Outcomes and evaluation of endoscopic retrograde cholangiopancreatography via Gastro-Laryngeal Tube in adult patients: a prospective randomised control study.

OBJECTIVES: In conventional endoscopic retrograde cholangiopancreatography (ERCP), the patient lies prone or in a semi-prone position under deep sedation and maintains spontaneous ventilation. Sedative-induced respiratory depression and unprotected airway compromise patients' safety. The gastro-laryngeal tube (G-LT) is a novel reusable supraglottic airway device with two separate ports for endoscopy and ventilation. This study attempts to evaluate the performance characteristic of G-LT. METHODS: One hundred and forty patients undergoing ERCP were enrolled and randomized. In Group G, patients underwent ERCP with G-LT, whereas Group S patients underwent ERCP conventionally. G-LT insertion attempts, esophageal visualization times, vital parameters, propofol consumption, endoscopists' and anesthesiologists' satisfaction scores, time to achieve Modified Aldrete Score of ≥ 9, and complications were recorded. RESULTS: Both groups showed similar demographic parameters and 100% procedure completion rates. G-LT group showed shortened esophageal visualization times (4.71 ± 1.687 s vs 7.37 ± 1.515 s) and increased propofol consumption (423.14 ± 106.982 mg vs 178.00 ± 100.125 mg). Group G showed better endoscopic maneuvrability and lesser hemodynamic variability. Sore throat, dysphagia, and mucosal trauma were higher in the G-LT group. CONCLUSION: G-LT provides less intra-procedural hemodynamic changes, quicker esophageal visualization, and better scope maneuvrability at the cost of higher propofol consumption, sore throat, dysphagia, and mucosal trauma. TRIAL REGISTRATION: Clinical Trial Registry of India CTRI/2021/06/034212 (Registered on: 14/06/2021).

Smartphone Use among Anesthesiologists during Work Hours: A Survey-Based Study.

Context: Smartphone use has revolutionized life in all spheres, including the medical field. Smartphones provide immense opportunities but may also lead to negative consequences due to the element of distraction. In the medical profession and more so among anesthesiologists, multitasking has become very common, but the presence of mind is equally important. This study attempts to analyze the smartphone practices and trends among anesthesiologists during work hours in our country. Aims: The study aimed to identify recent trends and practices of smartphone use among anesthesiologists during working hours and its distribution as per designation and institutions. It also intends to determine the purposes of smartphones and their impact on patient care. Settings and Design: Online survey consisting of open-ended multiple-choice questions was conducted and circulated as Google Forms via E-mail and WhatsApp. Subjects and Methods: This survey was conducted to compare the respondents' views as per designation and workplace distribution. In addition, participants were asked about the current practices in smartphone use at their workplace, purposes of use, time spent on smartphones, and any negative medical consequences faced due to the same. Statistical Analysis Used: One-way ANOVA test was used to compare the means between the groups. Chi-square test/Fisher's exact test was used to compare the proportions. Results: Two hundred and sixteen (54%) were resident doctors, whereas 184 (46%) were consultants. Most of the respondents were young, with a mean age around 36 years. 31.5% of the residents used smartphones very often during anesthetized patient care compared to 10.3% of the consultants. Purposes of using smartphones were multiple, with phone calls (100%) being the most common followed by WhatsApp messaging (79.2%). 86.1% of the residents, as compared to 61% of the consultants, had anesthesia/intensive care unit-related apps on their smartphones. There was almost an equivocal response to how the smartphone has impacted patient care. 50.9% of the residents and 43% of the consultants felt improved patient care, whereas 38% of the residents and 43.5% of the consultants believed it had worsened. Conclusion: There was no clear-cut consensus whether smartphone use improved or worsened patient care. On the one hand, there can be distractions leading to adverse medical consequences, while on the other hand, the use of medical apps has been made possible because of the handy and easily accessible smartphones. Thus, the use of smartphones may be carried out with a sense of responsibility by the anesthesiologists during work hours.

A comparison of endotracheal intubation characteristics between Macintosh, CMAC, and Smart Trach Video laryngoscope: a randomized prospective clinical trial.

