Recent advances in cardiac anaesthesia.

The speciality of cardiac anaesthesia has rapidly evolved over the past few decades with advances in technology, including artificial intelligence (AI), newer devices, techniques, imaging, pain relief and a better understanding of the pathophysiology of disease states. Incorporation of the same has led to improved patient outcomes in terms of morbidity and mortality benefits. With the advent of minimally invasive surgical methods, minimising the dose of opioids and ultrasound-guided regional anaesthesia for pain relief, enhanced recovery after cardiac surgery has been made possible. Perioperative imaging including 3D transoesophageal echocardiography, newer devices and drugs and AI algorithms will play a significant role in cardiac anaesthesia. This review briefly addresses some of the recent advances that the authors believe can impact the practice of cardiac anaesthesia.

The clinical learning environment in anaesthesiology in Kerala---Is it good enough?---A web-based survey.

BACKGROUND AND AIMS: Evaluation of postgraduate (PG) training is important so that necessary modifications can be made. The quality of anaesthesiology teaching in our country has not been explored. We performed a survey among the anaesthesiology PGs of Kerala to assess their perceptions about their learning environment as well as to look for the deficits in the training program. METHODS: An online web-based survey was conducted. The questionnaire was developed after a detailed validation process and circulated via Google forms. The questionnaire had three parts. First part asked for demographic details. Second part had 22 statements in four domains to evaluate the quality of training, which were to be answered based on a five-point Likert scale. The third part asked for the suggestions of the trainees on changes to be made for the improvement in quality of their training. RESULTS: The response rate was 64%. The social atmosphere was perceived positively in general by our PGs. Majority of them received feedback on their work and had a regular class schedule. Only 34% of the residents got training in non-technical skills. More tutorials and case discussions were the most common change suggested by the residents. Lack of research training and training in simulation labs were the major lacunae identified. CONCLUSION: The clinical learning environment (CLE) was perceived to be of medium to high quality by the anaesthesiology PGs of Kerala. Lack of routine assessments and regular academic sessions were reflected in the responses.

A novel technique for intra-aortic balloon positioning in the intensive care unit.

Proper positioning of the intra-aortic balloon catheter is very important as an improperly placed balloon can cause problems. A balloon placed too high can block off the arch vessels, whereas one placed too low can block the renal and splanchnic vessels. We propose a simple and reliable technique to properly position the intra-aortic balloon pump (IABP) catheter without the use of any sophisticated or expensive equipment in the intensive care unit if the catheter has migrated from the previously placed desired position. In this technique, we rely on the left radial arterial trace obliteration as the IABP catheter is pushed in along a guidewire as a marker for tip positioning.