Recent advances in research, training and teaching in anaesthesia and critical care.

Teaching and learning in anaesthesia and critical care has traditionally included seminars, journal clubs and clinical teaching in the operation theatre. The aim has always been to ignite the spark of thinking and self-directed learning in the students. The process of 'dissertation preparation' introduces basic knowledge and interest in research in the postgraduate student. All this is followed by an examination at the end of the course including the theory and practical assessment in the form of long and short case discussions and table viva-voce. The National Medical Commission in 2019 introduced the competency-based medical education curriculum for anaesthesia postgraduates. This curriculum focuses on structured teaching and learning. It has specific learning objectives in theoretical knowledge, skills and attitude development. The building up of communication skills has been given due importance. Though research in anaesthesia and critical care is steadily progressing, much work needs to be done on its improvement.

Evaluation of the HemoCue® for blood loss estimation in suction fluid in patients undergoing neurosurgical procedures: A prospective observational study.

Background and Aims: Blood loss in neurosurgical procedures can be rapid and tremendous leading to consequential hemodynamic instability. HemoCue is a portable photometer used for the measurement of blood hemoglobin concentration. Using this point of care device, we contemplated this study to assess the reliability of HemoCue for suction hemoglobin determination and calculation of surgical blood loss by comparing with the gold standard laboratory Coulter Counter method in patients undergoing neurosurgical procedures. Material and Methods: This prospective observational study was conducted in 233 patients undergoing elective neurosurgical procedures in the age group of 18 to 60 years and having preoperative hemoglobin (Hb) values above 9 g/dL. Values of preoperative hemoglobin, suction hemoglobin, and volume in the suction container were used to obtain the estimated blood loss. The normality of the data was tested using the Kolmogorov Smirnov test. Bland Altman analysis was used to test the reliability of HemoCue in estimating hemoglobin and blood loss with reference to the gold standard laboratory Coulter Counter automated hematology analyzer. Results: Median blood loss calculated in our study using HemoCue was 554.65 mL with an interquartile range of 336.81 mL to 982.39 mL. Laboratory counter method estimated median blood loss was 533.37 mL with an interquartile range of 335.21 mL to 994.73 mL. The majority of the data obtained and analyzed using the Bland and Altman analysis method were within a 95% confidence interval. Conclusion: The HemoCue method is a reliable method and henceforth can be used to estimate blood loss in suction fluid in patients undergoing neurosurgical procedures.

Preoperative Amlodipine Is Efficacious in Preventing Intraoperative HDI in Pheochromocytoma: Pilot RCT.

CONTEXT: Preoperative blockade with α-blockers is recommended in patients with pheochromocytoma/paraganglioma (PPGL). The data on calcium channel blockade (CCB) in PPGL are scarce. OBJECTIVE: We aimed to compare the efficacy of CCB and α-blockers on intraoperative hemodynamic instability (HDI) in PPGL. METHODS: In the interim analysis of this monocentric, pilot, open-label, randomized controlled trial, patients with solitary, secretory, and nonmetastatic PPGL were randomized to oral prazosin gastrointestinal therapeutic system (GITS) (maximum 30 mg, n = 9) or amlodipine (maximum 20 mg, n = 11). The primary outcomes were the episodes and duration of hypertension (systolic blood pressure ≥ 160 mmHg) and hypotension (mean arterial pressure < 60 mmHg) and duration of HDI (hypertension and/or hypotension) as a percentage of total surgical time (from induction of anesthesia to skin closure). RESULTS: The median (IQR) episodes (2 [1-3] vs 0 [0-1]; P = 0.002) and duration of hypertension (19 [14-42] vs 0 [0-3] minutes; P = 0.001) and intraoperative HDI duration (22.85 ±â€…18.4% vs 2.44 ±â€…2.4%; CI, 8.68-32.14%; P 0.002) were significantly higher in the prazosin GITS arm than the amlodipine arm, whereas episodes and duration of hypotension did not differ between the 2 groups. There was no perioperative mortality. One patient had intraoperative ST depression on the electrocardiogram. The drug-related adverse effects were pedal edema (1 in amlodipine), dizziness (1 in prazosin GITS), and tachycardia (6 in prazosin GITS and 3 in amlodipine). CONCLUSION: Preoperative blockade with amlodipine is an efficacious alternative to prazosin GITS in preventing intraoperative HDI in PPGL. Larger studies that compare preoperative blockade by amlodipine with other α-blockers like phenoxybenzamine and/or doxazosin in PPGL patients are warranted.

A cohort study of anatomical landmark-guided midline versus pre-procedure ultrasound-guided midline technique of spinal anesthesia in elderly patients undergoing orthopedic surgery.

BACKGROUND AND AIMS: The primary objective of the study was to compare the number of attempts and number of passes of spinal needle insertion and secondary objective was to compare complications, bloody tap, and patient discomfort in anatomical landmark-guided versus pre-procedure USG-guided midline technique of spinal anesthesia in elderly patients posted for orthopedic surgery. MATERIAL AND METHODS: In this a prospective observational cohort study, 60 patients of either sex, ASA grades I-III, and aged more than 65 years were randomly allocated to 2 groups of 30 patients each. In group AG (Anatomical landmark guided), standard landmark technique was used. In group UG (Ultrasound guided), pre-procedure ultrasound guided marking for insertion point of a spinal needle was done before giving spinal anesthesia. Patients in both the groups were compared on the basis of number of attempts, number of passes, vascular injury (bloody tap), pain score, complications, and procedure time. RESULTS: Successful dural puncture on the first needle insertion attempt was achieved more in UG group (90%) than in AG group (50%) (P < 0.05). Dural puncture was not achieved in only 3.3% patients in the UG group even after three midline attempts at spinal needle insertion. Mean of the number of passes was more in AG group (1.90) than in UG group (1.07) (P < 0.05). VAS (Visual Analogue Scale) score was 0.4 in AG group and 0.3 in UG group (P > 0.05). Group UG had shorter procedure time (2.25 min) than AG group (4.35 min). CONCLUSION: Preprocedure ultrasound imaging is a very useful tool to facilitate the performance of central neuraxial blockade in patients with difficult anatomical landmarks, especially in elderly patients.