Background:The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American Heart Association (AHA) guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations.Aims:This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces.Methods:We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces.Results:No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR), CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ.Conclusion:A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Background:High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing.Aims:The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR.Design:The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment.Methods:A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results.Statistical Analysis:Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test.Results:The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%.Conclusion:The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.

Background and Aims:This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal anesthesia (SA) using bupivacaine (heavy) for closed hemorrhoidectomies.Methods:A prospective randomized study was conducted in sixty patients who underwent closed hemorrhoidectomy. Thirty patients of Group A received SA. Thirty patients in Group B received local perianal block. Patients were evaluated for onset of the block, total pain-free period, and time to ambulation. Patient satisfaction in terms of pain during injection and satisfaction with the anesthesia technique was assessed after 2-week telephonically. Data were statistically analyzed using unpaired t-test for the continuous variables and Fischer's exact test for categorical variables.Results:Onset of anesthesia was significantly earlier in Group B, mean (standard deviation [SD]) value being 3.17 (1.28) min as compared to Group A, 6.24 (4.28) min (P = 0.0004). Total pain-free period (mean [SD]) in minute was longer in Group B, 287 (120) min as compared to Group A, 128 (38) min. Time to ambulation was significantly earlier in Group B, 22.83 (29.32) min as compared to Group A 302 (92.41) min. Pain during injection between the two groups was comparable. However, more patients in Group B (60%) were satisfied with the anesthesia technique as compared to Group A (27.5%).Conclusion:Perianal block for hemorrhoidectomy with ropivacaine 0.2% using dexmedetomidine as an adjuvant is an effective and reliable technique which is as effective as SA. It provides prolonged postoperative analgesia and early ambulation.

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