National board governed post-graduate curriculum: Strengths and scope.

The National Board of Examinations was established to boost the quality of medical education by laying down exclusive norms, uniform standards and a national level evaluation for the postgraduate medical courses. The content and context of the training curriculum is well updated as per advances in the field and current requirements. Diplomate of National Board (DNB) courses are considered to be at par with the postgraduate and post doctorate degrees for all intents and purposes. The introduction of a formative assessment with objective evaluation pattern has improved the scope of the board. Moving on to a competency-based training with emphasis on novel research can maximise the quality of training to international standards. Training DNB teachers and assessors in the newer teaching and assessment methods can improve the calibre of residents. Stringent monitoring and review of the training can increase the credibility of the courses and the board can be expected to cater for students abroad.

Bilateral cochlear implantation under local anaesthesia in a young adult - A case report.

OBJECTIVE: Cochlear implantation is routinely performed under general anaesthesia in most centres in the world. There have been reports of this surgery being performed under local anaesthesia and sedation for unilateral cochlear implantation. Our case study reports the first bilateral cochlear implantation carried out under local anaesthesia with sedation. This paper outlines the protocol used and discusses the challenges and advantages of the procedure being performed under local anaesthesia. CASE STUDY: A 28-year-old female with a history of multidrug-resistant tuberculosis presented with bilateral severe to profound sensorineural hearing loss. On evaluation, she was found to be a suitable candidate for cochlear implantation. However, she was clinically unfit to undergo the surgery under general anaesthesia. After counselling the patient, the decision to undertake the procedure under local anaesthesia was made. The procedure took 105 min and was uneventful. The patient was discharged the next day Conclusion: In the hands of an experienced surgeon and anaesthesiology team, bilateral cochlear implantation is possible under local anaesthesia. Patient motivation and cooperation are extremely important for the procedure to be done under local anaesthesia. This is an option for patients needing cochlear implantation who are medically unfit for general anaesthesia.

Effect of total intravenous anaesthesia on intraoperative monitoring of cochlear implant function in paediatric patients.

UNLABELLED: There is increasing evidence in medical literature which proves that post-operative outcomes in children implanted early are better. Initial setting of these children's stimulation parameters is challenging because of their limited communication abilities. Intraoperative electrical impedance measurements, electrically evoked stapedial reflex threshold (ESRT) and evoked compound action potential (ECAP) are used for implant settings in some centres as no cooperation is required from the child. Aim Evaluate the effects of intravenous anaesthesia on intraoperative monitoring of cochlear implant function in paediatric cochlear implantees at our centre. Method Prospective study from January 2011 to December 2011. COHORT: 29 children. Age - 18 months to 11 yrs. All children had bilateral severe to profound sensorineural hearing loss. Children with compromised neural/cochlear anatomy were excluded. Patients were maintained on an infusion of Fentanyl @ 0.3-0.6 ugm/kg/hr and Propofol @ 4-8 mg/kg/hr intraoperatively. Intraoperative measurements were done after performing the train of four test on the adductor pollicis muscle Results It was observed that ESRT was unaffected by intravenous anaesthesia. Electrical impedance and ECAP were not affected by any technique of anaesthesia. Conclusion Intravenous anaesthesia has little or no effect on the intraoperative auditory thresholds and is therefore recommended for determining these thresholds during cochlear implant surgery.