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Diabetic patients may have neuropathy-induced gastroparesis predisposing them to aspiration. Point-of-care gastric ultrasonography (GUSG) is useful in the qualitative assessment of the antrum and quantitative prediction of gastric volume (GV) in diabetic patients. In this study, we compared the GUSG findings between fasting diabetic and non-diabetic patients in the elective preoperative setting. A total of 220 patients were included in the study with 110 diabetic patients in the diabetes mellitus (DM) group and 110 non-diabetic patients in the non-diabetes mellitus (NDM) group. GUSG was performed in supine and right lateral decubitus (RLD) positions and qualitative grading was done. An empty antrum in both supine and RLD positions was graded 0. Fluid present in the RLD position but empty in the supine position was graded 1. The presence of solids or fluid in both supine and RLD positions was graded 2. Quantitative assessment was done by calculating the estimated GV using the measured cross-sectional area (CSA). The presence of grade 2 antrum or solids or GV >0.8 mL/kg was considered as criteria for a 'high-risk' antrum. Grade 2 antrum was found in 18% of patients in the diabetic group compared to 3% in the non-diabetic group. Mean CSA (5.65 cm ) and mean GV (34.52 mL) were significantly higher in diabetic patients. Forty-one (37.2%) patients among the diabetic patients had a high-risk antrum and a potentially higher risk of aspiration when compared to non-diabetic patients. Higher age and female gender were found to be associated with the incidence of 'high-risk' antrum in the univariate logistic regression model. Diabetic patients have a higher incidence of grade 2 antrum, and higher CSA and GV, when compared to non-diabetic patients. Risk factors such as female gender and increasing age are associated with the high-risk antrum incidence. Further studies where objective tests are done to identify the presence of diabetic autonomic neuropathy might help determine the relationship between GUSG and aspiration risk.

ABSTRACT Background and Aims: Ultrasound-guided central venous (CV) cannulation is the standard of care for inserting CV catheter in the right internal jugular vein (RIJV). However, mechanical complications can still occur. The primary objective of this study was to compare the incidence of posterior vessel wall puncture (PVWP) using conventional needle holding technique with pen holding method of needle holding technique for IJV cannulation. Secondary objectives were comparison of other mechanical complications, access time and ease of the procedure. Methods: This prospective, randomised parallel-group study included 90 patients. Patients requiring ultrasound-guided RIJV cannulation under general anaesthesia were randomised into two groups P (n = 45) and C (n = 45). In group C, the RIJV was cannulated using the conventional needle holding technique. In group P, the pen holding method of needle holding technique was used. Incidence of PVWP, complications (arterial puncture, haematoma) number of attempts for successful cannulation, time to insertion of guidewire and performer's ease were compared. The data were analysed using Statistical Package for the Social Sciences (SPSS version 24.0). A P value less than 0.05 was considered statistically significant. Results: In our study, there was no significant difference in incidence of PVWP and complications between the two groups. Number of attempts and time for successful guidewire insertion were comparable. Ease of the procedure was scored a median of 10 in both the groups. Conclusion: There was no significant difference in the incidence of PVWP between the two techniques in this study, necessitating further evaluation of this novel technique.

Background and Aims: There are no surveys documenting the existing regional anaesthesia (RA) practices in our country. This nationwide survey aims to record the existing RA practices, identify any lacunae that might exist and project the future direction of evolution. Methods: This online survey consisting of 31 questions was sent to all members of the Indian Society of Anaesthesiologists and addressed participants' demographic features, central neuraxial block and peripheral nerve block practices, drug selection, RA training and safety measures. The data were analysed using Statistical Package for the Social Sciences version 24.0. All categorical variables were expressed as frequencies and percentages. Results: A total of 2141 responses were received, with participants distributed across the country. Forty-two per cent of the respondents reported that more than 60% of surgeries were performed under RA. Most of the participants use 'traditional' test dose for epidural space confirmation. Fifty participants (2.4%) use ultrasound for neuraxial space identification. Twenty per cent of the participants use a checklist for monitoring post-operative epidural analgesia. 6.7% have undergone specialised training in RA. Around 3.5% of the respondents have performed a wrong-side block. 31.4% of the respondents store intralipid in the operating room. Conclusion: The current survey highlights the prevailing practices, various deficiencies in monitoring and the need for RA training programmes. The data accrued can serve as a baseline for future comparison.

Background and Aims: Erector spinae plane block (ESPB) has been found effective in providing postoperative analgesia following a myriad of surgeries. This study was designed to evaluate the effectiveness of ultrasonography (USG) guided erector spinae plane block to provide postoperative analgesia following percutaneous nephrolithotomy (PCNL). Methods: This was a prospective, double-blinded, randomised parallel-group study conducted in patients undergoing PCNL. Patients in Group C (n = 33) received subcutaneous infiltration of 20 mL of 0.25% bupivacaine at the incision site and Group B (n = 33) received USG guided ESPB with 20 mL of 0.25% bupivacaine postoperatively. Numeric rating scale (NRS) scores were assessed at intervals of 30 min, 60 min, then hourly for six h, followed by four-hourly up to 24 h. The primary objective of the study was to compare postoperative pain relief using the NRS score between the two groups. Secondary objectives were to compare the analgesic requirement and to assess the incidence of complications. Normally distributed data were expressed as mean and standard deviation and analysed using Student's t-test. Data following non-normal distribution were expressed as median and interquartile range and analysed using Mann- Whitney U-test. For categorical data, the Chi-square test was used. Results: NRS scores were lower in Group B than Group C. There was significant prolongation in time for first analgesia in Group B (12 h) compared to Group C (30 min). There was a significant reduction in total tramadol consumption at 24 h postoperatively in the ESPB group. Conclusion: Ultrasound-guided ESPB is an efficacious analgesic technique with an opioid-sparing effect following PCNL.

