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Anesthesia Thesis Topics For MD/DNB

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• Effects of intravenous dexmedetomidine in patients receiving 0 5% hyperbaric bupivacaine spinal asaesthesia.
• A comparative study of patient controlled epidural analgesia vs continous epidural infusion in labour analgesia using ropivacaine with fentanyl.
• To study correlation of extravascular lung water and compliance of lung in mechanicaly ventilated patients in ICU of a tertiary care centre.
• Combination of ropivacaine and dexmedetomidine for supraclavicular brachial plexus block using ultrasound and nerve stimulator guided technique: An intervention study to determine the effective volume.
• Comparison of efficacy of sedation with dexmedetomidine plus ketamine and propofol plus fentanyl in adult patients undergoing out-patient colonoscopy.
• To study the correlation between cerebral,rSO2 and outcomes in severe head injury cases.
• Comparision of dexmedetomidine and ketamine vs propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterisation lab.
• To compare the analgesic efficacy of continuous femoral nerve block (CFNB) with local anaesthetic through a catheter versus patient controlled analgesia with intravenous morphine after total knee arthroplasty.
• Correlation between centrally versus peripherally transduced venous pressure in patients undergoing craniotomy.
• To study the incidence and risk factors of post-operative sore throat in patients undergoing elective surgeries under general anaesthesia with endotracheal tube.
• A comparative study of scoring systems used to predict difficult airway.
• An assessment of satisfaction of family members of patients admitted in the ICU.
• Comparative study of IV dexmedetomidine vs IV midazolam for sedation during tympanoplasty and modified plasty and modified radical mastoidectomy.
• Comparison between epidural tramadol and fentanyl for post operative analgesia.
• The efficacy of dexmedetomidine as an adjuvant in brachial plexus block by supraclavicular approach with 0.25% bupivacaine.
• Effect of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with 05% hyperbaric bupivacaine.
• Effects of IV dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries.
• Comparison of haemodynamic changes of proseal LMA and endotracheal tube for laparoscopic surgeries.
• Comparative study of intrathecal isobaric 0.5% bupivacaine and isobaric 0.75% ropivacaine for lower abdominal and lower limb surgeries.
• Comparison of recovery characteristics of desflurane, sevoflurane and propofol in patients undergoing laparoscopic cholecystectomy.
• Effect of preoperative intramuscular morphine injection for post operative analgesia in patients undergoing joint replacement surgery.
• Evaluation of efficacy of tranversus abdominis plane block for post operative analgesia in patients undergoing total abdominal hysterectomy.
• A comparative study between ropivacaine with fentanyl versus bupivacaine with fentanyl for post operative epidural analgesia in patients undergoing elective lower abdominal and lower limb surgeries.
• To compare the effect of preloading with 6% (HES) hexaethyl starch versus intravenous ephedrine for the prevention of hypotension following spinal anesthesia for parturients undergoing caesarean section.
• Comparative study of dexmedetomidine and lignocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation.
• Effect of addition of intrathecal fentanyl to hyperbaric bupivacaine (0.5%) for casearean section.
• Comparative study of the intubating conditions and cardiovascular effects following succinylcholine and rocuronium in adult elective surgical patients.
• Attenuation of the circulatory responses to endotracheal intubation with preinduction intravenous labetalol.
• Comparative evaluation of bupivacaine and bupivacaine with dexmedetomidine in subarachnoid block.
• Comparative evaluation of thiopentone sodium and propofol for electro convulsive therapy.
• Comparative study of 0.5% lignocaine with dexmedetomidine and 0.5% lignocaine in intravenous regional anaesthesia.
• Comparison of efficacy of levobupivacaine and clonidine with bupivacaine and clonidine in spinal anaesthesia for lower segment caesarean section.
• A comparative study of intrathecal dexmedetomidine and fentanyl as an adjuvant to bupivacaine.
• Comparision of bupivacaine,bupivacaine plus clonidine, bupivacaine plus dexmeditomedine intrathecally in lower abdominal surgeries.
• The effects of ephedrine infusion for the prevention of hypotension during spinal anaesthesia for elective lower segment caesarean section.
• The comparative study of epidural anaesthesia between isobaric ropivacaine 0.5% and isobaric bupivacaine 0.5% for lower abdominal surgeries in tertiary care institute.
• A comparative study on effect of adding dexmedetomidine and dexamethasone to local anaesthetics in brachial plexus block.
