Rural perspective about anesthesia and anesthesiologist: A cross-sectional study.

BACKGROUND: More than 3/4(th) of Indian population resides in rural areas. The public awareness towards "Anesthesia and Anesthesiologist" is limited even in urban population. There is no data available from rural India on this perspective. Our cross-sectional analysis highlights this lack of public awareness and discusses possible remedies to overcome these limitations. MATERIALS AND METHODS: Surgical outpatient department of Comprehensive Rural Health Center (CRHC) Ballabgarh, Haryana (model CRHC for Indian health schemes) was screened for 6 months period. A questionnaire divided into 3 parts (Awareness about Anesthesiologist, Consent, Present surgical experience) was filled out for each patient. The patients on the basis of their answers were classified as "aware or unaware", also source of patient information was analyzed. RESULTS: Even with an extremely low threshold, only 36.44% of population could be classified as aware, and commonest source of their information was not anesthesiologist but surgeon (64.32%). 83.6% patients were not aware of contents of pre-operative consent they had signed and further, only 3.4% were aware of anesthesia-related issues. Pain was reported as the most common pre-operative fear and post-operative patient concern. 47.17% patients due to lack of pre-operative counseling were not able to recognize the type of anesthesia and thought they had received both general anesthesia and spinal anesthesia. At the end, after explaining the role of anesthesia for surgery, 99.06% patients presented desire to meet the anesthesiologist beforehand if they were to be operated in future. CONCLUSION: The rural awareness about anesthesia is extremely low likely because of low literacy rates and lack of pre-operative counseling by anesthesiologist. Both patient and anesthesiologist must understand the importance of consent, as it is not only a legal binding but can eliminate pre-operative factitious fears of patients and can improve patient satisfaction towards surgery.

Recurrent intraoperative silent ST depression responding to phenylephrine.

Intraoperative myocardial ischemia is attributed to decreased myocardial oxygen supply. We present an unusual case of recurrent, symptomless inferior wall ischemia in an apparently healthy male with no history of coronary artery disease after a spinal block. The recurring episodes were linked to tachycardia and presented with significant ST depression in Lead II with reciprocal elevation in lead aVL. The episodes responded to phenylephrine and subsided without residual sequelae.

The critically ill obstetric patient - Recent concepts.

Obstetric patients admitted to an Intensive Care Unit (ICU) present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.