Bhavna Gupta

Most daunting threat for humankind is the corona virus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2. Various vaccine production platforms are available, each with distinct advantages and obstacles. Pharmaceutical formulation science plays a critical role in the race for a safe, effective coronav virus disease vaccine (COVID)-19. The target population of vaccinees includes high-risk individuals over the age of 60, those with chronic co-morbid conditions, frontline healthcare workers, and those involved in critical industries. Once a safe and reliable vaccine policy becomes available, pre-pandemic normalcy will never return. As COVID-19 continues to wreak havoc on people's health and livelihoods around the world, the prospect of an effective vaccine may appear to be a silver bullet. Despite this, a number of challenges remain, each of which necessitates careful and ongoing debate to ensure that vaccination strategies are safe, appropriate, and realistic. So the best way forward is simply to register oneself on Aarogya Setu and get vaccinated as soon as possible, regardless of Covishield or Covaxin. Keywords: Vaccine, Pandemic, COVID, Corona virus 19

Introduction: Airway management in critically ill patients in emergency room and periphery wards is an essential component of resuscitation and is considered a high-risk procedure with one or more complications occurring in 22–54% of all intubations performed. As there are few hospitals in India with dedicated emergency physician available, the airway management in emergencies and peripheral wards is done by residents pooled from various specialities. This survey was conducted with objective to assess the challenges encountered during tracheal intubation in emergency settings outside the controlled environment of operation theatre and to know the complications occurring during airway management in these scenarios. Further assessment was conducted with objectives to assess the challenges and dilemma faced by them and to know complications and outcomes associated airway management in these cases. Materials and Methods: An anonymous 30 questions survey was sent online to 500 doctors from different branches in India as online google forms via email. Data pertaining to respondent demographics, practice characteristics (including availability of resources, medications and equipment’s) were collected and analysed descriptively using different frequencies and percentages and Fisher’s exact tests followed by post hoc multiple comparisons. Results: 248 residents filled up the questionnaire, 78% were anaesthesiologists, and rest were from different medical branches. Ninety-seven percentage felt the need for display of protocol regarding the guidelines for intubation and cardiopulmonary resuscitation in emergency and periphery locations. All participants felt the need for teaching residents from all specialities to manage peripheral intubation calls. Conclusions: Airway management at periphery locations is challenging and needs the implementation of algorithms including the new airway devices. Finally, the standard airway guidelines for difficult airway management remain the cornerstone of managing and securing airway at periphery for obvious reasons, although some specific aspects can be adapted in specific scenarios. Keywords: Difficulties and challenges; Periphery intubation calls, Residents, Need for protocol, Emergency scenario.

The stress response to surgery, trauma, burns, and critical illness is a well-known entity and encompasses derangements in metabolic and physiological pathways which leads to inflammatory, acute phase, hormonal and genomic responses. There is a state of hyper catabolism and hyper metabolism, which results in impaired wound healing, impaired immune functions and muscle wasting. The stress response to surgery is similar to that induced as a result of traumatic injuries, however it depends on the duration and severity of surgical or traumatic injury. Body responds to such stimuli which may range from minor to massive insults and response is characterized by local or generalized responses. The generalized responses vary from endocrinal, metabolic and biochemical changes in the body and magnitude of the same vary dep/ending on the intensity, severity and duration of stimuli. Stress responses are known to be well tolerated in normal healthy adults, however in patients with known ailments and co-morbidities such as coronary heart disease, hypertension, diabetes, liver diseases, renal insufficiency, old age, changes may be detrimental and life threatening. Keywords: Stress, Metabolic Response, Surgery, Anesthesia.

