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   2020| May  | Volume 64 | Issue 14  
    Online since May 23, 2020

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Indian resuscitation council (IRC) suggested guidelines for comprehensive cardiopulmonary life support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient
Baljit Singh, Rakesh Garg, S S C Chakra Rao, Syed M Ahmed, JV Divatia, TV Ramakrishnan, Lalit Mehdiratta, Muralidhar Joshi, Naveen Malhotra, Sukhminder Jit Singh Bajwa
May 2020, 64(14):91-96
Management of the recent outbreak of the novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) remains challenging. The challenges are not only limited to its preventive strategies, but also extend to curative treatment, and are amplified during the management of critically ill patients with COVID-19. Older persons with comorbidities like diabetes mellitus, cardiac diseases, hepatic impairment, renal disorders and respiratory pathologies or immune impairing conditions are more vulnerable and have a higher mortality from COVID-19. Earlier, the Indian Resuscitation Council (IRC) had proposed the Comprehensive Cardiopulmonary Life Support (CCLS) for management of cardiac arrest victims in the hospital setting. However, in patients with COVID-19, the guidelines need to be modified,due to various concerns like differing etiology of cardiac arrest, virulence of the virus, risk of its transmission to rescuers, and the need to avoid or minimize aerosolization from the patient due to various interventions. There is limited evidence in these patients, as the SARS-CoV-2 is a novel infection and not much literature is available with high-level evidence related to CPR in patients of COVID-19. These suggested guidelines are a continuum of CCLS guidelines by IRC with an emphasis on the various challenges and concerns being faced during the resuscitative management of COVID-19 patients with cardiopulmonary arrest.
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Re-emergence of TIVA in COVID times
Tushar Chokshi, Shivakumar Channabasappa, Davies C Vergheese, Sukhminder Jit Singh Bajwa, Bhavna Gupta, Lalit Mehdiratta
May 2020, 64(14):125-131
Total intravenous anaesthesia (TIVA) is a technique of general anaesthesia (GA) given via intravenous route exclusively. In perspective of COVID-19, TIVA is far more advantageous than inhalational anaesthesia. It avoids the deleterious effects of immunosuppression and lacks any respiratory irritation, thus providing an edge in the current situation. Many peripheral surgeries can be done with the patient breathing spontaneously without any airway device, thus avoiding airway instrumentation leading to droplet and aerosol generation. Intravenous agents can be utilized to provide sedation during regional anaesthesia (RA), which can easily be escalated to contain pain due to sparing of blocks or receding neuraxial anaesthesia. The present narrative review focuses on the merits of adopting TIVA technique during this pandemic so as to decrease the risk and morbidity arising from anaesthetizing COVID-19 patients.
  3,398 384 -
All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic
Apeksh Patwa, Amit Shah, Rakesh Garg, Jigeeshu Vasishtha Divatia, Pankaj Kundra, Jeson Rajan Doctor, Sumalatha Radhakrishna Shetty, Syed Moied Ahmed, Sabyasachi Das, Sheila Nainan Myatra
May 2020, 64(14):107-115
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.
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Tough times and Miles to go before we sleep- Corona warriors
Bhavna Gupta, Sukhminder Jit Singh Bajwa, Naveen Malhotra, Lalit Mehdiratta, Kamna Kakkar
May 2020, 64(14):120-124
The world has changed due to COVID-19 pandemic. Global spread of COVID-19 has overwhelmed all health systems and has incurred widespread social and economic disruption. The authorities are struggling to ramp up the healthcare systems to overcome it. Anaesthesiologists are facing long duty hours, have fear of bringing disease home to their families, being companion to critically ill patients on long term life support, being on front line of this pandemic crisis, may take toll on all aspects of health of corona warriors- physical, mental, social as well as the emotional.At this juncture, we must pause and ask this question to ourselves, “Buried under stress, are we okay?”
  2,899 207 -
Anaesthetic management of a COVID-19 parturient for caesarean section - Case report and lessons learnt
Anjolie Chhabra, Tangirala Nageswara Rao, Mritunjay Kumar, Yudhyavir Singh, Rajeshwari Subramaniam
May 2020, 64(14):141-143
The corona virus disease 2019 (COVID-19) pandemic sweeping across the world has severely strained health care resources (equipment and personnel) forcing us to rethink strategies to provide obstetric care while judiciously using resources. We describe the anaesthetic management of a mildly symptomatic, COVID-19 positive, 28-year-old second gravida with term pregnancy who was taken up for an elective caesarean section under subarachnoid block in a standalone maternity facility. Challenges encountered and modifications of standard procedures so as to optimize patient care and minimize exposure of health care professionals are also discussed.
  2,249 714 -
Society of Onco-Anesthesia and Perioperative Care (SOAPC) advisory regarding perioperative management of onco-surgeries during COVID-19 pandemic
Sohan Lal Solanki, Raghu S Thota, Rakesh Garg, Anjali A Pingle, Jyotsna Goswami, Namrata Ranganath, Sudipta Mukherjee, Sameer Gupta, Shraddha Patkar, Rajesh H Chikkalingegowda, Tarun Jindal, Mukur D Ray, Sanjay Muralidhar Upadhye, Jigeeshu V Divatia
May 2020, 64(14):97-102
Coronavirus disease 2019 (COVID-19) has gripped the world and is evolving day by day with deaths every hour. Being immunocompromised, cancer patients are more susceptible to contract the infection. Onco-surgeries on such immunocompromised patients have an increased risk of infection of COVID-19 to patients and health care workers. The society of Onco-Anesthesia and Perioperative Care (SOAPC) thereby came out with an advisory for safe perioperative management of cancer surgery during this challenging time of the COVID-19 pandemic.
