Frequency of Positive Cuff Leak Test Before Extubation in Robotic Surgeries Done in Steep Trendelenburg Position.

Anaesthesia for robotic surgeries done in steep trendelenburg position are associated with risks such as facial oedema, conjunctival chemosis, raised intraocular pressure, laryngeal oedema, and delayed awakening. We proposed the use of the cuff leak test in them to record the frequency of laryngeal oedema at the end of surgery and attempted to find its correlation with probable risk factors. We conducted a prospective observational study of 100 patients aiming primarily to assess the frequency of positive cuff leak test in robotic abdominal surgeries performed in trendelenburg position. The secondary outcomes were to check its correlation with intravenous fluid administration, duration of pneumoperitoneum, and angle of trendelenburg position. We also recorded the frequency of chemosis, the frequency of post-extubation stridor in 24 h post-operatively, and the frequency of reintubation. Out of 100 participants undergoing elective abdominal robotic surgery in trendelenburg position, ninety were analysed. Total 31.6% (n = 30) participants showed positive cuff leak test. Chemosis was observed in 31 (32.6%) participants. No patient experienced post-extubation stridor or required reintubation during post-operative follow up. There was a no correlation between cuff leak test and intravenous fluid, duration of pneumo-peritoneum, or with angle of trendelenburg. The frequency of positive cuff leak test was high in patients at the end of robotic surgery but none of these patients had post-extubation stridor or required reintubations. There was no correlation with the fluid, angle, or duration of surgery. Clinical Trials Registry of India (CTRI/2017/04/008289), ctri.nic.in.

Study of risk factors and psychological impact in physicians diagnosed with COVID-19: An online, postexposure, cross-sectional survey.

BACKGROUND AND AIMS: Healthcare workers (HCW's) who have contracted the disease while working in the hospital may have a deep psychological impact in the form of depression and anxiety, along with the stress of passing the infection to their family members. This study attempts to highlight the risk factors and psychological impact on doctors who have tested positive for coronavirus disease-2019 (COVID-19). MATERIAL AND METHODS: This online cross-sectional survey-based study enrolled all level doctors of all specialities of in Mumbai, India, who had tested positive for novel coronavirus. The survey questionnaire was a 26-item self-administered anonymous set of questions in English language only. This validated questionnaire was distributed by a link via Google forms for 1 week. RESULTS: We received 51 completed responses. Most of them were (67%) postgraduate students. Forty-three (85%) respondents were working in a COVID-19 center. Twenty-three (45%) had a history of contact with these patients without proper personal protective equipment (PPE) with unknown COVID-19 status of the patient at the time of contact. Ten percent regretted their decision of becoming a doctor. Only half (51%) had family support during their illness and 45% relied on friends and colleagues in the hospital. Twenty-six percent mentioned having a low mood throughout the illness. A major portion of people (32%) having fear of severe illness and death. CONCLUSION: Medical doctors working in direct contact with confirmed cases of COVID-19 are at increased risk of contracting the infection and it has a major impact on physical and mental health of medical doctors.

Ultrasound-guided subarachnoid block in a case of osteogenesis imperfecta in an adolescent girl presenting with femur fracture - A case report.

Osteogenesis imperfecta (OI) is a rare congenital bone disorder with underlying Type 1 collagen defect, in which patients are prone to fractures. The disease is associated with increased spinal curvature, short stature, loose joints, and poor muscle tone, all contributing to difficulty in identifying landmarks and hindering successful subarachnoid block. We report an interesting case of a successful ultrasonogram (USG)-guided subarachnoid block given in an adolescent girl with OI for fixation of femur fracture. This report underlines the importance USG in managing difficult neuraxial blocks.

Perioperative management of cytoreductive surgery and hyperthermic intraoperative thoraco-abdominal chemotherapy (HITAC) for pseudomyxoma peritonei.

Peritoneal carcinomatosis is intraperitoneal spread of gastrointestinal and gynaecological cancers. Cytoreductive surgeries and hyperthermic intraperitoneal chemotherapy offers survival benefits in these cases. Spread of peritoneal carcinomatosis to thorax pose challenges to surgeon and anaesthesiologist. Haemodynamic, temperature and coagulopathy monitoring as well as intraoperative airway pressure, pre- and postoperative pulmonary function test monitoring is required in these cases where diaphragm excision is done and intraoperative intra peritoneal as well as pleural chemotherapy is given. We are reporting a case of pseudomyxoma peritonei involving the abdomen and left side of pleura and lung, posted for cytoreductive surgery and hyperthemic chemotherapy to abdomen and thorax, i.e., hyperthemic intraoperative thoraco-abdominal chemotherapy.