{Figure 1} She was posted for proximal femoral nailing under spinal anaesthesia with bupivacaine and fentanyl combination to reduce the level of sympathetic blockade. [3] In addition to the usual operating room preparation, (which includes preparing the defibrillator), we also placed stick on paddles to facilitate transcutaneous pacing should the need arise. [...]bifascicular block in elderly patients can be common and the incidence of progression to CHB though rare is not impossible.

Transthoracic echocardiography (TTE) showed a ventricular septal defect (VSD) with bidirectional shunt, dilated right atrium and right ventricle with right ventricular systolic pressure (RVSP) of 150 mmHg. On the eve of the planned surgery, left radial artery and right-sided internal jugular vein were cannulated under ultrasound guidance. Baseline intra-arterial blood pressure (IBP) was 150/94 mmHg, CVP (6 mmHg), cardiac output (5.6 L/min), SVR (1290 dyne/s/cm 5), stroke volume (SV 58 mL).

Background and Aims: In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome. Methods: Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score <7, umbilical cord blood pH <7.2, neonatal intensive care unit admission or death) was created for adverse neonatal outcome. Logistic regression was done to assess the influence of confounding factors on the occurrence of adverse neonatal outcome. Results: Of 123 patients who underwent category 1 cesarean section, 114 patients were included for analysis. The DDI and UIDT were comparable. One and 5-min Apgar scores were significantly lower in the group general anaesthesia (GA) than in the group spinal anaesthesia (SA). The umbilical cord blood pH was comparable (7.21 ± 0.15 vs 7.25 ± 0.11 in groups GA and SA, respectively). Neonatal intensive care admission and maternal outcome were comparable in both the groups. Subgroup analysis of patients with foetal heart rate of less than 100 showed that group GA had significantly lower 1-min Apgar scores and umbilical cord blood pH and significantly more neonatal admission and mortality. Binominal logistic regression showed that group GA (odds ratio 2.9, 95% confidence intervals 1.27-6.41) and gestational age were independently associated with adverse neonatal outcome. Conclusion: GA for category 1 CS was associated with increased incidence of adverse neonatal outcome.

The Institute of Medicine report states that almost 44,000-98,000 patients die due to medical errors of which most are medication related. Drug errors could result in patient death, increased hospital length of stay, health costs and increased morbidity.

Ultrasound-guided central venous (CV) cannulation is the standard of care for inserting CV catheter in the right internal jugular vein (RIJV). However, mechanical complications can still occur. The primary objective of this study was to compare the incidence of posterior vessel wall puncture (PVWP) using conventional needle holding technique with pen holding method of needle holding technique for IJV cannulation. Secondary objectives were comparison of other mechanical complications, access time and ease of the procedure. This prospective, randomised parallel-group study included 90 patients. Patients requiring ultrasound-guided RIJV cannulation under general anaesthesia were randomised into two groups P (n = 45) and C (n = 45). In group C, the RIJV was cannulated using the conventional needle holding technique. In group P, the pen holding method of needle holding technique was used. Incidence of PVWP, complications (arterial puncture, haematoma) number of attempts for successful cannulation, time to insertion of guidewire and performer's ease were compared. The data were analysed using Statistical Package for the Social Sciences (SPSS version 24.0). A P value less than 0.05 was considered statistically significant. In our study, there was no significant difference in incidence of PVWP and complications between the two groups. Number of attempts and time for successful guidewire insertion were comparable. Ease of the procedure was scored a median of 10 in both the groups. There was no significant difference in the incidence of PVWP between the two techniques in this study, necessitating further evaluation of this novel technique.

There are no surveys documenting the existing regional anaesthesia (RA) practices in our country. This nationwide survey aims to record the existing RA practices, identify any lacunae that might exist and project the future direction of evolution. This online survey consisting of 31 questions was sent to all members of the Indian Society of Anaesthesiologists and addressed participants' demographic features, central neuraxial block and peripheral nerve block practices, drug selection, RA training and safety measures. The data were analysed using Statistical Package for the Social Sciences version 24.0. All categorical variables were expressed as frequencies and percentages. A total of 2141 responses were received, with participants distributed across the country. Forty-two per cent of the respondents reported that more than 60 of surgeries were performed under RA. Most of the participants use ‘traditional' test dose for epidural space confirmation. Fifty participants (2.4) use ultrasound for neuraxial space identification. Twenty per cent of the participants use a checklist for monitoring post-operative epidural analgesia. 6.7 have undergone specialised training in RA. Around 3.5 of the respondents have performed a wrong-side block. 31.4 of the respondents store intralipid in the operating room. The current survey highlights the prevailing practices, various deficiencies in monitoring and the need for RA training programmes. The data accrued can serve as a baseline for future comparison.