Opioid-Based vs Opioid-Free Anesthesia in Breast Cancer Surgery.

Introduction: Breast cancer is the most widely recognized malignant growth in ladies in India and accounts for 14% of all tumors in women. Modified radical mastectomy (MRM) is a surgery done for breast cancer. It leads to about 30% chances of postoperative nausea and vomiting (PONV) and 40% pain in the immediate postoperative period. Objectives: Changes in blood pressure after intubation, waiting time for postoperative pain medication, and possibility of adverse effects. Methodology: After the approval of ethical committee, the study was conducted in the procedure and possible complications associated with the procedure were explained to patients. Written informed consent was obtained from each patient. Result and Conclusion: We conclude that opioid-free anesthesia is "more effective in reducing the incidence of postoperative nausea and vomiting, produces stable hemodynamics, and reduces incidence of side effects when compared with opioid-based general anesthesia in patients undergoing breast cancer surgeries."

An integrated mediapipe-optimized GRU model for Indian sign language recognition.

Sign language recognition is challenged by problems, such as accurate tracking of hand gestures, occlusion of hands, and high computational cost. Recently, it has benefited from advancements in deep learning techniques. However, these larger complex approaches cannot manage long-term sequential data and they are characterized by poor information processing and learning efficiency in capturing useful information. To overcome these challenges, we propose an integrated MediaPipe-optimized gated recurrent unit (MOPGRU) model for Indian sign language recognition. Specifically, we improved the update gate of the standard GRU cell by multiplying it by the reset gate to discard the redundant information from the past in one screening. By obtaining feedback from the resultant of the reset gate, additional attention is shown to the present input. Additionally, we replace the hyperbolic tangent activation in standard GRUs with exponential linear unit activation and SoftMax with Softsign activation in the output layer of the GRU cell. Thus, our proposed MOPGRU model achieved better prediction accuracy, high learning efficiency, information processing capability, and faster convergence than other sequential models.

An automatic estimation of the ridge parameter for extreme learning machine.

Extreme learning machine (ELM) is an emerging learning method with a single-hidden layer feed-forward neural network that involves obtaining a solution to the system of linear equations. Unlike traditional gradient-based back-propagating neural networks, ELM is computationally efficient with fast training speed and good generalization capability. However, most of the time when applied to real-time problems, the linear system becomes ill-posed in the structure and needs the inclusion of a ridge parameter to obtain a reliable solution, and hence, the selection of the ridge parameter (C) is a crucial task. The ridge parameter is chosen heuristically from a predefined set. The generalized cross-validation is a widely used technique for the automatic estimation of the same, which is computationally expensive as it involves inversion of large matrices. The focus of the proposed work is on pragmatic aspects of the time-efficient automatic estimation of ridge parameter that result in a better generalization performance. In this work, methods are proposed that use the L-curve and U-curve techniques to automatically estimate the ridge parameter, and these methods are effective in the estimation of the ridge parameter even for systems with larger data. Through extensive numerical results, it is shown that the proposed methods outperform the existing ones in terms of accuracy, precision, sensitivity, specificity, F1-score, and computational time on various benchmark binary as well as multiclass classification data sets. Finally, the proposed methods are statistically analyzed using the nonparametric Friedman ranking test, which is also proving the effectiveness of the proposed method as it is providing a better rank for the same over existing methods.

A Prospective Study on Operation Theater Utilization Time and Most Common Causes of Delays and Cancellations of Scheduled Surgeries in a 1000-Bedded Tertiary Care Rural Hospital with a View to Optimize the Utilization of Operation Theater.

BACKGROUND: The operation theater (OT) complex is a costly component of a hospital budget expenditure. This area of hospital activity requires maximum utilization to ensure optimum cost benefit. To achieve a high level of utilization in the OT, it is necessary to efficiently coordinate number of activities and personnel. METHODS: This study was conducted in a 1000-bedded tertiary care teaching hospital in rural maharashtra over aperiod of two months. The OT complex consists of eight major OTs. Normal working hours for routine scheduled cases on all working days except Sundays and public holidays. RESULTS: Total study period consisted of 96 working days. There were a total of eight OT tables of various specialties, and parameters were observed during the routine hours excluding Sundays and holidays. The total procedure time was maximum for ENT followed by orthopedics and least for obstetrics. Room turnover time was maximum for obstetrics followed by general and oncosurgery. Case delays were maximum in general surgery and least for ophthalmology. The most common reason for delay in starting the operation table was patient getting shifted late from the ward and administrative causes. The most prominent reasons for cancellation were lack of operating room time followed by medical reasons of the patient. CONCLUSION: We concluded that most of the causes of delays and cancellations of surgeries were avoidable with proper preoperative planning and optimization of patients and resources and good communication between surgeon anesthesiologists and the nursing staff.

