Dexamethasone in anesthesia practice: A narrative review.

Dexamethasone is routinely used in anesthesia practice and has been regarded as one of the ideal perioperative agents. It is a synthetic glucocorticoid with potent antiinflammatory action. It reduces postoperative nausea and vomiting, pain, postoperative opioid requirements after general anaesthesia as well as spinal anaesthesia. It has been used via intravenous, epidural and perineural routes. It has been used successfully in fascial blocks. It significantly decreases fatigue, shivering and postoperative sore throat and improves quality of recovery.

Recent advancements in total intravenous anaesthesia and anaesthetic pharmacology.

Target-controlled infusion pumps and depth of anaesthesia monitors have made total intravenous anaesthesia (TIVA) easy, safe, and precise. The merits of TIVA were highlighted during the coronavirus disease 2019 (COVID-19) pandemic, confirming its potential further in the post-COVID clinical practice as well. Ciprofol and remimazolam are newer drugs that are being tried with a hope to upgrade the practice of TIVA. While research on safe and effective drugs continues, TIVA is being practised with a combination of drugs and adjuncts to overcome the disadvantages of each and to provide complete and balanced anaesthesia with additional benefits in recovery and pain relief postoperatively. Modulation of TIVA for the special population groups is still under process. Advancement in digital technology with mobile apps has increased the scope of TIVA in day-to-day use. The formulation and update of guidelines can establish a safe and efficient practice of TIVA.

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.

A novel approach in understanding the basic modes of ventilation in a recent generation mechanical ventilator- A review of the underlying principles.

Understanding the basic concepts and the dynamics of the equation of motion will help the anaesthesiologist and the intensive care physician in gaining an insight into the basics of modern mechanical ventilation. An equation of the type Vt = V0 × (1-e-kt) is often encountered while studying the concepts of mechanical ventilation. This leaves one wondering about the meaning of 'e'. It is explained as the base of a natural logarithm, and the base e as an irrational constant approximately equal to 2. 7182. In medical literature, various physiological mechanisms are explained by using the exponential function e. However, the explanations do not sufficiently help the learner to demystify the enigmatic term e. In this article, an effort is made to explain this function with the help of simple analogies and relevant mathematical concepts. The process of volume build-up in the lungs during mechanical ventilation is used as a model for the explanations.

Dissertation writing in post graduate medical education.

A dissertation is a practical exercise that educates students about basics of research methodology, promotes scientific writing and encourages critical thinking. The National Medical Commission (India) regulations make assessment of a dissertation by a minimum of three examiners mandatory. The candidate can appear for the final examination only after acceptance of the dissertation. An important role in a dissertation is that of the guide who has to guide his protégés through the process. This manuscript aims to assist students and guides on the basics of conduct of a dissertation and writing the dissertation. For students who will ultimately become researchers, a dissertation serves as an early exercise. Even for people who may never do research after their degree, a dissertation will help them discern the merits of new treatment options available in literature for the benefit of their patients.

Breaking barriers to remain healthy and fit during a residency in anaesthesiology.

Anaesthesiology is a high-demand speciality of medicine in terms of long and unpredictable work hours, stressful work requirements, pressure for a cent per cent productivity in academics, clinical work and research. Higher stress levels can cause non-communicable diseases like hypertension, obesity and depressed immunity, among many others. In the journey as a trainee anaesthetist, vigorous and diligent efforts are needed to gain perfection in knowledge and skills ultimately. While this path is being transversed, it is essential to address physical and mental fitness by exercising it to the recommended benefits, to ward away stress and burnout. In this special article, the authors will discuss the barriers young anaesthesia trainees face to staying healthy and fit during their training and practical and appropriate measures to mitigate the same through intervention at various levels of hierarchy.

Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient. METHODS: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I2 statistics. Funnel plots were used for the assessment of publication bias. RESULTS: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5-5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03-0.84) and 0.1 (0-0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies. CONCLUSION: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.