The central nervous system (CNS) deserves special consideration in the perioperative setting for several reasons for an anesthetist. An understanding of neuroanatomy is essential because neuro anesthesia continues to develop and evolution of neurosurgical practice is accompanied by new challenges for the anesthetist. Basic knowledge and expertise of the neuro-anesthetist can directly influence patient outcome. With the recent advancement in functional and minimally invasive procedures, there is an increased emphasis on the provision of optimal operative conditions, preservation of neurocognitive function, minimizing interference with electrophysiological monitoring, and a rapid, high-quality recovery. So, during neuro anesthesia, anesthesiologist needs to know physiology of CNS including cerebral metabolism and cerebral blood flow. Neuro anesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. One of the peculiarities of neuro anesthesia has always been that as much importance is attached to wakening the patient as sending them to sleep. We have included the anesthesia for neurosurgery in two parts. In the first part, we had discussed cerebral anatomy, physiology and intracranial pressure, in the second part we have included anesthesia considerations for surgery for brain tumor, aneurysmal surgery, temporal lobe surgery, trans sphenoidal surgery and traumatic brain injury.  Keywords: Anesthesia, Neurosurgery.

Objectives: The ProSeal Laryngeal Mask Airway (PLMA) mostly inserted by finger technique and by an introducer tool method. Recently a newer Suction Catheter Guided (SC) insertion technique has been successfully used in children. We performed a study in children with aims and objective to compare the ease of PLMA insertion using SC and conventional techniques. Methods: 126 American Society of Anaesthesiologist’s class I and II children in age group of 1-12 years weighing 10-50 kg, admitted in our hospital, undergoing an elective surgery in under general anaesthesia in supine position were included in our study. An appropriate size PLMA was inserted using Suction Catheter, introducer tool or digital technique in Groups SC, I and D respectively (n=42) after induction of general anaesthesia. Correct placement of the PLMA was confirmed by using appropriate clinical tests. Ease of PLMA insertion with hemodynamic response was done by time to insertion, number of insertion attempts to achieve effective ventilation and number of cases which required lateral approach of insertion. Results: In Group SC, PLMA device was inserted after a single attempt in 41 (97.6%) patients, but PLMA insertion was failed in 5 patients in Group I (11.9%) and 6 patients in Group D (14.3%) even after two attempts, and the difference was statistically significant (p=0.044). Time taken for successful placement was statistically shorter in the SC-guided group (SC 22.5±4.021 seconds, I 31.4± 17.57 seconds, D 27.10±12.9 seconds, p value Conclusion: Suction Catheter guided ProSeal LMA insertion was an easier, faster, more successful and a relatively atraumatic technique which also ensures correct placement of the PLMA in the hypopharynx as compared to the routine conventional PLMA insertion techniques with no hemodynamic pressor response to PLMA insertion using any of the three  techniques. Keywords: ProSeal LMA, Suction Catheter insertion.

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respiratory tract in which child presents with severe respiratory distress, pneumonitis or sepsis. Anesthetic management of such children is challenging owing to hyperinflation or rupture of cystic lesions or iatrogenic pneumothorax with positive pressure ventilation, sudden hemodynamic collapse during induction, excessive bleeding and situation becomes more challenging if child is presenting with sepsis. We report successful management of 42 days old infant with CCAM with pneumonitis and sepsis who underwent lobectomy and was successfully extubated on operating table with meticulous planning and optimum perioperative management. Early extubation is desirable to avoid iatrogenic ventilator induced bronchial stump dehiscence by positive pressure ventilation. Keywords: Anesthesia considerations, Congenital cystic adenomatoid malformation, Pneumonitis, Sepsis.

The central nervous system (CNS) deserves special consideration in the perioperative setting for several reasons for an anesthetist. An understanding of neuroanatomy is essential because neuro anesthesia continues to develop and evolution of neurosurgical practice is accompanied by new challenges for the anesthetist. Basic knowledge and expertise of the neuro-anesthetist can directly influence patient outcome. With the recent advancement in functional and minimally invasive procedures, there is an increased emphasis on the provision of optimal operative conditions, preservation of neurocognitive function, minimizing interference with electrophysiological monitoring, and a rapid, high-quality recovery. So, during neuro anesthesia, anesthesiologist needs to know physiology of CNS including cerebral metabolism and cerebral blood flow. Neuro anesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. One of the peculiarities of neuro anesthesia has always been that as much importance is attached to wakening the patient as sending them to sleep.