Complications in Neurosurgery: General Ethical Principles for Minimizing Them and Subsequent Legal Action.

Medicine and surgery carry inherent risks of inadvertent and unintended harm to the patient. Training, experience, and skill help ensure smooth recovery in most cases. However, there are circumstances beyond the control of the neurosurgeon that may predispose to complications. This review discusses steps that may help to diminish risks to the patient and can be taken before their admission to hospital, in the operating theater, and after surgery. When a complication does occur despite all care, it is essential to maintain total transparency with the patient and his or her family. It is important that they are active witnesses to the care and treatment being lavished on the individual to minimize the harm from the mishap. Should legal action follow despite such efforts, the neurosurgeon must be prepared to defend with the help of a wise, experienced lawyer and to provide evidence of his or her professional competence and the appropriateness of care offered to the patient. In any case, it is counterproductive to view every patient as a potential legal threat or indulge in defensive medical practice.

Acute Respiratory Distress Syndrome in Pregnancy.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by several clinical features and pathological responses involving the respiratory system primarily. Infections (viral), sepsis, and massive transfusion are the commonest causes of ARDS during pregnancy. The majority of them recover with noninvasive ventilatory (NIV) support. NIV is safe in pregnancy provided the center is experienced and has a protocolized patient care pathway. Parturients requiring invasive mechanical ventilation are best managed in experienced centers. PaO2/FiO2 targets are higher in parturients compared to nonpregnant patients. Permissive hypercapnia is not a safe option in pregnancy. In severe ARDS with refractory hypoxemia, prone ventilation is a safe option. However, it has to be done in experienced centers. Venovenous ECMO is a safe alternative option in pregnant women with refractory hypoxemia, and delivery has been prolonged to a safe viable age on ECMO. The decision to deliver and the mode of delivery have to be a multidisciplinary decision; primary criterion is maternal survival. Postdelivery, establishing maternal bonding while in ventilatory support facilitates early weaning and minimizes lactation failure. How to cite this article: Pandya ST, Krishna SJ. Acute Respiratory Distress Syndrome in Pregnancy. Indian J Crit Care Med 2021; 25(Suppl 3):S241-S247.

Management of pregnant laboring women during COVID-19 pandemic.

Since its first outbreak in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has become a global public health threat. In the midst of this rapidly evolving pandemic condition, the unique needs of pregnant women should be kept in mind while making treatment policies and preparing response plans. Management of COVID-19 parturients requires a multidisciplinary approach consisting of a team of anesthesiologists, obstetricians, neonatologists, nursing staff, critical care experts, infectious disease, and infection control experts. Labor rooms as well as operating rooms should be in a separate wing isolated from the main wing of the hospital. In the operating room, dedicated equipment and drugs for both neuraxial labor analgesia and cesarean delivery, as well as personal protective equipment, should be readily available. The entire staff must be specifically trained in the procedures of donning, doffing, and in the standard latest guidelines for disposal of biomedical waste of such areas. All protocols for the management of both COVID-19 suspects as well as confirmed patients should be in place. Further, simulation-based rehearsal of the procedures commonly carried out in the labor room and the operation theaters should be ensured.

Women in the neurosciences.

