic disorders genital anomalies, wilms tumor and aniridia.

A letter to the editor is presented about a blocked oxygen humidifier.

A letter to the editor is presented regarding the experience of the authors about patients in the post-operative area who failed to maintain oxygen saturation which is avoidable.

A letter to the editor about the role of oxygen in treating critically ill patients while anesthetizing and the errors arising from the use of oxygen humidifier is presented.