Correlation of trainees' selection scores with their subsequent performance during specialty training in anesthesiology

Objective: To determine the correlation of trainee selection scores [TSS] with subsequent performance in anesthesiology trainees at a university hospital

Study Design: Descriptive analytical study

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from August 2016 to January 2017

Methodology: Data were collected on 44 anesthesiology trainees completing their training between 2009 and 2015. TSS consisted of entrance test, final-year medical school scores, and interviews. Assessment included written tests, viva voce, and clinical assessment. Non-parametric Spearman rank correlation coefficient was computed to assess the relationship between scores

Results: Weak correlation was found between TSS and overall assessment scores for first three years of training. Correlation of TSS with clinical component of assessment was weak throughout training, while it was moderately significant with cognitive component of assessment in third and fourth years of training. Correlation between interview scores and cognitive as well as clinical assessment was non-significant. TSS showed weak correlation with success in exit level examination

Conclusion: Correlation between overall TSS and assessment scores was weak for first three years of training, and becoming moderately positive in later years of training. Cognitive component of TSS had moderately positive correlation with cognitive assessment, but not with clinical performance. Anesthesiology training programmes need to strengthen their selection criteria; and development of structured interviews might prove useful. Future research should focus upon identifying most useful traits in selecting high performers in anesthesiology training

Radiographic appearance in hands and feet of rheumatoid arthritis patients at a tertiary care hospital in Pakistan

Objective: The aim of the study was to see the radiographic appearance [erosions and joint space narrowing [JSN]] in hand and foot joints of patients of rheumatoid arthritis [RA]coming to a tertiary care hospital in Islamabad, Pakistan

Study Design: Cross-sectional descriptive study

Place and Duration of Study: The study was conducted in Department of Rheumatology at Pakistan Institute of Medical Sciences from June, 2013 till December, 2013

Subjects and Methods: Both male and female patients of RA coming to Rheumatology outpatient department were recruited in the study after taking their consent. X-rays of both hands and feet were performed in each of these patients. These X-rays were scored using simple erosion narrowing score

Results: There were total 153 patients in the study, 121 [79.10%] females and 32 [20.90%] males. The mean duration of RA was 6.36 +/- 5.47 years. Joint erosions were found in 142 [92.81%] patients. All of these 142 [100%] patients had hand joint erosions. Only 63 [44.36%] patients had foot joint erosions as well. Radiographic changes [combined erosions and JSN] were found in 3712 [39.13%] hand joints and 335 [9.12%] foot joints

Conclusion: Both erosions and JSN were seen predominantly in hand joints of our RA patients, with the foot joints showing much less radiographic changes. Therefore, doing X-Rays of only hands may be sufficient in RA patients for diagnostic and prognostic purposes

Assessment of procedural skills in anesthesiology trainees: changing trends

In this brief article, the author highlights the important issue of assessment of procedural skills in anesthesiology trainees and stresses on the need to adopt the currently recommended assessment method of direct observation of procedural skills [DOPS] into the local training programmes, to enhance patient safety by ensuring adequate attainment of skills

Frequency of fetal anomalies in polyhydramniotic patients through antenatal ultrasound in radiology department of PIMS

To evaluate frequency of fetal anomalies in polyhydramniotic patients through antenatal ultrasound in Radiology Department of Pakistan Institute of Medical Sciences [PIMS]. Cross Sectional Observational study. This study was conducted at the Mother and Child Health [MCII] Centre, Pakistan Institute of Medical Sciences [PIMS], Islamabad from January to December, 2003. All women coming for antenatal ultrasound scan during the period January December 2003 were included in this study. The ultrasound scans were done by the Radiology resident and confirmed by a single consultant radiologist. The data obtained was entered on a proforma. A total of 42[0.79%, n5260] women were found to have polyhydramnios, out of which 11[26%] had associated fetal anomalies. Among all [11] anomalies detected, there were 5 cases [45.45%] of anencephaly, 3 cases [27.27%] ofhydrocephalus, one of which had associated nieningocele, and 01[9%] case each ofomphalocele, spinal anomaly and skeletal dysplasia. 3 [27.27%] women had concurrent disease. Expart antenatal ultrasound is recommended to assess the presence of polyhydramnios and any associated fetal anomalies. Amniocentesis, glucose tolerance test or HbA1c levels are advisable when the suspicion of associated fetal anomalies is high

Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy undergoing modified radical mastectomy