• A randomised study on the efficacy of ketamine and pethidine in the treatment of postoperative shivering in patients undergoing general anaesthesia.
• A double blinded randomized control trial to compare hyperbaric ropivacaine (18 mg) with hyperbaric bupivacaine (18 mg) for spinal anaesthesia in lower limb orthopedic surgeries.
• Comparative evaluation of addition of dexamethasone to two different local anaesthetics in supraclavicular brachial plexus block
• Comparative study of propofol versus ketamine as inducing agent on hemodynamic and seizure activity in modified electroconvulsive therapy.
• Prevention of sevoflurane related emergence agitation in children undergoing general anaesthesia : a comparison study between dexmedetomidine and propofol.
• A comparative study of hernial block versus subarachanoid block for elective inguinal hernia repair.
• Effect of dexmedetomidine in supraclavicular brachial plexus block as an adjuvent : A comparative study.
• Mechanical complications during insertion of central venous catheter in subclavian vein and internal jugular vein – A comparitive study.
• Comparison of ambu laryngeal mask airway with soft seal laryngeal mask airway during routine surgical procedure.
• Study of efficacy of dexmethasone as preemptive analgesic in patients undergoing total abdominal hysterectomy under spinal anaesthesia.
• A clinical assessment of macintosh,miller blades and king visionTM video laryngoscope for laryngeal exposure and difficulty in endotracheal intubation.
• Comparison of two doses of dexmedetomidine combined with ketamine for anesthesia in dilatation and curettage.
• Evaluation of effect of low dose of intravenous dexmedetomidine supplementation on sensory and motor blockade produced by intrathecal hyperbaric bupivacaine.
• Comparison of the effects of lateral and sitting position during induction of spinal anaesthesia with plain levobupivacaine in cesarean section.
• Comparitive study of bupivacaine with dexmedetomidine and bupivacaine alone in supraclavicular brachial plexus block.
• A comparative study of propofol and thiopentone with local anaesthetic spray as inducing agents for I gel insertion.
• A comparative study of perioperative effects of preemptive dose of dexamethasone versus clonidine in lower abdominal surgeries under spinal anaesthesia.
• Intravenous dexmedetomidine vs. intravenous clonidine to prolong bupivacaine spinal anesthesia.
• Comparative study of the effect of IV ketamine and IV tramadol for control of shivering in cases of caesarean section under spinal anaesthesia.
• Comparison of inj. Lignocaine (preservative free) 1.5mg/kg IV with oral pregabalin 150 mg for attenuation of haemodyanamic response to laryngoscopy and tracheal intubation.
• Comparative study of supraclavicular block using bupivacaine with perineural dexamethasone, bupivacaine with I.V. dexamethasone and bupivacaine only.
• Comparative study of intrathecal bupivacaine with fentanyl and intrathecal bupivacaine with clonidine for quality of anaesthesia and duration of post operative pain relief in patients undergoing lower abdominal and lower limb surgeries.
• A comparison of efficacy of pre-emptive analgesia with three small doses of N-Methyl-D- aspartate antagonist ketamine for improving post operative analgesia after laparoscopic surgeries,
• A study of perioperative airway and respiratory complications in children undergoing cleft lip and palate repair.
• Identification of risk factors for hypotension after spinal anaesthesia in patients undergoing casarean section.
• Use of McCoy and truview laryngoscope blades for intubation in patients with anticipated difficult airway with respect to ease of intubation and haemodynamic response.
• Audit of perioperative complication of patients unergoing turp surgeries :: an anaesthetist’s perspective.
• An audit of blood and blood products transfusion practices in elective spine surgery.
• The type of anaesthesia and outcome in preeclamptic patients undergoing caesarean section an observational study.
• Comparison of palonosetron, ondansetron, and metoclopramide in controlling post operative nausea and vomiting in obstetrical and gynaecological surgeries.
• Comparison between intranasal dexmedetomidine and intranasal midazolam for preanaesthetic sedation in children.
• Comparison between 0.125% bupivacaine and 0.125% ropivacaine for epidural analgesia during labour.
• Dexamethasone as an adjuvant to local anaesthetic in supra clavicular block a comparitive study.
• Observational study of hemodynamic effects of etomidate and propofol used as induction agents in patients planned for off pump cabg
• An observational study to compare the haemodynamic parameters following spinal anaesthesia with hyperbaric bupivacaine in hypertensive and normotensive patients.