The term 'scientist' was coined to describe Mary Somerville (1780-1872) as her contributions to astronomy commanded recognition of her excellence in science. Up to then, the term 'man of science' had been in use. In fields traditionally considered the province of males, the entry of women was viewed with consternation, apprehension and alarm. Resistance was instinctive in most leading scientists. This attitude was strengthened by illogical and pseudoscientific statements on the frailty of women. The pioneers blazing trails in medicine for their sisters to follow braved ridicule, hostility, and discrimination. At times they used subterfuge. The example of Dr. James Barry (Margaret Ann Bulkley) is well-known. Thanks to them, we now have nationally and internationally eminent scientists from the gentler sex, and some of them in commanding positions. The neurosciences developed in India as a result of the efforts made by pioneer neurosurgeons such as Drs. Jacob Chandy (Vellore), B. Ramamurthi (Madras), R.G. Ginde (Bombay), Dr. Prakash N. Tandon (New Delhi) and neurophysicians such as Drs. Baldev Singh (New Delhi), T.K. Ghosh (Calcutta) and Noshir H. Wadia (Mumbai). They and others such as Drs. V.R. Khanolkar, Darab K. Dastur, B.K. Bachhawat and Obaid Siddiqui encouraged individuals like Dr. Vimla Virmani, Dr. Devika Nag, Dr. T.S. Kanaka and Dr. Gourie Devi in the clinical neurosciences and Drs. Kamal Ranadive, V.S. Lalitha, Veronica Rodrigues and Gomathy Gopinath in the basic neurosciences. Two eminent neuroscientists from abroad (Drs. Nancy Kopell and Indira Raman), and three from India (Drs. Vijaylakshmi Ravindranath, Chitra Sarkar and Vidita Vaidya) have been chosen by me as representatives and their careers, contributions and views on discrimination against women in science discussed in brief. (This is not to deny outstanding work by others but limitations of space have made this choice necessary.) The factors favouring the blossoming of women in science include encouraging and stimulating parents, a conducive environment at home and mentors. A compelling drive to excel, hard work and sincerity are crucial to success. Nasty forms of experiences demoralise women. Sexual harassment by seniors and colleagues in the laboratory and elsewhere can lead to the victim leaving the field altogether. Discrimination in selection, promotion and publication lower morale and impact output in terms of research and contributions to journals and books. Suggestions made by the five eminent neuroscientists named above to liberate women from such negative behaviour by males are presented. The Indian Women Scientists' Association is playing an important role in helping their members, making their work known to society and generally empowering them. Since unity strengthens, collaborative activities with other similar organisations will augment efficacy. One such organisation is the much older Association of Medical Women of India.

The Department of Neurosurgery, Grant Medical College and Sir J.J Group of Hospitals, Mumbai.

The Department of Neurosurgery was founded in the Grant Medical College, Mumbai, in the year 1958, and is celebrating its 60th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was one of the first government medical colleges to start a Neurosurgery Department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centers throughout Maharasthra and in several other parts of the country. The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent, and the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence. This article traces the illustrious history of the Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India.

Obstetric ICU: Analysing and Understanding the Data is Important.

How to cite this article: Pandya ST, Mogal S, Kulkarni AP. Obstetric ICU: Analysing and Understanding the Data is Important. Indian J Crit Care Med 2019;23(5):201-202.

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial (K.E.M.) Hospital, Mumbai.

Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial (K.E.M.) Hospital, Mumbai were inaugurated in 1925. This article traces its illustrious history and of the eminent neurosurgeons who shaped its destiny.

ASSIST - Patient satisfaction survey in postoperative pain management from Indian subcontinent.

INTRODUCTION: To compare pain scores at rest and ambulation and to assess patient satisfaction between the different modalities of pain management at different time points after surgery. SETTINGS AND DESIGN: The ASSIST (Patient Satisfaction Survey: Pain Management) was an investigator-initiated, prospective, multicenter survey conducted among 1046 postoperative patients from India. MATERIAL AND METHODS: Pain scores, patient's and caregiver's satisfaction toward postoperative pain treatment, and overall pain management at the hospital were captured at three different time points through a specially designed questionnaire. The survey assessed if the presence of acute pain services (APSs) leads to better pain scores and patient satisfaction scores. STATISTICAL ANALYSIS: One-way ANOVA was used to evaluate the statistical significance between different modalities of pain management, and paired t-test was used to compare pain and patient satisfaction scores between the APS and non-APS groups. RESULTS: The results indicated that about 88.4% of patients reported postoperative pain during the first 24 h after surgery. The mean pain score at rest on a scale of 1-10 was 2.3 ± 1.8 during the first 24 h after surgery and 1.1 ± 1.5 at 72 h; the patient satisfaction was 7.9/10. Significant pain relief from all pain treatment was reported by patients in the non-APS group (81.6%) compared with those in the APS (77.8%) group (P < 0.0016). CONCLUSION: This investigator-initiated survey from the Indian subcontinent demonstrates that current standards of care in postoperative pain management remain suboptimal and that APS service, wherever it exists, is yet to reach its full potential.