Resilience of healthcare professionals involved in anesthesia practice: A cross-sectional questionnaire based pilot study.

Background and Aims: Resilience of healthcare professionals involved in Anesthesia practice is relatively a new area of research. Improvement of resilience is important for the sustainability of the healthcare workforce. The aim of this study was to evaluate resilience of the health care providers towards intra-operative emergency situation and intensive care unit. Material and Methods: In this cross-sectional pilot study, healthcare providers working involved in anesthesia practice responded to a questionnaire consisting of 20 questions related to their regular work profile. Answers were graded as- "Yes", "Not often" and "No". Scores of "Three", "Two" and "One" were assigned to these responses and total score was calculated. Frequency and percentage of each response were compared based on place of work and roles. Scores were compared based on the designation. Results: Out of 103 healthcare workers 56 (54.4%) were from government or charity hospital. Thirty-one (30.1%) were Junior Residents. Comparison of responses based on the role/designation, significant differences were observed for questions- I reach to operation theatre well before the proposed time for the case (0.02994), I personally check operation theatre preparation (p = 0.01966), I check for the consent form every time (p = 0.02018), I can recognize different electrocardiogram (ECG) patterns (p = 0.00231) and I always try to learn from everything (p = 0.01989). Based on the place of work of study participants, there was a significant difference (p = 0.002095) for question, i.e., "I personally check operation theatre preparation." Conclusion: The study results suggested good resilience of healthcare professionals involved in anesthesia and intensive care. Some pointers towards burnout are seen among study population. Early interventions may be useful to improve resilience and reduce risk of burnout.

Awareness of safety protocols for prevention of needle stick injuries in anaesthesiologists from Maharashtra: A survey study.

BACKGROUND AND AIM: Needle stick injury (NSI) has a serious risk of transmission of various blood borne pathogens amongst healthcare personnel and more so in anaesthesiologists. This survey assessed the prevalence of NSI and awareness of safety protocols for its prevention amongst the anaesthesiologists from Maharashtra, India. METHODS: This self-administered survey was completed by 403 anaesthesiologists across Maharashtra from August 2019 to October 2019. The pre-validated and pretested 18-item questionnaire was administered using Google forms and the link was circulated amongst anaesthesiologists electronically. The questionnaire items included information on the awareness of safety protocols and immediate measure after NSI, knowledge of immunisation and safety practices followed in routine practice. Data were collected, tabulated and coded in Microsoft Excel. Descriptives are presented for the different items and prevalence of NSI. Comparison of prevalence of NSI in subgroups based on gender, period of experience and type of practice were analysed using Chi-square test. RESULTS: The prevalence of NSI was 73.7% (n = 403) in anaesthesiologists with 71.1% (n = 235) in males and 77.4% (n = 168) in females. The anaesthesiologists from the medical schools had a prevalence of 75.0% (n = 148), those in private practice had a prevalence of 72.7% (n = 216), whereas those working in both medical school and private practice had a prevalence of 74.4% (n = 39). A greater prevalence was observed in those working for longer periods. CONCLUSION: The prevalence of NSI's is alarmingly high amongst anaesthesiologists and there is an immediate need of creating awareness and practice safety protocols in routine practice. Training and education are required in the formative years of healthcare curriculum.

Comparative Efficacy and Safety of Intravenous Clonidine and Tramadol for Control of Postspinal Anesthesia Shivering.

