Comparison of three scoring criteria to assess recovery from general anesthesia in the postanesthesia care unit in the indian population.

Background: Different discharge criteria are available for shifting patients out from postanesthesia care room following surgery. This study was done to compare the three-scoring system namely traditional time-based criteria, Fast track criteria and modified Aldrete score, in Indian population patients who recover after general anesthesia in postanesthesia care unit (PACU). Materials and Methods: Three hundred and seventy-five patients scheduled for general anesthesia were included in this study. Induction of anesthesia was done with intravenous (IV) propofol and maintained with sevoflurane inhalation with oxygen and nitrous oxide. Reversal of residual neuromuscular blockade was done with IV neostigmine and glycopyrrolate. Patients were shifted to PACU following tracheal extubation and recovery was assessed using the traditional time-based criteria, fast track criteria, and modified Aldrete score. Results: As per modified Aldrete score, mean time of shift out is 19 min with median of 15 min and standard deviation of 21.7 min. As per fast-track score, mean time of shift out is 187 min with median of 30 min and standard deviation of 243.7 min. As per the time-based criteria, mean time of shift out is 222 min with median of 240 min and standard deviation of 136.8 min. While using modified Aldrete score, majority of patients had a shorter stay in PACU and faster time to shift out as compared to fast-track criteria and traditional time-based criteria. Conclusion: Modified Aldrete score when compared to fast-track scoring and time-based criteria shows early recovery and reduces the length of stay in PACU.

Résumé Contexte: Différents critères de sortie sont disponibles pour faire sortir les patients de la salle de soins post-anesthésie après une intervention chirurgicale. Cette étude a été réalisée pour comparer le système de notation à trois, à savoir les critères traditionnels basés sur le temps, les critères accélérés et le score Aldrete modifié, en Inde. Population de patients qui se rétablissent après une anesthésie générale en unité de soins post-anesthésiques (USPA). Matériels et méthodes: Trois cent et soixante-quinze patients devant subir une anesthésie générale ont été inclus dans cette étude. L'induction de l'anesthésie a été réalisée par voie intraveineuse (IV) propofol et maintenu avec inhalation de sévoflurane avec de l'oxygène et du protoxyde d'azote. L'inversion du bloc neuromusculaire résiduel a été réalisée avec néostigmine IV et glycopyrrolate. Les patients ont été transférés vers une USPA après l'extubation trachéale et la récupération a été évaluée à l'aide du critères traditionnels basés sur le temps, critères accélérés et score d'Aldrete modifié. Résultats: Selon le score d'Aldrete modifié, temps moyen de sortie est de 19 min avec une médiane de 15 min et un écart type de 21,7 min. Selon le score accéléré, le temps moyen de sortie est de 187 minutes avec une médiane de 30 min et écart type de 243,7 min. Selon les critères temporels, le temps moyen de changement de poste est de 222 minutes avec une médiane de 240 minutes et écart type de 136,8 min. En utilisant le score d'Aldrete modifié, la majorité des patients ont eu un séjour plus court en USPA et un temps de changement plus rapide. Par rapport aux critères accélérés et aux critères traditionnels basés sur le temps. Conclusion: Score d'Aldrete modifié par rapport au traitement accéléré la notation et les critères basés sur le temps montrent une récupération précoce et réduisent la durée du séjour en USPA. Mots-clés: Critères accélérés, score d'Aldrete modifié, unité de soins post-anesthésie, critères de sortie post-anesthésie, sortie basée sur le temps.

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.

Hypertensive disorders in pregnancy.

Hypertensive disorders of pregnancy (HDP) remain among the most significant and intriguing unsolved problems in obstetrics. In India, the prevalence of HDP was 7.8% with pre-eclampsia in 5.4% of the study population. The anaesthetic problems in HDP may be due to the effects on the cardiovascular, respiratory, neurologic, renal, haematologic, hepatic and uteroplacental systems. The basic management objectives should be facilitating the birth of an infant who subsequently thrives and completes restoration of health to the mother, or the termination of pregnancy with the least possible trauma to mother and foetus in severe pre-eclampsia. This comprises obstetric management, adequate foetal surveillance, antihypertensive management, anticonvulsant therapy, safe analgesia for labour and management of anaesthesia for delivery.

Ludwig's angina and airway considerations: a case report.

INTRODUCTION: Patients with deep neck infections present challenging airways for an anesthesiologist. Patients with Ludwig's angina may die as a result of the inability to effectively manage the airway. CASE PRESENTATION: Here we discuss the anesthetic management with fiberoptic intubation of a 45-year-old man with Ludwig's angina scheduled for emergency drainage. CONCLUSION: Awake fiberoptic intubation under topical anesthesia may be the ideal method to secure the airway in advanced cases of Ludwig's angina. When fiberoptic bronchoscopy is not feasible, not available or has failed, an awake tracheostomy may be the preferred option.