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Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

Background and Aims: This study assessed the applicability of C-MAC videolaryngoscope (VL) D-blade for awake intubation in patients with laryngeal tumour. The primary study objective was to determine the rate of successful intubation in the first attempt. The other parameters recorded were number of attempts required for intubation, duration of different stages of intubation, haemodynamics, ease of intubation and patient comfort on visual analogue scale (VAS) postoperatively. Methods: Thirty patients were studied. Patients were sedated with dexmedetomidine and fentanyl as a slow bolus (over 20 min) and Ramsay sedation score was assessed. Topicalisation of the oropharynx, tonsillar pillars and base of the tongue was done with lignocaine 10% spray. Four ml of 4% lignocaine using MADgic atomiser was used for anaesthetising the glottis and the tracheal lumen. Results: Successful intubation was achieved in 86.6% patients in first attempt and 13.3% in two attempts. Total time for all intubations was less than 30 seconds. Fremantle score was F-1-C-MAC D-blade (easy intubation with full view) in 60% patients, while 23.3% had F-2-C-MAC D-blade (full view and either required more than one attempt or a modified technique), 13.3% had P-1-C-MAC D-blade (partial view with easy intubation) and 3.3% had P-2-C-MAC D-blade (partial view and required more than one attempt or a modified technique). The VAS score for anaesthesiologist's ease and for patient's experience was 85.83 ± 7.20 and 86.66 ± 14.46, respectively. Conclusion: C-MAC VL D-blade-assisted awake intubation is an effective and safe method to manage the airway of patients with laryngeal tumour once adequate topicalisation is ensured before the procedure.

Background and Aims: The Air-Q blocker (Cook gas LLC, Mercury Medical, Clearwater, FL, USA) is a relatively new supraglottic airway device (SAD) with capability to serve as a conduit for intubation. As there is limited data on Air-Q blocker, the present study was performed to compare the efficacy of Air-Q blocker and Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. Methods: A total of 90 American Society of Anesthesiologists (ASA) physical status I and II patients were randomly allocated to Air-Q blocker or PLMA group. Oropharyngeal leak pressure (OLP), insertion success, insertion time, ease of orogastric tube (OGT) insertion, fibreoptic visualisation of the glottis, haemodynamic and ventilation parameters, and complications at emergence and postoperatively were investigated. Results: OLPs were higher in PLMA group as compared to Air-Q blocker group (P = 0.002). Still, the OLP (27.5 ± 5.8 cm H2O) was clinically effective in Air-Q blocker group.The mean time for successful insertion was significantly shorter for Air-Q blocker than PLMA (P = 0.019). The number of attempts to insert both the devices was comparable (P ≥ 0.05). Air-Q blocker provided a significantly better fibreoptic score than PLMA (P = 0.038). The two groups were comparable in terms of ease of OGT insertion, haemodynamics and ventilation parameters, and complications at emergence and postoperatively. Conclusions: Air-Q blocker provides a clinically effective OLP though PLMA provides a slightly better sealing function in patients undergoing laparoscopic and non-laparoscopic surgeries under general anaesthesia requiring neuromuscular blockade. Air-Q blocker has shorter insertion time and a better fibreoptic view of glottis as compared to PLMA.

Tracheomalacia is characterised by collapse of the tracheal wall with respiration. Computed tomography angiography (CTA) can be utilised for evaluation of airway abnormalities but providing sedation/anaesthesia for CTA in such a case carries the risk of airway catastrophe. We describe the anaesthetic management of an infant who had tracheomalacia with >90% collapse in lower two third of the intrathoracic trachea as diagnosed on videobronchoscpy and was scheduled for CTA.

Long QT syndrome (LQTS) is a myocardial repolarisation disorder caused by cardiac ion channelopathy and one of its common presentations is recurrent syncope. This reduced repolarisation reserve in LQTS can be unmasked by perioperative factors like electrolyte imbalance, drugs, hypothermia and changes in cardiac autonomic tone. We report the anaesthetic management of left thoracoscopic sympathectomy in a 5-year-old child with LQTS and epicardial pacemaker in situ. It is very challenging to isolate the lung on one hand and prevent the predisposition to torsadogenic potential on the other.

Oculocerebrorenal syndrome of Lowe is a rare X-linked metabolic disorder complicated by Fanconi's syndrome. Anaesthetic management of Lowe syndrome with Fanconi's syndrome is challenging to the anaesthesiologists in view of difficult airway due to microcephaly, metabolic abnormalities, and risk of peri-operative seizures. We report a successful anaesthetic management of a case of 2-year-old child scheduled for evaluation under anaesthesia following bilateral lens aspiration surgery.