BACKGROUND: Shivering is a common problem in patients undergoing surgery under spinal anesthesia. AIMS: The aim of this study was to compare efficacy and safety of clonidine versus tramadol in postspinal anesthesia shivering. SETTINGS AND DESIGN: This prospective, randomized, double-blind controlled clinical trial was conducted in a tertiary care setting. MATERIALS AND METHODS: A total of 60 American Society of Anesthesiologists physical status Class l and II adult patients (age 18-65 years) undergoing surgery under spinal anesthesia and developed shivering received either clonidine 1 µg/kg or tramadol 1 mg/kg intravenously. The time required for cessation of shivering, control and recurrence rate of shivering, effect on hemodynamics and side effects were compared between two groups. STATISTICAL ANALYSIS: Unpaired t-test and Chi-square test were used for comparison of continuous variables and dichotomous data between two groups, respectively. P < 0.05 was considered as statistically significant. RESULTS: Time for cessation of shivering was less in clonidine group than tramadol group (02.51 vs. 04.82 min; P < 0.001). Complete control of shivering was achieved in 80% of patients in clonidine group versus 70% in tramadol group. There was no significant difference for control (P = 0.5) and rate of recurrence of shivering between clonidine and tramadol group (06.7% vs. 16.7%; P = 0.42). Pulse rate and systolic blood pressure were significantly lower in clonidine group at 5 and 15 min as compared with tramadol. Significantly more number of patients experienced nausea and dizziness (36.7% vs. 0%; P < 0.001 and 20% vs. 0%; P = 0.01) with tramadol while bradycardia and hypotension were numerically more common in patients receiving clonidine (6.7% vs. 0% and 13.3% vs. 0%). CONCLUSION: Clonidine provides early relief from shivering than tramadol with fewer side effects in patients undergoing surgery under spinal anesthesia.

Anesthesia Management in an Adult Patient with Sleep-Disordered Breathing and Difficult Intubation: A Case Report.

Obstructive sleep apnea may be associated with numerous comorbidities and perioperative complications. Poor laryngeal anatomy visualization can be a cause of failed tracheal intubation after multiple attempts in patients with sleep-disordered breathing due to the underlying adenoid enlargement. We present a case of difficult endotracheal intubation in a 52-year-old menopausal female patient posted for tonsillectomy with adenoid resection with a history of snoring and difficulty in breathing while asleep. A thorough preoperative assessment focusing on history and investigating obstructive sleep apnea, and preparing and planning for difficult tracheal intubation in such patients can lead to successful endotracheal intubation inside the operation theater.

Comparative Study of the Effect of Dexmedetomidine Vs. Fentanyl on Haemodynamic Response in Patients Undergoing Elective Laparoscopic Surgery.

INTRODUCTION: Dexmedetomidine and fentanyl, both have sedative and analgesic effects. They are often used as adjunct during anaesthesia to attenuate pressor response during tracheal intubation. Limited study has been done comparing the effect of both drugs on haemodynamic response in patients undergoing laparoscopic surgery. AIM: The study was designed to compare the effect of dexmedetomidine Vs fentanyl on haemodynamic response to tracheal intubation, following pneumoperitoneum and intraoperative period in patients undergoing laparoscopic surgery. MATERIALS AND METHODS: Sixty patients of age group 18-60 years of either sex, classified as American Society of Anaesthesiologist (ASA) Grade I and II undergoing elective laparoscopy surgery were randomly allocated to one of the two groups (Group-D) and (Group F) of 30 each. Group D received dexmedetomidine and Group F received fentanyl. Patients received intravenous 0.5 µg/kg of the study drug as loading dose over 10 minutes prior to intubation followed by 0.2-0.7 µg/kg/hr as infusion till surgery was over. In operating room parameters like Heart Rate (HR), Respiratory Rate (RR), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP), SpO2, EtCO2 were recorded 10 minutes after infusion of drug i.e., dexmedetomidine or fentanyl. The said parameters were again recorded after injection of induction drugs, after intubation, five minutes after intubation, just after pneumoperitoneum, and 5,10,15,30,45 and 60 minutes after pneumoperitoneum, five minutes after release of pneumoperitoneum, five and 10 minutes after extubation. RESULTS: Dexmedetomidine significantly attenuates stress response at intubation with lesser increase in HR (5% Vs 18%), SBP (9% Vs 19%) and DBP (3% Vs 15%), MAP (2% Vs 15%) as compared to fentanyl (p<0.05). Throughout intraoperative period of pneumoperitoneum Group D showed significant fall in HR, SBP, DBP, MAP from baseline value at all points of time intervals whereas it remained constantly high above baseline value in Group F (p-value <0.05). CONCLUSION: Dexmedetomidine when compared to fentanyl causes greater attenuation of stress response to tracheal intubation, following pneumoperitoneum and in intraoperative period resulting in greater reduction of HR, SBP, DBP, MAP than that of fentanyl, thus causing better haemodynamic stability in patients undergoing elective laparoscopic surgery.