BACKGROUND: In this study, we compared the performance characteristics of Macintosh laryngoscope, CMAC videolaryngoscope with a recently developed videolaryngoscope called Smart Trach. RESEARCH DESIGN AND METHODS: Three hundred seventy-five patients belonging to mixed population without having anticipated difficult airways undergoing elective surgeries were randomly allocated to be intubated using either of the three laryngoscopes (Macintosh, CMAC, or Smart Trach). Time needed for successful intubation, number of attempts, Cormack Lehane's (CL) grading, optimization maneuverers, intubation difficulty score (IDS), subjective ease of intubation (VAS), subjective lifting force, and complications were recorded. RESULTS: Demographic and anthropometric measurements (sex, height, weight, and body mass index) among the groups were comparable. CL grades, lifting force, IDS, VAS, and intubation times (seconds) were significantly different whereas need for maneuver, attempts, and complications was similar (p > 0.05 each). Intubation times (seconds) were significantly different between Macintosh [36(29-43) seconds], CMAC [30(24-37)], and Smart Trach [35(30-42] groups. (p < 0.001). Subjective ease of intubation based on VAS score was lowest in Smart trach group [1(1-2)] (p < 0.001). CONCLUSION: Shortest intubation times were achieved with CMAC with least use of lifting force. First attempt success rates of were similar. Intubation was easiest subjectively using Smart Trach as manifested by lowest VAS and IDS. TRIAL REGISTRATION: Clinical Trial registry of India (CTRI/2019/09/021279 dated 17/09/2019).

A survey on knowledge, attitude, and practices of workplace radiation safety amongst anaesthesiology personnel in northern Indian tertiary care institutes.

Background and Aims: Exposure to ionising radiation to Anaesthesiology consultants, residents, technicians and nurses (Anaesthesiology personnel) is steadily increasing as a consequence of growing usage of imaging technology for diagnostic and therapeutic purposes. We conducted a questionnaire-based survey of Anaesthesiology professionals (consultants, residents, technicians and nursing staff) working in three major tertiary care medical institutes in northern India regarding the existing knowledge, attitudes and practices of radiation safety at their workplaces. Methods: A printed and validated 30-point questionnaire was distributed. Questions were graded into the domains of demographics (6 questions), knowledge (9 questions), attitude (4 questions) and practice (11 questions). Data obtained from the responses was collated and analysed statistically. Results: Out of the 403 questionnaires distributed, 222 were returned completed (55%). Majority of the respondents were residents (53.60%) and males (57.20%). Many were unaware of the principle of As Low As Reasonably Achievable (ALARA), (70.7%) regarding collimators (65.85%) and their usage (41.9%). Maximum respondents stressed on the necessity of knowing the exposure dosage of radiations (89.2%) and were concerned regarding the same (87.8%). Lead apron was the commonest protection equipment and 97.3% of them were not using dosimeters. Highest levels of knowledge, attitude, and practices were demonstrated by the consultants. In terms of practices, the technicians fared better than the residents. Conclusion: Knowledge, attitude and practices regarding radiation protection issues and doses of radiological procedures is limited. Although all the cadres scored high on their attitude scores, the practice sector requires improvement.

Randomized Trial to Compare Plasma Glucose Trends in Patients Undergoing Surgery for Supratentorial Gliomas under Maintenance of Sevoflurane, Desflurane, and Propofol.

BACKGROUND: Anesthetic agents influence the glycemic response by affecting the neuroendocrine surgical response or directly modifying pancreatic insulin release. Due to chances of neuronal damage, intraoperative hyperglycemia and hypoglycemia both are detrimental for patients undergoing neurosurgeries. Inhalational (sevoflurane and desflurane) and intravenous (propofol) agents have been found to raise intraoperative glucose levels in nonneurological surgeries. AIM: We aimed to compare the intraoperative glucose levels in supratentorial glioma surgeries under the maintenance of three anesthetic agents such as sevoflurane, desflurane, and propofol. MATERIALS AND METHODS: This randomized trial was conducted with 90 nondiabetic adults with supratentorial glioma. Thirty patients were allocated randomly to the three groups receiving sevoflurane, desflurane, and propofol. Baseline and hourly plasma glucose levels were recorded. Postoperatively, the time required to achieve an Aldrete score of 9 and complications were assessed. RESULTS: Baseline plasma glucose levels were 111.23 ± 11.67, 109.47 ± 19.75, and 111.7 ± 13.88 mg/dL (P = 0.84) in sevoflurance, desflurane, and propofol group, respectively. All of them showed an elevation of plasma glucose in relation to the time of surgery with variable trends. In the 4th and 5th h, the elevations in the inhalational groups (sevoflurane and desflurane) were significantly higher than the propofol group (P = 0.003 and 0.002, respectively). The time for achieving Aldrete's score of 9 was higher in the propofol group (P < 0.0001). No differences were observed in the duration of hospital stay or complications. CONCLUSIONS: Maintenance of anesthesia in nondiabetic patients showed clinically modest rise of plasma glucose which is higher in patients under sevoflurane and desflurane than under propofol. However, the immediate recovery was faster with inhalational agents compared to propofol-based anesthesia.

Evaluation of I-Gel™ versus Classic LMA™ for Airway Management by Paramedics and Medical Students: A Manikin Study.

BACKGROUND AND AIM: Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices. MATERIALS AND METHODS: The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device. RESULTS: The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA. CONCLUSION: This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.