Background and Aims:Anaesthesia practice demands medical knowledge and skills as essential components for patient management in peri-operative emergencies. Since all residents are not exposed to such situations during their residency, training them using simulation technology could bridge this knowledge and skill gap. The aim of this study was to train and evaluate residents to manage anaesthesia emergencies on high fidelity simulators.Methods:Kirkpatrick model of program evaluation was carried out. Resident reaction was captured using a satisfaction questionnaire and the change in knowledge was assessed using pre-test and post-test Multiple Choice Questions (MCQs). Six scenarios were created and executed on a human patient simulator (HPS). All 22 residents participated in this teaching learning method. The steps of simulation teaching included pre-test, pre-briefing, orientation to manikins, performing/scribe, debriefing, feedback questionnaire, and post-test. The satisfaction questionnaire was administered following the second and fourth scenario.Results:95% residents agreed on overall satisfaction, that it helps in building team dynamics and clinical reasoning. All students agreed that this teaching had positive professional impact. 14% residents felt they were anxious during the class. The items in the questionnaire had a Cronbach's α value of 0.9. The mean score for pre-test was 24.22 ± 7 (Mean ± SD) and the post-test was 47.18 ± 5.6, the difference between the scores were statistically significant (P = 0.007).Conclusion:The use of high-fidelity simulation to train anaesthesia residents resulted in greater satisfaction scores and improved the residents' reasoning skills.
Background: Laparoscopic cholecystectomy is a minimally invasive procedure gaining popularity in the recent years. Open cholecystectomy procedures are more invasive with prolonged recovery, increased analgesic requirement, delayed gastric recovery and wound healing and increased pulmonary complications. Laparoscopic surgeries provide major benefits with faster recovery time, reduced postoperative pain and reduced hospital stay. Laparoscopic surgeries, require the creation of pneumoperitoneum using carbon dioxide along with patient positioning (Trendelenburg or reverse Trendelenburg) which causes physiologic changes which can be deleterious to patients with preexisting diseases. The changes occurring during laparoscopy can be attenuated using various drugs like vasodilating agents, alpha2 adrenergic agonists, opioids and beta blocking agents. This study was done to compare the efficacy of low dose infusion of dexmedetomidine using different strengths on attenuating the hemodynamic responses occurring in laparoscopic cholecystectomy. Sixty patients between 18 and 60 years of either sex belonging to ASAMethodology: grade 1 and 2 scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allotted to one of the two groups of 30 each. Group DEX 0.2 received Dexmedetomidine at 0.2mcg/kg/hour and Group DEX 0.4 received Dexmedetomidine at 0.4mcg/kg/hour 15 minutes prior to induction. Haemodynamic variables were recorded at baseline, post intubation, aftercreation of pneumoperitoneum and after extubation. Other parameters noted were VAS score, RSS score and time to first supplementation of rescue analgesic. In both the groups there was a rise in theResults: mean arterial pressure and heart rate post intubation and after creation of pneumoperitoneum from the baseline. But the rise was considerably lower in DEX 0.4 group. After 30 minutes of pneumoperitoneum, there was a considerable fall in the heart rate and mean arterial pressure in the DEX 0.4 group. There was no difference in the time for extubation in both the groups. The postoperative analgesic requirements were lesser in DEX0.4 group. No significant side effects were noted. Low dose dexmedetomidine as an infusion started 15 minutes prior to induction does notConclusion: completely attenuate the stress response to intubation and pneumoperitoneum. In comparison, o.4mcg/kg/hour of Dexmedetomidine provides better response than 0.2mcg/kg/hour.
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