Hypertrophic obstructive cardiomyopathy [HOCM] is a rare genetic disorder characterized by left ventricular outflow tract [LVOT] obstruction. Clinical presentation ranges from absence of symptoms to sudden death. Our 60 year old patient scheduled for left modified radical mastectomy had HOCM since seventeen years with severe LVOT obstruction and mitral regurgitation. An implantable cardioverter defibrillator [ICD] and permanent pacemaker [PPM] was inserted 15 months earlier for ventricular tachycardia. Anesthetic management of these patients presents considerable challenges and requires maintenance of desired hemodynamic parameters and management of specific complications. Factors like tachycardia, hypovolemia, vasodilation and increased cardiac contractility leads to exacerbation of the obstruction. In our patient there was the additional consideration of the ICD which required to be turned off during surgery with full provision for external defibrillation. We managed to successfully maintain the desired hemodynamics throughout the surgery and the patient was discharged home on the seventh postoperative day

Postoperative sore throat after elective surgical procedures

Postoperative sore throat is a common complication of anaesthesia and can lead to dissatisfaction after surgery. Many factors can contribute to postoperative sore throat and the incidence varies with the method of airway management In this prospective observational study elective gynaecological and general surgical patients were interviewed 24 hours postoperatively to determine the presence of sore throat. Information collected included demographic data, surgical procedure, duration of surgery, airway device used and position of patient during surgery. This study was done over a period of 3 months. 3 12 patients were interviewed. 81[26%] patients suffered with sore throat postoperatively. 28% of patients with endotracheal intubation [ETT] and 3.5% of patients with laryngeal mask airway had a sore throat. Female patients reported more sore throat than male patients [27.1% vs. 19.1%]. Sore throat was found to be more common with older age group, grade of difficulty in intubation, duration of surgery and patient's position during surgery. Awareness of the factors responsible for increased incidence of postoperative sore throat and appropriate care especially during endotracheal intubation can help to reduce the incidence of postoperative sore throat. Keywords: Anaesthetic complications; Postoperative; Sore throat

Anaesthesia for interventional neuroradiology

There have been rapid and significant advances in diagnostic and interventional radiology, including interventional neuroradiology, in recent years. Many intracranial vascular pathologies are being successfully managed by endovascular interventional neuroradiology techniques. These techniques include procedures like embolization of vascular tumours and arterio-venous malformations, coiling of cerebral aneurysms, etc. The support of anaesthesia team is requested for these therapeutic endovascular neuroradiological procedures. The main aims of the anaesthesiologist during any interventional neuroradiology procedure are provision of a physiologically stable and immobile patient, alteration of arterial blood pressure as necessary, and appropriate and timely management of complications. Provision of anaesthesia in remote locations, such as the radiology suite, has its own inherent risks. In this article the anaesthetic considerations for therapeutic interventional neuroradiology procedures performed in the radiology suite have been reviewed, including the preprocedure preparation, monitoring requirements, suitable anaesthetic techniques, postprocedure management and complications

Laparoscopic surgery in children - anaesthetic considerations

Laparoscopic surgery has several advantages over conventional surgery for the patient. An increasing number of diagnostic and surgical procedures are being done laparoscopic not only in adults but also in paediatrics patients. In addition to the routine anaesthetic considerations for any surgical patient, the choice of the anaesthetic technique in patients undergoing laparoscopic procedures should consider the patient's underlying cardio respiratory functions induced by the pneumoperitoneum and carbon dioxide [CO2] insufflations. This article describes the physiological alterations induced by laparoscopic procedures in children and the anaesthetic implications of laparoscopic in the paediatric patient population

Unanticipated hospital admission after andbulatory surgery

The unplanned admission rate is considered to be an important measure of the quality of ambulatory surgical units. The objective of our study was to evaluate the unanticipated hospital admission rate from the Surgical Day Care [SDC] unit of our university affiliated teaching hospital and to analyze the reasons for admission. A review of all unanticipated admissions over a one-year period was done. The admission rate was calculated and the reasons for admission were analysed. The overall admission rate was 4.93%. Most of the admissions were ordered by the surgeons [97%]. The main reasons for admission were patient observation indicated for various reasons [72%] and patient request [18%]. Eighty percent of the admitted patients had received general anaesthesia. Admissions were also related to the male gender [69%], age over 65 years [27%] and surgeries ending in the afternoon [69%]. On analyzing the reasons for admission, a large number of admissions were found to be due to preventable causes. We conclude that proper selection of patients, careful scheduling of lists and education of patients and clinical professionals can help to avoid many unanticipated admissions after day care surgical procedures

Perioperative anaesthetic management of a patient with relapsed aplastic anaemia

Aplastic anaemia occurs due to failure of blood cell production by bone marrow. All blood cell counts are low. Untreated patients may die within one year mainly due to uncontrolled infection due to neutropenia. Anaemia and thrombocytopenia cause troublesome symptoms and necessitate frequent red cell and platelets transfusions. Surgery poses a very high risk for these patients because of the several complications that can occur in the perioperative period. In this paper we report on a patient with relapsed aplastic anaemia who was optimized preoperatively and underwent a total abdominal hysterectomy under general anaesthesia