Background and Aims: An important assessment of the quality of health care is patient satisfaction. However, only few studies are available which look into this aspect. The primary objective of this study was to compare patient satisfaction between regional anaesthesia (RA) and general anaesthesia (GA) in patients undergoing upper limb surgeries. The length of hospital stay and duration of analgesia between the two techniques were the secondary objectives. Methods: This cross-sectional study was carried out in a tertiary care teaching hospital. Patients aged between 18 years and 60 years, of physical status American Society of Anesthesiologists (ASA) grade 1–3, undergoing upper limb surgeries were included in the study. Patient satisfaction with anaesthesia was assessed in patients receiving GA and RA, with 100 patients in each group, at least 24 h after the surgery with a 10-item predesigned peri-operative questionnaire. The continuous variables were compared between the groups using Mann–Whitney–Wilcoxon test, and for categorical variables Chi-square test was used. Results: The patients in group RA showed significantly higher satisfaction scores than those in GA (P < 0.001) with respect to all the 10 items of the questionnaire and the total score. Duration of analgesia was also significantly longer in RA than GA (P < 0.001). Duration of hospital stay was also significantly longer in GA than in RA (P < 0.001). Conclusions: RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.

Background and Aims: Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Subsequently, this questionnaire could be used for the survey to look for the trends and disparities in PNB practices and further to develop a national registry in the future. Methods: Thirty questions were prepared after evidence-based search and reviewed by experts for suggestions. Changes were done and the questionnaire with the grading sheet was sent to 19 experts. The responses were analysed to calculate the content validity index (CVI) item-wise (I-CVI), scale-wise (S-CVI), and modified kappa statistics. The I-CVI of 0.78 and an S-CVI/average of 0.90 was taken as acceptable with more than six experts. Results: Fourteen experts out of 19 assessed and graded the questions as per the provided sheet and submitted suggestions through the mail. Question reframing, option reconsideration, and change from single to multiple choices were incorporated as per the suggestions of the experts. Mean I-CVI for relevance, simplicity, clarity, and ambiguity was 0.99, 0.98, 0.98, and 0.99, respectively. S-CVI/average was 0.98, 0.97, 0.98, and 0.99 for relevance, simplicity, clarity, and ambiguity, respectively. Conclusion: We conclude that this questionnaire has met the content validity criteria and can be used to study plexus and PNBs practices.

Background and Aims: Formative assessment of procedural skills of Anaesthesiology postgraduate (PG) students is not conducted conventionally. Direct observation of procedural skills (DOPS) helps to identify gaps in performance and provides structured feedback. The present study was taken to explore perceptions of PG students and faculty about DOPS. Methods: This mixed design interventional study was conducted on 12 PGs and 10 faculty members in Department of Anaesthesiology. After conducting DOPS, a pre-validated questionnaire was given to them about perceptions using 3-point Likert's scale along with open ended questions. Statistical analysis was done using descriptive statistics of perception to calculate percentages and themes were identified for qualitative data. Results: Responses of students were positive about skill improvement (83%), time provided (75%), feedback (100%), interaction (83%), motivation (83%), satisfaction (83%), effectiveness (83%) and opportunity creation (92%). Faculty responded positively regarding change in attitude (100%), effectiveness (100%), scope (90%), feasible application (90%), ease (90%), opportunity creation (80%), gap identification (100%), satisfaction (80%). However, 60% felt training was required, 50% thought more time and commitment was required. Themes identified were DOPS is comprehensive, interactive, student-friendly, good teaching-learning tool, identifies gaps, provides focus for learning, provides systematic constructive feedback, improves skills, prepares for future practice, requires planning, may not reflect competence, has assessor variability and can be included in PG curriculum. Conclusion: DOPS was perceived as an effective assessment and teaching-learning tool by PG students as well as faculty.

Background and Aims: This study assesses the extubation practices of anaesthesiologists and whether these practices differ from existing guidelines. Methods: The literature related to tracheal extubation was searched and a validated questionnaire was designed to assess practices of tracheal extubation. The questionnaire included techniques, manoeuvres, preparation, timing and plan of extubation. The survey link was shared with eligible participants. The responses were assessed using Statistical Package for Social Sciences (SPSS) software. Results: Of the 1264 respondents, 66.8% keep difficult airway cart ready only when difficult extubation is anticipated. Only 12.3% of respondents perform deep extubation with supraglottic airway device (SAD) exchange while 73.3% of respondents perform awake extubation with pharmacological control for preventing haemodynamic fluctuations. In the case of anticipated difficult extubation, 48.3% anaesthesiologists prefer the airway exchange catheter (AEC) exchange technique. Of all, 84.8% anaesthesiologists administer 100% oxygen before performing extubation and 81.7% continue to oxygenate during and 83.9% provide oxygen after extubation in all patients. In the case of suspected airway edema or collapse or surgical cause for airway compromise, 70% anaesthesiologists perform a leak test. The most preferred plan of extubation in patients with suspected airway collapse after surgery is direct extubation in fully awake position (54.6%). In patients with anticipated difficult extubation, 50.8% anaesthesiologists prefer to ventilate for 24 hours and reassess. Conclusion: We observed that the extubation practices vary widely among anaesthesiologists. Almost half of the anaesthesiologists were unaware of extubation guidelines.

