Knowledge, Attitude, and Practices of Labor Analgesia Amongst Obstetric Residents: A Cross-Sectional Survey.

BACKGROUND: Labor analgesia plays a crucial role in ensuring a comfortable and positive birthing experience. It provides physiological benefits to both the mother and the child. Knowledge, awareness, and communication between the anesthesiologist and the obstetrician are essential for the safe conduct of labor analgesia. We conducted this cross-sectional online survey amongst obstetric residents to assess their knowledge, attitude, and practices of labor analgesia. METHODS: A structured questionnaire consisting of 19 questions was circulated amongst obstetric residents of various hospitals via electronic mode of communication. The responses were analyzed using statistical methods. RESULTS: Among the obstetric residents that we surveyed, 75.7% of them only sometimes employed labor analgesia for their patients. The most commonly employed methods of pain relief are opioids and non-steroidal anti-inflammatory drugs (NSAID). Most of them feel that pain-free labor is necessary because it makes the whole labor process a pleasurable one. Labor analgesia was mostly advocated at patients' request and demand. The barrier to using labor analgesia was most commonly found to be the non-availability of labor analgesia services. CONCLUSION: Despite the increasing awareness of labor analgesia there still lies a gap between the attitude toward it and the practice of it. Further education to rectify the misconceptions and barriers needs to be taken for providing beneficial services to pregnant females.

Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report.

Bronchogenic cysts (BCs) are a congenital anomaly, forming fluid-filled sacs in the bronchial tree during fetal development, and are relatively rare in adults. Patients with large BCs in the mediastinum presenting with severe tracheal compression pose a significant challenge to anesthesiologists. The confined and narrow space of the mediastinum exacerbates the compression effect on surrounding structures, leading to potential respiratory or cardiovascular collapse during anesthesia and postoperatively. Herein, we report the stepwise anesthetic management of a patient with a BC in the paratracheal region of superior mediastinum, causing near-complete tracheal compression, scheduled for right posterolateral thoracotomy and tumor excision. The patient presented with dyspnea, chest pain, cough, and severe tracheal compression necessitating meticulous airway management. Utilizing awake fiberoptic intubation with a single-lumen endotracheal tube and one-lung ventilation facilitated by an EZ bronchial blocker, we successfully secured the airway, provided ideal surgical conditions through lung deflation, and ensured perioperative safety. This case underscores the crucial role of comprehending the underlying pathophysiology, anticipating complications, and meticulously planning, preparing, and executing strategies for airway management and perioperative care in patients with mediastinal masses leading to significant tracheal compression.

Ultrasound-Guided Clavipectoral Fascial Plane Block as a Stand-Alone Anesthetic Technique for Clavicle Fracture Management: A Case Report.

The clavipectoral fascial plane block (CFPB) that has been utilized for clavicle fracture surgeries and pain management is an emerging anesthetic technique. It has been previously used for postoperative pain management, but it can also be used as a stand-alone anesthetic technique for clavicle fracture management. Here we describe a case of a 20-year-old male who underwent open reduction and internal fixation (ORIF) with plating for a mid-shaft clavicular fracture under a CFPB as a sole anesthetic.

Navigating the Complexities: Addressing the Challenges of Aneurysmal Atrial Septal Defects.

Aneurysmal atrial septal defects (ASDs) represent a rare subset of congenital cardiac anomalies, characterized by bulging of the interatrial septum. This condition poses unique challenges in diagnosis, management, and outcomes due to its variable clinical presentation and associated complications. While echocardiography remains the cornerstone of diagnosis, advanced imaging modalities such as cardiac magnetic resonance imaging (MRI) and computed tomography (CT) may provide additional insights. Optimal management strategies for aneurysmal ASDs require careful consideration of patient-specific factors, including the size and location of the defect, associated cardiovascular abnormalities, and the presence of pulmonary hypertension. Surgical repair, whether through conventional open-heart techniques or transcatheter interventions, remains the primary treatment modality; however, the approach may vary based on individual patient characteristics. Anesthetic considerations, including hemodynamic monitoring and perioperative care, are crucial in optimizing outcomes and reducing the risk of complications during surgical interventions. Long-term follow-up is essential to monitor potential complications such as residual shunting, arrhythmias, and the development of pulmonary vascular disease. Collaborative efforts among cardiologists, cardiothoracic surgeons, anesthesiologists, and other multidisciplinary specialists are paramount in providing comprehensive care for patients with aneurysmal ASDs.