  2,002 365 -
Difficult airway management in COVID times
Sukhminder Jit Singh Bajwa, Madhuri Kurdi, Konstantinos Stroumpoulis
May 2020, 64(14):116-119
  1,567 555 -
COVID-19 mask: A modified anatomical face mask
Rajesh Panda, Pankaj Kundra, Saurabh Saigal, Divya Hirolli, Priyadarshani Padhihari
May 2020, 64(14):144-145
  1,498 291 -
Corona pandemic: Bringing Anaesthesiologist's professional role and other skills to the fore
Sushma Bhatnagar, Lalit Mehdiratta, AR Karthik
May 2020, 64(14):87-90
  1,026 325 -
Cancer and COVID-19: A war on multiple fronts
Sukhminder Jit Singh Bajwa, Madhuri Kurdi, Konstantinos Stroumpoulis
May 2020, 64(14):103-106
  1,016 238 -
Aerosol box for protection during airway manipulation in covid-19 patients
Sundeep Vijayaraghavan, Nitu Puthenveettil
May 2020, 64(14):148-149
  925 201 -
Effectiveness of simulation based teaching of ventilatory management among non-anaesthesiology residents to manage COVID 19 pandemic - A Quasi experimental cross sectional pilot study
Tatikonda Chandra Mouli, Anjani Davuluri, Sana Vijaya, Avala Devi Yamini Priyanka, Sushant Kumar Mishra
May 2020, 64(14):136-140
Background and Aims: Simulation is one of the important learning tools when it comes to skill acquisition and as a supplemental tool for training in high stake situations like COVID-19. The aim of this study is to meet the global requirements of knowledge on ventilatory management, prepare and to evaluate the effectiveness of the teaching module for non-anesthesiology trainees on COVID-19 patients. Methods: Quasi experimental cross sectional pilot study was conducted with a sample of twenty-six trainees. A teaching module was prepared and validated which consisted of lectures, audio-video sessions, demonstrations with hands-on training, debriefing, analytical-phase and reflection. Pre and Post evaluations from student t-test and direct observation of procedural skills (DOPS) were used for knowledge and skill assessment respectively and feedback obtained from Likert's score. Results: Pre- and Post-tests had a mean score of 7.42 ± 2.12 and 14.92 ± 2.9 respectively (P value 0.00001). DOPS included 16 point score, in which 23 trainees (88.4%) met the expectations and above expectations as per training objectives. A five-point Likert's score feedback revealed satisfactory and highly satisfactory scores of 100% (ABG), 96.1% (mechanical ventilation), and 84.6% (ventilation in COVID-19 patients). Overall satisfaction for the workshop among respondents was 100 per cent. Confidences of handling scores were 84.5% (interpreting ABG), 65.3% (maneuvering mechanical ventilation), and 96.15% (intubation in COVID-19 patients). Conclusion: A planned teaching module in ventilation management helps to train non-anaesthesiologists more effectively as a part of COVID-19 preparedness. Simulation with debriefing based training to the medical fraternity is the best alternative in the present pandemic and it will also ensure the safety of health care professionals.
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Barrier enclosure for airway management in COVID-19 pandemic
Karthika Asokan, Bibilash Babu, Arya Jayadevan
May 2020, 64(14):153-154
  693 178 -
Simple innovations in the operating room amid the COVID-19 pandemic
Varun Suresh
May 2020, 64(14):146-147
  644 198 -
Railway anaesthesiologists and Indian railway COVID-19 management system
Chandra Kant Patel, V Kamatchi Selvam, Dinesh Kumar Sahu
May 2020, 64(14):132-135
Ever since the outbreak of novel Corona Virus 2019 pandemic, Anaesthesiologists are among the frontline leaders in not only the prevention of and control over the spread of the pandemic but also planning, organizing and coordinating the deployment and utilization of the medical and all other resources effectively and efficiently in order to minimize the losses and sufferings of human lives and recouping the global wellbeing at large. This article briefly highlights the prompt, optimal and effective contributions of the Indian Railways, Indian Railway Health Services and the Railway Association of ISA (RAISA) towards the provision of safe and scientific health services to maximum number of our fellow citizens.
  718 119 -
Aerosol containment device for use on suspected COVID-19 patients
Baljit Singh, Sham L Singla, Priyanka Gulia, Ajay Kumar, Rashmi Bhanwala
May 2020, 64(14):154-156
  658 170 -
Management of potential ventilator shortage in India in view of on-going COVID-19 pandemic
Pankaj Kumar, Malay Kumar
May 2020, 64(14):151-152
  618 104 -
Visualized effect of the Frankfurt COVid aErosol pRotEction Dome – COVERED
Jan A Kloka, Christoph Martin, Patrick Gilla, Gösta Lotz, Kai Zacharowski, Florian J Raimann
May 2020, 64(14):156-158
  556 117 -
The dilemma of being non COVID-19 hospital in the era of COVID-19
Swati Singh
May 2020, 64(14):150-150
  532 120 -