Background and Aims: Unilateral paravertebral block (PVB) as a sole anaesthetic technique is underutilised even in experienced hands. Hence, this study was undertaken regarding the efficacy and safety of PVB and compared with subarachnoid block (SAB) for inguinal hernia repair procedures. Methods: Sixty-three consenting adult male patients scheduled for unilateral inguinal hernia repair were randomly assigned to receive either PVB or SAB (Group P: PVBs at T10–L2 levels, 5 mL of 0.5% bupivacaine at each segment; Group S: SAB at L3–L4 level with 12.5 mg 0.5% of hyperbaric bupivacaine). Primary objective was to compare duration of post-operative analgesia and time to reach discharge criteria (modified Aldrete scores and modified post-anaesthetic discharge scoring [PADS] scores). Secondary objectives were to compare the block characteristics (time required for performing the block, time to surgical anaesthesia, time to ambulation, time to the first analgesic, total rescue analgesic consumption) and adverse effects. Independent Student's t-test was used for continuous data and Pearson Chi-square test for categorical data. P

Background: Organ retrieval from brain dead patients is getting an increased attention as the waiting list for organ recipients far exceeds the organ donor pool. In our country, despite a large population the number of brain dead donors undergoing organ donation is very less (2% in our study). Aims: The present study was undertaken to address issues related to organ donation and share our experience for the same. Methods: A retrospective case record analysis of over 5 years from September 2007 to August 2012 was performed and the patients fulfilling brain death criterion as per Transplantation of Human Organs and Tissue (Amendment) Act were included. Patient demographics (age, sex), mode of injury, time from injury to the diagnosis of brain death, time from diagnosis of brain death to organ retrieval and complications were analysed. Statistics Analysis: Student′s t test was used for parametric data and Chi square was used for categorical data. Results: Out of 205 patients who were identified as brain dead, only 10 patients became potential organ donors. Conclusion: Aggressive donor management, increasing public awareness about the concept of organ donation, good communication between clinician and the family members and a well-trained team of transplant coordinators can help in improving the number of organ donations.

Background and Aim: Exchanging endotracheal tube (ETT) with classic laryngeal mask airway TM (CLMA TM ) prior to emergence from anaesthesia is a safe technique to prevent the coughing and haemodynamic changes during extubation. We had compared CLMA TM and AMBU laryngeal mask TM (ALM TM ) during ETT/laryngeal mask (LM) for haemodynamic changes and other parameters. Methods: A total of 100 American Society of Anesthesiologist Grade I and II adult female patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were selected and randomly divided into two groups of 50 patients each. In Group I, CLMA TM and in Group II, ALM TM was placed prior to tracheal extubation. Haemodynamic parameters were recorded during ETT/LM exchange. Glottic view was seen through the LM using flexible fibrescope. Coughing/bucking during removal of LM, ease of placement and post-operative sore throat for both groups were graded and recorded. Statistical Analysis: Data within the groups was analysed using paired t-test while between the groups was analysed using unpaired t-test. Chi-square test was used to analyse grades of glottic view, coughing, and post-operative sore throat. Results: In Group I, there was a significant rise in systolic blood pressure and heart rate in contrast to insignificant rise in Group II. Glottis view was significantly better in Group II. Incidence of coughing, ease of placement and post-operative sore throat was identical between both groups. Conclusion: ALM TM is superior to CLMA TM for exchange of ETT before extubation due to greater haemodynamic stability during exchange phase and is better positioned.

Scoliosis may be of varied aetiology and may be associated with severe congenital anomalies. It often poses a challenge in its anaesthetic management. We present anaesthetic management of a child who underwent scoliosis reconstruction with a rare triad of cerebral palsy, glucose-6-phosphate dehydrogenase deficiency and severe mitral regurgitation. Anaesthetic management in these patients should focus primarily on associated co-morbidities and congenital anomalies affecting the course of the perioperative management and thereafter comprehensive pre-operative strategies must be executed to enhance the safety profile during the surgery.

Byline: Aparna. Pande, Thilaka. Muthiah, Rashmi. Ramachandran, Balachandran. Sundaraperumal, Manpreet. Kaur, Dalim. Baidya Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by [...]

Byline: Selwin. Selvam, Swati. Jindal, Lakesh. Anand, Manpreet. Dawar, Arjun. Dass Background and Aims: This study assessed the applicability of C-MAC videolaryngoscope (VL) D-blade for awake intubation in patients with [...]

