Background and Aims:With the availability of modern workstations and heightened awareness on the environmental effects of waste anaesthesia gases, anaesthesiologists worldwide are practicing low flow anaesthesia (LFA). Although LFA is being practiced in India, hard evidence on the current practice of the same from anaesthesiologists practicing in India is lacking and hence, we conducted this survey.Methods:A questionnaire containing 16 questions was distributed among a subgroup of anaesthesiologists who attended the 2014 National Conference of Indian Society of Anaesthesiologists. The filled-in questionnaires were computed and analysed with SPSS version 11.Results:The response rate to the survey was 82%. About 73% of the respondents practiced LFA routinely, with 65% having workstations. Most of the anaesthesiologists used fresh gas flows <1.5 L/min with 45.1% using O2 concentrations at a range of 30–40%. ETCO2 monitoring was used routinely by most whereas use of agent analysers and bispectral index monitoring were restricted. The availability of scavenging system was also limited to only 33.5%. Majority preferred N2 O as carrier gas and sevoflurane as volatile agent of their choice.Conclusion:Our survey revealed that practice of LFA in India has numerous lacunae. Provision of better monitoring facilities, workstations as well as awareness regarding the environmental issues of waste anaesthetic gases need to be addressed.

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Introduction: Postoperative Delirium (POD) is one of the most common complications in geriatric surgical patients. POD has immense implication because it can initiate a cascade of deleterious events leading to functional decline, reduced cognitive function, prolonged hospitalisation, and death. The risk factors for POD include increased age, cognitive, visual or sensory impairment, functional dependence, infection, and electrolyte abnormalities. Published literature on POD in patients aged >60 years undergoing oncosurgeries are few. According to the American Geriatric Society, evidence for recommendation of intraoperative risk factors is lacking. The relation between intraoperative haemodynamics and postoperative pain with POD is controversial, as studies provide differences in evidence. Hence this relation needs to be studied further. Aim: To find the incidence of POD in patients >60 years of age undergoing oncosurgery, and its association with intraoperative hypotension and blood pressure fluctuations. The secondary objective was to assess the relation of POD with postoperative pain. Materials and Methods: The present study was prospective cohort study which was carried on 50 patients aged >60 years undergoing cancer surgery. Intraoperative hypotension and blood pressure fluctuations were measured based on predefined criteria. Postoperative pain and total opioid consumption were also noted. Delirium was assessed with the short Confusion Assessment Method (short CAM), on the first three postoperative days. The association between hypotension and intraoperative blood pressure fluctuations with POD were analysed with Fisher exact test and MannWhitney U test. Association of pain scores and total dose of opioid with POD was performed using Student’s t-test and Mann-Whitney U test. Results: The mean age of the study population was 69.5±2.8 years. The mean preoperative Addenbrook’s Cognitive Examination (ACE) score was 83.78. The incidence of POD was 22%. There was a significant association between intraoperative blood pressure fluctuation and POD. The mean BP variance ranged from 126.89 to 111.13 mm Hg. Increased age and more co-morbidities ≥3 (present in 58%) showed an association with POD. Conclusion: The incidence of POD was high (22%) among the elderly requiring oncosurgery. Intraoperative blood pressure fluctuation as well as hypotension was associated with increased risk of POD. Hence in elderly patients, tight blood pressure control is advisable during surgery.

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