Management of postoperative pain is a central piece in the jigsaw of postoperative care. This article reports a series of three patients who were managed with intrathecal morphine to provide postoperative analgesia, for major abdominal surgeries. Morphine was injected intrathecally before the induction of anaesthesia. The patients were pain free postoperatively, required minimal intravenous opioids on the first postoperative day. There was no incidence of postoperative nausea or vomiting, pruritus and respiratory depression. Intrathecal morphine improves the quality of postoperative analgesia, there is a reduction in pain scores in the first 24 hours after surgery and the need for rescue analgesia with intravenous opioids is less. Intrathecal morphine can be used as an alternative to continuous epidural analgesia in early postoperative period.
Aims and objectives: Sudden cardiac death (SCD) is the most common cause of mortality worldwide. Bystander cardiopulmonary resuscitation (CPR) improves the victim's outcome, especially when the response time for advanced life support is prolonged. We performed a study to estimate the difference in knowledge among first-year medical students after basic life support (BLS) training (part of their foundation course) before and during the novel COVID-19 pandemic. Materials and methods: We recruited first-year medical college students (batch of 2019-20: pre-COVID group - P and batch of 2020-21: COVID-19 era group - C) who were undergoing BLS training for the first time and consented to this study. Since the training was delayed and affected by COVID-19 for the batch of 2020-21, their training duration was shorter with more usage of audiovisual aids. The difference in the change in knowledge (by a questionnaire with 10 questions of one mark each) after training by the two methods was analysed. Analysis of variance, Wilcoxon signed-rank test, Mann-Whitney U test, and chi-square tests was used as applicable to compare the groups, and p-value <0.05 was considered significant. The results are analysed by IBM SPSS version 20.0 software (SPSS Inc, Chicago, IL, USA). Results: The median (inter-quartile range) marks in group P (89 students) in the pre-test was 3 (4-2) and in the post-test was 6 (7-5) (out of 10). The corresponding marks in group C (112 students) in the pre-test were 3 (4-2) and in post-test was 7 (8-6). The knowledge improvement in group C was more with all the three changes being significant (p=0.0001). In group C, females had more improvement than males (p=0.0001). Conclusion: We found a significant increase in the improvement of the knowledge after the BLS training in group C compared to group P. In group C, the improvement was better in females (59% increase in mean marks versus 22% in males).
Securing airway is an important routine for any Anesthesiologist. Assessment of airway preoperatively is an essential part of predicting difficulty in airway management. Mallampati test (MP) is commonly applied during such preoperative assessments. However, Mallampati test is an indirect clinical sign in which thickness of the base of the tongue is assessed by whether it masks faucial pillar (palatoglossal and palatopharyngeal arches) or not. Though MP is an indirect assessment, this test is routinely applied because of ease of applying this test. This test however is not completely reliable in predicting difficulty in laryngoscopy and intubation and has high false-positive and false-negative outcome. The depth of floor of the mouth and thickness of tongue can be assessed to improve prediction of difficult airway. This depth can be measured by cheap and rapid test using ultrasonography. Material and Methods: In this study depth of the tissues in the floor of the mouth were measured by placing USG probe above hyoid bone in sagittal plane and measurement taken from skin to mucous membrane of tongue and attempted to establish any relationship between this thickness and difficulty in laryngoscopy as assessed by Cormack-Lehanne scoring. 60 ASA I & II patients undergoing elective surgeries under GA were assessed during the pre-anaesthetic evaluation and supra-hyoid USG depth in sagittal plane was measured and recorded. During laryngoscopy Cormack and Lehanne scoring was recorded for each of the subjects by 2 experienced anaesthesiologists who were blinded to the depth assessment.
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