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Background and Aims: Spinal anaesthesia induced hypotension (SAIH) and bradycardia may prove deleterious to both parturient and baby, hence vasopressors play a vital role in their management. Recent studies on norepinephrine as rescue vasopressor during subarachnoid block (SAB) enlighten its role for SAIH. This randomised double-blind trial was conducted to compare the effect of intermittent intravenous boluses of norepinephrine and frequently used mephentermine for management of SAIH in caesarean section (CS) to prove whether norepinephrine produces comparable effects or superior to mephentermine. Methods: After approval from Institutional Ethics Committee and registration in Clinical Trials Registry India (CTRI/2019/06/019652), 256 parturients posted for elective CS under SAB were randomly allocated into Group-N and Group-M (n = 84) using chit system, who received boluses of intravenous norepinephrine 8μg and mephentermine 6mg for SAIH, respectively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), Response%, Apgar score and maternal complications were analysed. Results: The changes in SBP and DBP were comparable in both the groups. It was significantly low after SAB compared to baseline and significantly high compared to 1^st hypotensive value in both the groups throughout the study period (<0.0001). HR was comparable for initial 10 min, thereafter it was significantly high in Group-M (<0.0001) till 40 min. Response% after the first bolus was significantly high in Group-N (59.30n ± 29.21 vs 39.78 ± 25.6; P = <0.0001). Conclusion: Intravenous norepinephrine is better than mephentermine with respect to high response% and stable maternal HR although both are equally effective in maintaining blood pressure following SAIH during elective CS.

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Background and Aims: Anaesthesiologists have been in the forefront of managing patients of the novel coronavirus disease 19 (COVID-19) globally. The rearrangement of duties of anaesthesiology professionals and trainees along with the enforced containment measures like cessation of gatherings (for classroom teaching), cancellation of large number of elective cases and restricted number of procedures that are being performed have adversely affected the training of anaesthesiology postgraduate students across the country. Methods: An electronic survey to assess the effect of the measures taken by hospitals due to COVID-19 on postgraduate teaching was undertaken using a validated questionnaire. We used snowball sampling, and the survey invitation with the web link was shared through freeware WhatsApp. The participation in the survey was voluntary and anonymity was maintained. Data obtained from the responses was collated and analysed. Results: A total of 595 anaesthesiology postgraduate students (males = 298, females = 297) responded to the survey. Majority of the participants reported a steep depreciation (>50%) in the quality and quantity of academic activities (57.47%), major changes or cessation of clinical rotations (73.61%) and inability to conduct thesis-related cases (55.29%). In total, 56.97% of the students reported the rise in usage of online platforms like “Zoom” for conduct of routine academic activities. Conclusion: Teaching and training schedules of anaesthesiology postgraduate students have undergone major modifications following the COVID 19 pandemic. Resourcefulness and ingenuity in teaching methods is the need of the hour to sustain the desired standards of training courses and to maintain the quality of the budding anaesthesiologists.

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Background: Optimal intra-operative fluid therapy in renal transplantation (RT) is essential to ensure adequate graft function while preventing fluid overload related complications. This RCT was to compare the intraoperative goal directed fluid therapy (GDFT) based either on corrected flow time (CFT), measured by trans oesophageal Doppler (TED) or on the stroke volume variation (SVV), by FloTrac in patients undergoing living donor RT. Methods: This prospective, randomised controlled trial (RCT) was done on 60 end stage renal disease (ESRD) patients, American Society of Anaesthesiologists(ASA) grade III–IV, age 18 to 65 years of either sex, scheduled for living donor RT under general anaesthesia. They were randomly divided into two groups: TED group (n = 30) and FloTrac™ group (n = 30) and administered GDFT, based upon CFT (TED) and SVV (FloTrac™). The primary outcome was to compare the total fluid and number of fluid boluses administered intraoperatively, while the secondary outcomes were to compare any postoperative complications due to fluid overload and allograft function, assessed by serial serum creatinine levels up to 90 days postoperatively. Results: The mean total intra-operative fluid [3991.67 ± 856.32 vs. 3543.33 ± 1131.35, P = 0.089] and the amount of fluid administered per kg body weight per hour [13.32 ± 4.67 vs. 11.82 ± 4.76, P = 0.222] were lesser in the FloTrac compared to TED group, though not statistically significant. However, the postoperative incidence of allograft dysfunction, including rejection (P = 0.743) and acute tubular necrosis (ATN) (P = 0.999), and other complications (P = 0.643) were comparable. Conclusions: Both TED and FloTrac devices can be used effectively to guide GDFT in RT, However, lesser total fluid was required in the FloTrac group, which may lead to a lesser number of fluid-related postoperative complications.

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Presence of intraoral pathology especially in neonates poses a great challenge during airway management. Epignathus is a rare form of teratoid tumour that arises from the oropharyngeal region. We hereby report a case of a 7-day-old neonate who presented with feeding difficulty secondary to swelling arising from the hard palate. Surgical excision was decided to overcome feeding difficulty and to enable the child to thrive better. In view of anticipated difficult airway, the child was induced with sevoflurane, maintaining spontaneous breathing and intubated with Airtraq optical laryngoscope size 0. The further intraoperative and postoperative period was uneventful.

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