An Audit of Comparison of Perioperative Outcomes with the Introduction of Standardized Preoperative Evaluation form at a Tertiary Care Hospital in Rural India.

INTRODUCTION: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures. AIM: The aim of the study was to conduct an audit to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized pre-operative evaluation form. STUDY DESIGN: This was a retrospective study, using a sample of 3000 files of patients who underwent elective surgery in a tertiary care hospital of rural India. We devised 11 quality indicators, looking at factors in the pre-operative, peri-operative and post-operative period, and used them to audit 3000 patient records in our Hospital. RESULTS: We found several areas where quality could be significantly improved;last minute postponement/change of plan of planned surgeries has reduced from 134 (8.9%) to 23 (1.53%) cases after implementation of standardised PEF. 784 (52.26%) patients were not formally handed over to the theatre recovery staff before implementation of standardised PEF compared to 147(9.8%) after implementation of standardised PEF. CONCLUSION: This audit found several areas of practice that fall below expected standards before the introduction of standardised PEF, but after the introduction of standardised PEF there is a significant improvement in quality of pre anaesthetic evaluation and overall outcome of the patient. We therefore advocate the use of such standardised PEFs for performing preoperative and perioperative assessment of surgical patients.

Effectiveness of a 5-year school-based intervention programme to reduce adiposity and improve fitness and lifestyle in Indian children; the SYM-KEM study.

DESIGN: Non-randomised non-blinded school-based intervention study. SETTING: Two schools in the cities of Pune and Nasik, India. PARTICIPANTS: The intervention group comprised children attending a Pune school from 7-10 years until 12-15 years of age. Two control groups comprised children of the same age attending a similar school in Nasik, and children in the Pune intervention school but aged 12-15 years at the start of the study. INTERVENTION: A 5-year multi-intervention programme, covering three domains: physical activity, diet and general health, and including increased extracurricular and intracurricular physical activity sessions; daily yoga-based breathing exercises; making physical activity a 'scoring' subject; nutrition education; healthier school meals; removal of fast-food hawkers from the school environs; and health and nutrition education for teachers, pupils and families. MAIN OUTCOME MEASURES: Body mass index (BMI), waist circumference, physical fitness according to simple tests of strength, flexibility and endurance; diet; and lifestyle indicators (time watching TV, studying and actively playing). RESULTS: After 5 years the intervention children were fitter than controls in running, long jump, sit-up and push-up tests (p<0.05 for all). They reported spending less time sedentary (watching TV and studying), more time actively playing and eating fruit more often (p<0.05). The intervention did not reduce BMI or the prevalence of overweight/obesity, but waist circumference was lower than in the Pune controls (p=0.004). CONCLUSIONS: It was possible to achieve multiple health-promoting changes in an academically competitive Indian school. These changes resulted in improved physical fitness, but had no impact on the children's BMI or on the prevalence of overweight/obesity.

Dexmedetomidine with low-dose ketamine for cataract surgery under peribulbar block in a patient with Huntington's chorea.

Huntington's chorea (HC) is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia, and psychiatric disturbances. There are only a few case reports regarding the anesthetic management of a patient with HC and the best anesthetic technique is yet to be established for those patients which are at higher risk of perioperative complications. We report the anesthetic management of a 64-year-old patient with HC admitted for cataract surgery.

Vapourisers: physical principles and classification.

Vapourisers have evolved from rudimentary inhalers to the microprocessor controlled, temperature compensated and flow sensing devices, which are universal today. The improvements in the design was influenced by the development of potent inhalational anaesthetics, unique properties of some agents, a deeper understanding of their mechanism of action, inherent flaws in the older vapourisers, mechanical problems due to thymol deposition, factors influencing their output such as temperature and pressure variations. It is important to review the principles governing the design of the vapouriser to gain insight into their working. It is fascinating to know how some of the older vapourisers, popularly used in the past, functioned. The descendant of Oxford Miniature Vapourizer, the Triservice vapouriser is still a part of the military anaesthesia draw over equipment meant for field use whereas the Copper Kettle the first precision device is the fore-runner of the Tec 6 and Aladdin cassette vapouriser. Anaesthesia trainees if exposed to draw over techniques get a deeper understanding of equipment and improved skills for disaster situations. In the recent advanced versions of the vapouriser a central processing unit in the anaesthetic machine controls the operation by continuously monitoring and adjusting fresh gas flow through the vapouriser to maintain desired concentration of the vapour.