Euthanasia - Review and update through the lens of a psychiatrist.

Euthanasia is not infrequent in the modern practice of medicine. Active euthanasia is legal in seven countries worldwide and passive euthanasia has recently been legalized in India by the Supreme Court. In India, physicians and nurses generally have a favorable attitude towards euthanasia but lack in adequate training to deal with such requests. The role of a psychiatrist is very important in evaluation of request for euthanasia on medical as well as psychiatric grounds. Among patients with end-stage medical illnesses who make a request for euthanasia or physician-assisted suicide, many may have underlying untreated depression. In the complex backdrop of long-term chronic medical illnesses, depression can be very difficult to diagnose and treat. Patients with dementia and other neuropsychiatric illnesses have the issue of consent and capacity. Legalizing euthanasia in these patients can heave dire moral implications. There is clear need of adequate training, formulation of guidelines, and supportive pathway for clarity of clinicians regarding euthanasia in India.

Clinical Comparison of I-gel and Laryngeal Mask Airway-Supreme Airway Devices During General Anaesthesia in the Paediatric Population.

OBJECTIVES: Both the Supreme Laryngeal Mask Airway (SLMA) and the I-gel (I-gel) are supraglottic airway devices (SADs) commonly used for airway management in paediatric patients. This study aims to compare the efficacy in terms of insertion and ventilation profiles of size 2 SLMA and the I-gel in anaesthetised paediatric patients. METHODS: 100 children were prospectively allocated to two groups depending upon the device inserted as SLMA (n = 50) and I-gel (n = 50). The primary outcomes were studied in terms of ease of insertion, haemodynamic changes, ventilation parameters, leak pressure and incidences of complications during general anaesthesia. RESULTS: There were no failed attempts in the insertion of the airways in either group. The SLMA was more easily inserted in the majority of cases compared to the I-gel group. The number of attempts for insertion and the time taken for insertion were comparable in the I-gel and the SLMA group (13.8462.38 vs. 14.0261.7) (P .57, .66). Securing an effective airway took <30 seconds in both the groups with an overall median duration of 15 seconds. There was no difficulty in passing the gastric tube in either group (P<.30). There was a statistical difference between the oropharyngeal seal pressure (OSP), which was 25.1861.59 and 22.1061.36 cmH2O for SLMA and I-gel, respectively (P<.001). Haemodynamic parameters after the insertion of the device were comparable, and there were no clinically important complications in the post-operative period. CONCLUSIONS: Both the devices appeared to be simple and suitable for airway management during elective surgery in paediatric patients. However, the SLMA was easily inserted with less insertion time in the majority of patients. Also, it provides higher OSP during anaesthesia and is better tolerated during emergence, with minimal risk of injury to the oropharynx.