The Efficacy and Safety of Spinal Anesthesia With Hyperbaric Ropivacaine 0.75% and Bupivacaine 0.5% in Patients Undergoing Infra-Umbilical Surgeries: A Randomized, Double-Blind Study.

BACKGROUND: Spinal anesthesia utilizing hyperbaric 0.75% ropivacaine has been gaining clinical acceptance recently. It is a pure S-enantiomer of bupivacaine, which is expected to have a better clinical profile, but the studies for the same are yet limited. We aimed to compare the efficacy and safety of these two drugs. METHODS: Sixty patients, aged 18 to 60 years of either sex, classified as American Society of Anesthesiologists class I and II, who were undergoing elective infra-umbilical surgery, were randomly assigned to receive either 3 mL of 0.5% bupivacaine heavy or 3 mL of 0.75% ropivacaine heavy intrathecally. Efficacy parameters, including the onset and duration of sensory and motor block, time to rescue analgesia, hemodynamics, and safety in terms of complications, were recorded. We compared the data for statistical significance, considering a p-value of less than 0.05 as significant. RESULTS: Ropivacaine exhibited a slower onset for both sensory (153.90 ± 6.53 versus 92.46 ± 12.16 seconds; p < 0.001) and motor blockades (301 ± 6.62 versus 239.96 ± 6.27 seconds; p < 0.001). Two-segment sensory and motor blockade regression were faster with ropivacaine compared to bupivacaine (p < 0.001). However, the mean duration of sensory blockade for ropivacaine compared to that for bupivacaine (219.29 ± 15.14 versus 227.31 ± 17.20 minutes) and the requirement for rescue analgesia were not statistically different (p > 0.05). Ropivacaine also caused fewer side effects on a percentage scale. CONCLUSION: In patients undergoing infra-umbilical surgery, hyperbaric ropivacaine at an equipotent dose (0.75%) proved to be a comparable and safer alternative to hyperbaric bupivacaine (0.5%). Furthermore, it had better motor-recovery profiles.

Soundless Trouble: Syringe Pump Malfunction and the Hypotension Threat.

Drug infusion devices have become indispensable tools in ICU patient care, drug delivery, and operation rooms (OR) and for controlled fluid delivery. Syringe pump safety is paramount in healthcare and laboratory settings to ensure accurate medication delivery and prevent adverse events. Healthcare professionals must receive thorough training on syringe pump operation, including loading syringes, programming infusion rates, and responding to alarms. Using the correct syringe size and type is essential to prevent inaccuracies in drug/fluid delivery. Regular calibration and maintenance checks are necessary to ensure the accuracy and reliability of the syringe pumps. Two cases of refractory hypotension are reported here, which were resolved by careful inspection of the infusion pumps.

The Uneventful Use of Modern-Day Anesthetic Drugs in Post-polio Paralytic Patients: A Report of Three Cases.

The Western world has been polio-free for decades; however, many are affected by the stigmata of polio in several countries, including India. While general anesthesia (GA) and subarachnoid block (SAB) have been used successfully and widely, all those cases were mostly done with relatively older drugs and without additives. Therefore, further literature is needed to note the effect of newer anesthetic agents on post-polio paralytic patients for both GA, viz., propofol, fentanyl, rocuronium, and desflurane, and SAB with intrathecal hyperbaric bupivacaine and adjuvants. We report three male cases from Central India, in their 40s, with post-polio residual paralysis (PPRP), sarcopenia, and deformity of the lower limb and scoliosis; one case was managed under GA using desflurane-based low-flow anesthesia technique, and the other two under SAB, one with intrathecal fentanyl as an adjuvant to bupivacaine and the other without an adjuvant. The case series describes the effect of these modern-day anesthetic drugs and techniques.