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BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution. METHODS: A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols. RESULTS: The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4-4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6-1.83) among anaesthesiologists and by 4.3 (CI: 5.3-3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination. CONCLUSION: Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times.
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CONTEXT: Induction of general anesthesia and mandatory low-ambient temperature in the magnetic resonance imaging (MRI) suite renders the pediatric patient prone to fall in core temperature. Previously done studies have shown mixed results with core temperature showing both rise and fall. AIMS: The aim of this study is to evaluate which effect, hypothermia or hyperthermia, predominates in children anesthetized for MRI. Is the change in temperature the same across age groups and for different MRI scanners?. SETTINGS AND DESIGN: Prospective, observational study in a tertiary care teaching hospital. SUBJECTS AND METHODS: Two hundred and fifty children of age between 1 month and 16 years scheduled for MRI under propofol-based total intravenous anesthesia (TIVA) were recruited. A baseline core temperature (pre-scan) was recorded with the pediatric nasopharyngeal temperature probe after induction of anesthesia and also after the scan in the recovery room. RESULTS: The study shows that there is a significant fall in temperature of 1.022°C (CI = 0.964, 1.081) following MRI (P < 0.001) but the difference across different age groups and type of MRI scanner used are not significant. There is a significant correlation between duration in the MRI room and a decrease in temperature (P value = 0.003). Using simple linear regression analysis, it is found that if there is a 1-min increase in the duration of MRI, there is a decrease of 0.006°C in temperature. CONCLUSION: Vigilant temperature preservation strategies have to be maintained during the time the anesthetized child is present in the MRI suite. MRI compatible active warming devices are warranted especially in high turnover centers.
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BACKGROUND: Currently, there is limited evidence to support the safety of neuraxial catheters in neonates. Safety concerns have been cited as a major barrier to performing large randomized trials in this population. The main objective of this study is to examine the safety of neuraxial catheters in neonates across multiple institutions. Specifically, we sought to determine the incidence of overall and individual complications encountered when neuraxial catheters were used for postoperative analgesia in neonates. METHODS: This was an observational study that used the Pediatric Regional Anesthesia Network database. Complications and adverse events were defined by the presence of at least 1 of the following intraoperative and/or postoperative factors: catheter malfunction (dislodgment/occlusion), infection, block abandoned (unable to place), block failure (no evidence of block), vascular (blood aspiration/hematoma), local anesthetic systemic toxicity, excessive motor block, paresthesia, persistent neurologic deficit, and other (e.g., intra-abdominal misplacement, tremors). Additional analyses were performed to identify the use of potentially toxic doses of local anesthetics. RESULTS: The study cohort included 307 neonates with a neuraxial catheter. There were 41 adverse events and complications recorded, resulting in an overall incidence of complications of 13.3% (95% confidence interval, 9.8%-17.4%). Among the complications, catheter malfunction, catheter contamination, and vascular puncture were common. None of the complications resulted in long-term complications and/or sequelae, resulting in an estimated incidence of any serious complications of 0.3% (95% confidence interval, 0.08%-1.8%). There were 120 of 307 patients who received intraoperative and/or postoperative infusions consistent with a potentially toxic local anesthetic dose in neonates. The incidence of potentially toxic local anesthetic infusion rates increased over time (P = 0.008). CONCLUSIONS: Neuraxial catheter techniques for intraoperative and postoperative analgesia appear to be safe in neonates. Further studies to confirm our results and to establish the efficacy of these techniques across different surgical procedures are required. We suggest that each center that uses neuraxial anesthesia techniques in neonates closely evaluate the dose limits for local anesthetic agents and develop rigorous quality assurance methods to ensure potentially toxic doses are not used.
