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.

Background The bispectoral index (BIS), a parameter derived from electroencephalogram, has been used to assess the depth of anesthesia. The objectives of this study were to evaluate the effect of BIS monitoring on sevoflurane consumption and recovery profile at the end of anesthesia. After obtaining Institutional Review Board approval and written informed consent, 25 American Society of Anesthesiologists (ASA) physical status classification 1 and 2 patients undergoing breast cancer surgeries who had BIS monitoring in addition to standard ASA monitoring (BIS GROUP) were compared against 25 controls (control group). In the control group, adequate depth of anesthesia was maintained using routine clinical parameters like heart rate (HR), mean arterial pressure (MAP), and minimum alveolar concentration (MAC) of sevoflurane, while in the BIS group, it was maintained by keeping the BIS score between 40 and 60 (mean 50). Data including demographics, sevoflurane consumption, hemodynamic variables, and recovery profile at the end of anesthesia was assessed in terms of time for eye opening (TEO), time for motor response (TMR), time for extubation (TE), and modified Aldrete scoring (MAS). Results The mean sevoflurane consumption was lower (P = 0.019) in the BIS group. TEO (P = 0.001), TMR (P = 0.0001), and TE (0.003) were shorter in the BIS group. Difference in MAS between the 2 groups was not statistically significant (P = 0.085). Conclusions BIS monitoring during anesthesia resulted in significant reduction in the sevoflurane consumption. Patients who had BIS monitoring awoke earlier and had better recovery profile at the end of anesthesia.

Background and Aims: The incremental shuttle walk test (ISWT) is a simple reproducible and non-invasive test for assessing cardiopulmonary function. The maximum oxygen consumption is less than 10 ml/kg/min for ISWT distance of less than 250 m. This study aimed to evaluate the effectiveness of ISWT in predicting morbidity and mortality in elective colorectal oncosurgery and to find the correlation of ISWT with the Duke Activity Status Index (DASI), Borg dyspnoea score, and peak oxygen uptake (VO 2 max). Methods: This prospective study involved 46 patients aged more than 60 years with American Society of Anesthesiologists physical status I and II undergoing elective colorectal surgery under general anaesthesia with an epidural block. ISWT was conducted preoperatively and patients were monitored for 30 days postoperatively. For a comparative analysis, patients were divided into two groups: group 1– who could walk 250 m and group 2 – could not walk 250m. Categorical data were evaluated using the Chi-square test, while continuous data were evaluated using the Student’s t -test. The strength of correlation was determined using Pearson’s correlation coefficient. Results: Postoperative complications ( P = 0.001) and lengthy stay in hospital and intensive care unit (P = 0.001) were experienced by all patients who were unable to complete the ISWT distance of 250 m. ISWT distance of 250 m corresponds to a DASI score of 10.5, which is equivalent to a calculated VO 2 max of 14.1ml/kg/min. Conclusion: The ISWT with a cutoff distance of 250 m is a reliable predictor of postoperative morbidity in patients undergoing colorectal oncosurgery.

Background Inadvertent perioperative hypothermia (IPH) defined as core temperature below 36.0 °C is a common complication of general anesthesia with prevalence up to 70%. Warming of peripheral tissues prior to induction of anesthesia reduces the central to peripheral temperature gradient, thereby minimizing central heat loss due to heat redistribution, after induction of anesthesia. This study aimed to evaluate the effect of prewarming on post-induction core temperature and incidence of perioperative inadvertent hypothermia leading to postanesthetic shivering (PAS) in patients undergoing general anesthesia. This is a single-arm study performed after authorization from the scientific review committee (IRB no.:10/2015/05) in a cohort of patients between the ages of 18 and 65 years in ASA I and II physical status, undergoing GA for elective surgeries lasting less than 3 h. Rates of IPH and PAS in 60 patients who were warmed before anesthesia over a 30-min period with a forced-air warmer set at 38.0 °C were compared with existing data from an equal number of cohorts who received only intraoperative warming, during similar surgical procedures according to routine GA. Comparisons between the two groups were made using the Student’s t-test and chi-square test. A paired t-test or Wilcoxon’s signed rank test was applied for pairwise comparisons. The results were considered statistically significant when the P-value was < 0.05. Results The mean decrease in core temperature in the unwarmed group was 0.7 °C (+ /- 0.23) compared with a 0.2 °C decrease (+ /- 0.06) in the prewarmed group of patients. A total of 31.70% of patients in the unwarmed group developed IPH compared with one patient (1.7%) in the prewarmed group shortly after onset. Twenty-six patients (43.30%) in the unwarmed group had hypothermia at the end of surgery, compared with one patient (1.7%) in the prewarmed group. Shivering was observed in 46% of patients in the unwarmed group, while no shivering was observed in the prewarmed group. Conclusions Preoperative warming is an effective intervention to reduce the frequency of core temperature drops after induction of anesthesia, thereby preventing inadvertent perioperative hypothermia and the incidence of postoperative shivering.