Byline: Swati. Jindal, Ankita. Mittal, Lakesh. Anand, Manpreet. Singh, Dheeraj. Kapoor Background and Aims: The Air-Q blocker (Cook gas LLC, Mercury Medical, Clearwater, FL, USA) is a relatively new supraglottic [...]

Byline: Ranju. Singh, Manpreet. Kaur Sir, Our patient was a 35-year, 35-kg woman, with history of neck swelling, weight loss, oligomenorrhoea, palpitations, difficulty in breathing on lying supine and difficulty [...]

Byline: Anjum. Goth, Manpreet. Kaur, Debashis. Das, Thilaka. Muthiah Sir, Zenker's diverticulum (ZD) is a rare acquired disorder (incidence 1 in 800) presenting in the 6th to 9th decades of [...]

Byline: Manpreet. Kaur, Nirupa. Ramakumar, Sangam. Yadav, Rajeshwari. Subramaniam Long QT syndrome (LQTS) is a myocardial repolarisation disorder caused by cardiac ion channelopathy and one of its common presentations is [...]

Byline: Manpreet. Kaur, Sana. Hussain Tracheomalacia is characterised by collapse of the tracheal wall with respiration. Computed tomography angiography (CTA) can be utilised for evaluation of airway abnormalities but providing [...]

Byline: Sana. Hussain, Manpreet. KaurSir,Escobar syndrome or multiple pterygium syndrome is a rare autosomal recessive disorder characterised by multiple pterygia in the cervical, antecubital and popliteal region, craniofacial dysmorphism, growth [...]

Byline: Gunjan. Singh, Manpreet. Kaur, Maya. Dehran Sir, Ventricular premature complexes (VPCs) are the premature discharge of ventricular ectopic focus. We report the anaesthetic management of a patient with VPCs [...]

Byline: Sunil. Sinha, Yudhyavir. Brahmchari, Manpreet. Kaur, Aruna. Jain Background and Aims: Unilateral paravertebral block (PVB) as a sole anaesthetic technique is underutilised even in experienced hands. Hence, this study [...]

Byline: Smaranika. Choudhury, Manpreet. Kaur, Maitree. Pandey, Aruna. Jain Sir, Sacrococcygeal teratomas (SCT), are the most common perinatal germ cell tumours which originate from primordial pluripotent cells. [sup][1],[2] The majority [...]

Byline: Dheeraj. Kapoor, Nitika. Goel, Manpreet. Singh, Jasveer. Singh Sir, Diesel oil aspiration is an uncommon mode of hydrocarbon aspiration and can lead to severe chemical pneumonitis either due to [...]

Byline: Jasveer. Singh, Dheeraj. Kapoor, Meghana. Srivastava, Manpreet. Singh Scoliosis may be of varied aetiology and may be associated with severe congenital anomalies. It often poses a challenge in its [...]

Byline: Shruti. Jain, Rashid. Khan, Syed. Ahmed, Manpreet. Singh Background and Aim: Exchanging endotracheal tube (ETT) with classic laryngeal mask airway [sup]TM (CLMA [sup]TM ) prior to emergence from anaesthesia [...]

Byline: Chhavi. Sawhney, Manpreet. Kaur, Sanjeev. Lalwani, Babita. Gupta, Ira. Balakrishnan, Aarti. Vij Background: Organ retrieval from brain dead patients is getting an increased attention as the waiting list for [...]

Byline: Manpreet. Kaur, Chandni. Sinha, P. Singh, Babita. Gupta Sir, Trauma patients with multisystem injuries and a high injury severity score (ISS) have an increased risk of thromboembolic events. Safe [...]

Byline: Ira. Balakrishnan, Manpreet. Kaur, Chhavi. Sawhney, Nita. D'Souza Sir, Catheter malposition is a known complication of central venous catheterisation, with incidence of less than 1% to above 60%. [sup][1] [...]

Byline: Kapil. Soni, Chhavi. Sawhney, Manpreet. Kaur, Sarita. Ramchandani, Maneesh. Singhal Sir, Radial artery thrombosis is a rare but serious limb-threatening complication of arterial cannulation. We report a case of [...]

Byline: Manpreet. Kaur, Babita. Gupta, Chandni. Sinha, Chandan. Dey Sir, Blunt cardiac injuries are often underestimated and missed in view of varied presentation from mild chest discomfort to severe haemodynamic [...]