Background and Aims: Assessment of pain using pain scales is essential. In the Numeric Rating Scale (NRS), patients are asked to score their pain intensity on a scale from 0 to 10 (10- worst pain). This requires some abstract thinking by the patient, also the pain scores (PS) may not essentially communicate the patients' need for more analgesia. We planned a study to evaluate the change in patients' self-assessed PS after understanding clinical interpretation of the NRS.Methods: This prospective study was registered after approval from our hospital ethics board. Sample size estimated for the trial was 360 patients. All postoperative patients were recruited after informed consent. Patients having prolonged stay in Intensive Care Unit (more than 48 h), or those who underwent emergency surgeries were excluded. During Acute Pain Service (APS) rounds, patients were asked to rate their PS on the NRS. This was followed by a briefing about the clinical interpretation of the scale, and the patients were asked to re score their pain using the same scale. The change in pain severity was compared using Chi-square test. Results: Following explanation, a change in severity was seen for PS at rest [X² (9, N- 360) = 441, P < 0.001] and at movement [X² (9, N- 360) = 508, P < 0.001].Overall, a change in PS severity was seen in 162 patients (45%). A decrease and an increase in the severity of pain was seen in 119 and 41 patients respectively. Conclusion: Explaining the clinical interpretation of PS on a NRS does lead to a change in patients' self-assessed PS.

Background and Aims: The aerosol box (AB), an improvised device used during the coronavirus disease (COVID)-19 pandemic, has attracted both interest and controversy. Several simulated studies have examined its protective efficacy as well as intubation efficiency. The aim of this study was to evaluate the practical conduct of intubation using the AB in patients undergoing elective, oncological surgery during the pandemic. Methods: This prospective, observational study included adult patients undergoing oncological surgery. Thirteen anaesthesiologists performed 132 intubations using one of three ABs designated as AB 1, AB 2 and AB 3. The primary outcome was the difference in the time to intubation (TTI) between patients with Mallampati score MP I-II (Group 1) and MP III-IV (Group 2). Secondary outcomes included first-pass success rate, fall in peripheral oxygen saturation to < 95%, total number of attempts and failure to intubate using the AB. Results: The mean TTI was not significantly different in Group 1 and Group 2 (71.02 (61.66) s vs. 101.35 (121.94) s respectively, P = 0.119). Desaturation during intubation was seen in 20 patients (15.1%). First pass success rate was achieved in 109 patients (82.6%). Twenty-one patients (15.9%) needed more than one attempt to intubate and the box had to be removed in 8 patients (6.1%) for facilitating intubation. The Mallampati score did not significantly influence either desaturation or first pass success rate. Conclusion: There was a non-significant increasing TTI trend in patients with a higher MP score with the use of an aerosol box. However, this did not translate to a clinically significant difference in the overall intubation outcomes.

Background and Aims: Pain of open thoracotomy is treated with systemic analgesics, thoracic epidural and paravertebral blocks which have associated adverse effects and complications. Research shows ultrasound guided erector spinae plane block (US-ESPB) as a simpler and safer alternative. As paucity of data of US-ESPB in paediatric thoracotomies exists. We aimed at studying the analgesic efficacy of US-ESPB for paediatric thoracotomy. Methods: In a prospective observational study, 30 children, 1-12 years age undergoing thoracotomy with decortication under general anaesthesia with US-ESPB were observed. At induction, patient received intravenous (IV) fentanyl 3 μg/kg for analgesia and standard general endotracheal anaesthesia was administered. US-ESPB was given at fourth thoracic vertebral level with 0.25% bupivacaine 0.3 ml/kg. Changes in haemodynamic parameters at skin incision, rib retraction, pleural incision, intercostal drain insertion, and skin closure were noted. Intraoperatively, additional fentanyl was administered, if required and its dose and time were noted. Postoperative pain was assessed by visual analogue scale (VAS) (0-10) for ≥6 years and by face, leg, activity, cry, consolability (FLACC) score (0-10) for <6 years at post extubation, 30 minutes and hourly postoperatively. Descriptive statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20. Results: Additional analgesic was not required in 14/30 patients (46.67%) intraoperatively and within 6 hours (7.4 ± 1.26) post-operatively. Five of the remaining 16 patients, required IV 1 μg/kg fentanyl only once intraoperatively. Median pain score was 2 in first four postoperative hours. Conclusion: US-ESPB provided effective supplemental intraoperative and postoperative analgesia in nearly half of the paediatric thoracotomy patients.

Background and Aims: Evaluation of postgraduate (PG) training is important so that necessary modifications can be made. The quality of anaesthesiology teaching in our country has not been explored. We performed a survey among the anaesthesiology PGs of Kerala to assess their perceptions about their learning environment as well as to look for the deficits in the training program. Methods: An online web-based survey was conducted. The questionnaire was developed after a detailed validation process and circulated via Google forms. The questionnaire had three parts. First part asked for demographic details. Second part had 22 statements in four domains to evaluate the quality of training, which were to be answered based on a five-point Likert scale. The third part asked for the suggestions of the trainees on changes to be made for the improvement in quality of their training. Results: The response rate was 64%. The social atmosphere was perceived positively in general by our PGs. Majority of them received feedback on their work and had a regular class schedule. Only 34% of the residents got training in non-technical skills. More tutorials and case discussions were the most common change suggested by the residents. Lack of research training and training in simulation labs were the major lacunae identified. Conclusion: The clinical learning environment (CLE) was perceived to be of medium to high quality by the anaesthesiology PGs of Kerala. Lack of routine assessments and regular academic sessions were reflected in the responses.