Epidural volume extension is a technical modification of the combined spinal epidural block. It involves the epidural injection of normal saline or a small volume of local anaesthetic after an intrathecal injection, aiming to augment the post-spinal sensory level. Although the consequent sensory block augmentation has been adequately documented, the probable factors influencing epidural volume extension and its implications for clinical practice are not well defined. This article reviews published literature relating to the probable factors affecting epidural volume extension, its clinical implications, case reports of its successful clinical application and summarises its unexplored effects.

Background and Objective: Various risk factors have been evaluated to predict the mortality associated with COVID-19. We aim to explore and compare the clinical and laboratory risk factors with various outcomes of the disease between survivors and non-survivors amongst patients with moderate to severe COVID-19 disease. Methods: All COVID-19 adult (≥ 18 years old) ICU in-patients with a definite outcome i.e. either death or discharge were included. The demographic, clinical, laboratory, treatment, and outcome data were retrieved. To explore the association between factors, univariate and multivariate logistic regression were done. Results: A total of 163 patients were included out of which eight patients were shifted to other hospitals. Finally, a total of 145 patients were included in the study. Out of 145, 47 patients didn’t survive and 98 survived. A significant proportion (85%) of non-survivors were current smokers and were observed to have COPD, HT, and CAD as comorbidities when compared to the survivors. The qSOFA score, CRP, and TLC counts were included in the multivariable logistic regression with the former being the independent risk factor. Interpretation and Conclusion: Our study highlighted that older age, higher SOFA score, increased levels of total leucocyte count, and C-Reactive protein were independent risk factors affecting the clinical outcome in moderate to severe COVID-19 patients; however, qSOFA was found to be an independent risk factor predictor.

An 11-year-old boy with Lesch–Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it.

Background and Aims:Students are exposed to basic life support (BLS) and advanced cardiac life support (ACLS) training in the first semester in some medical colleges. The aim of this study was to compare students’ satisfaction between lecture-based traditional method and hybrid problem-based learning (PBL) in BLS/ACLS teaching to undergraduate medical students.Methods:We conducted a questionnaire-based, cross-sectional survey among 118 1st-year medical students from a university medical college in the city of New Delhi, India. We aimed to assess the students’ satisfaction between lecture-based and hybrid-PBL method in BLS/ACLS teaching. Likert 5-point scale was used to assess students’ satisfaction levels between the two teaching methods. Data were collected and scores regarding the students’ satisfaction levels between these two teaching methods were analysed using a two-sided paired t-test.Results:Most students preferred hybrid-PBL format over traditional lecture-based method in the following four aspects; learning and understanding, interest and motivation, training of personal abilities and being confident and satisfied with the teaching method (P < 0.05).Conclusion:Implementation of hybrid-PBL format along with the lecture-based method in BLS/ACLS teaching provided high satisfaction among undergraduate medical students.