ProSeal Laryngeal Mask Airway versus Cuffed Endotracheal Tube for Laparoscopic Surgical Procedures under General Anesthesia: A Random Comparative Study.

CONTEXT: The Proseal LMA(PLMA), which has been designed especially for positive pressure ventilation and protection against aspiration can act as an alternative to Endotracheal Tube (ETT) as an effective airway device for patients undergoing elective Laparoscopic surgeries. AIMS: To compare the efficacy and safety of PLMA with ETT in patients undergoing Laparoscopic surgeries under general anaesthesia. SETTINGS AND DESIGN: A prospective, randomized study was conducted in a tertiary care teaching hospital with 60 patients of ASA grade I/II undergoing elective Laparoscopic surgery under general anaesthesia. Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the PLMA group (Group S) and to the ETT group (Group C) Heart rate (HR), mean blood pressure (MAP), ETCO2 values, intraoperative complications such as regurgitation- aspiration, and Postoperative complications such as nausea or vomiting, throat soreness and oral injuries were monitored. RESULTS: There was no difference demographically. Insertion success rate was 100% for both the groups. The mean increase in HR was seen all throughout the duration of the surgery to 8 % above the baseline in Group C and to 3% above the baseline in Group S. On comparing the MAP in Group C, there was a increased by 2.5% to 78.300 ± 14.2615 mmHg as compared to an increase by 5% to 76.233 ± 6.2072 mmHg in Group S. EtCO2 showed a rise in both groups after pneumoperitoneum, which returned to baseline values after completion of surgery. Gastric aspirate values showed no difference in each group. Post op complications were seen mainly in Group C with statistical significance. CONCLUSIONS: A properly positioned PLMA is a suitable and safe alternative to ETT for airway management in adequately fasted, adult patients undergoing elective Laparoscopic surgeries.

Effect of buprenorphine as an adjunct with plain local anesthetic solution in supraclavicular brachial plexus block on quality and duration of postoperative analgesia.

BACKGROUND AND AIMS: Supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine, an agonist antagonist opioid has been used as an adjunct to prolong analgesia. We aimed to evaluate the quality and duration of postoperative analgesia by addition of buprenorphine to local anesthetic solution. MATERIAL AND METHODS: A prospective, randomized, double-blind control study was conducted on 50 healthy patients of ASA Grade I/II of age group 20-70 years scheduled for orthopedic and reconstructive surgery of upper limb under supraclavicular brachial plexus block. Patients were allocated into two groups, 25 in each group viz.: Group B (buprenorphine group) received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000) + 4 ml normal saline + 1500 units hyaluronidase + 3 µg/kg buprenorphine diluted to 1 ml normal saline. Group C (control group) received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000) + 4 ml normal saline + 1500 units hyaluronidase + 1 ml normal saline. The parameters observed were onset and duration of sensory and motor block, quality and duration of analgesia and side-effects. RESULTS: The mean duration of postoperative analgesia was significantly longer in Group B (16.04 ± 3.19 h) than in Group C (6.20 ± 0.74 h). There was no difference between two groups on mean onset of sensory block. The mean duration motor block was significantly longer in Group B (4.93 ± 0.94 h) than in Group C (2.25 ± 0.62 h) [P < 0.05]. The mean duration of sensory block was also significantly longer in Group B (5.71 ± 0.94 h) than in Group C (4.94 ± 0.70 h) with P < 0.05. CONCLUSION: Addition of 3 µg/kg buprenorphine to 0.5% bupivacaine for supraclavicular brachial plexus block prolonged duration of postoperative analgesia and sensory blockade without an increase in side effects.

Caesarean section in a case of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of child bearing age and may co-exist with pregnancy. Disease exacerbation, increased foetal loss, neonatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an antinuclear antibody (ANA) positive parturient with bad obstetric history who underwent elective caesarean section under spinal anaesthesia.