• Correlation of leak around uncuffed endotracheal tube and postoperative morbidity in children: an observational study.
• A cross-sectional observational analysis of preoperative blood glucose levels in patients presenting for surgery.
• Monitoring of depth of anaesthesia using entropy monitor during cardiopulmonary bypass-a prospective study.
• An evaluation of procedural sedation techniques in duchenne muscular dystrophy patients undergoing stem cell therapy.
• Anaesthesia risk stratifaction: comparison between silverman-holt aggregate preoperative evaluation (SHAPE) and american society of anaesthesiologists physical status (ASA PS) evaluation systems.
• Efficacy of spinal anaesthesia for laparoscopic ventral hernia repair
• Comparative study of nalbuphine vs. pentazocine for postoperative analgesia.
• Comparative study of intrathecal isobaric levobupivacaine versus hyperbaric bupivacaine in lower abdominal surgery.
• Comparative study of 0.5% (heavy) intrathecal bupivacaine alone with 0.5% (heavy) intrathecal bupivacaine midazolam combination in patients undergoing elective inguinal hernia repair.
• Comparative evaluation of induction with propofol and sevoflurane for insertion of laryngeal mask airway in children.
• Hemodynamic behaviour,ECG changes and postoperative outcome of hypertensive and normotensive patients under spinal anaesthesia.
• The comparision of single bolus dose of dexmedetomidine with bolus plus infusion of dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine.
• Evaluation of airway and predicting difficult endo- tracheal intubation in diabetic patients -A comparison with non diabetic patients.
• Observational study for dose-response characteristics of intrathecal hyperbaric bupivacaine(0.5%) by using sequential combined spinal epidural anesthesia (SCSEA) in patients aged over sixty year for orthopedic surgeries.
• A comparison of thyromental height with the ratio of patient’s height to thyromental distance and the upper lip bite test in predicting difficult laryngoscopy.
• A comparetive study of arterial PH and chloride levels following 6% HES 130/0.4 saline solution or 6% HES 130/0.4 balanced solution used during cardiac surgery involving cardiopulmonary bypass.
• A prospective study to compare efficacy of interlaminar vs caudal epidural steroids in chronic lower back pain.
• A prospective comparative study of ondansetron against tramadol pretreatment to reduce pain on injection of propofol.
• A comparative study between clinical efficacies of levobupivacain plain and levobupivacaine with fentanyl for urological surgeries under subarachnoid block.
• A comparison of the efficacy of fentanyl and clonidine for attenuation of pressor response to endotracheal intubation.
• Pre treatment with intravenous granisetron to alleviate pain on propofol injection: A double blind randomised controlled study using normal saline as control.
• Randomised prospective study of comparison of USG guided subcostal transversus abdominis plane block techinque (sta block) versus conventional port site infiltration techinque used in laparoscopic cholecystectomy for post operative analgesia.
• Correlation of bispectral index with depth of sedation: A comparison between dexmedetomidine versus propofol in patients undergoing infraumabilical surgery under subarachnoid block.
• Ultrasonographic measurement of optic nerve sheath diameter to detect raised intracranial pressure in head injury patients in ICU and its correlation with CT scan findings.
• Comparison between palonosetron and granisetron in prevention of postoperative nausea and vomiting (PONV) in elective laparoscopic surgeries under general anaesthesia.
• A comparison of upper Lip Bite Test with modified mallampati classification in predicting difficulty in endotracheal intubation.
• Effect of dexmedetomidine hydrochloride as an adjuvant to lignocaine hydrochlorid for intravenous regional anaesthesia.
• Postoperative nausea and vomiting -prophylaxis with palonosetron hydrochloride.
• Comparison of dexmedetomidine and midazolam for sedation in post -operative surgical patients.
• Study of hemodynamic changes during laparoscopic surgery using non-invasive cardiac output monitor (NICOM) Low flow anaesthesia : a prospective observational study.

Disclaimer!

There are many methods of sample size determination. It is one of the first hurdle when someone starts writing a thesis. I have tried to give simplest way of determination of sample size. You need to show the method to your PG teacher before you include this method in your thesis. First confirm from your PG teacher and then only proceed.

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Anesthesiology Thesis/Dissertation Topics for MD/DNB

1.      Effects of intravenous dexmedetomidine in patients receiving 0 5% hyperbaric bupivacaine spinal asaesthesia.

2.      A comparative study of patient controlled epidural analgesia vs continous epidural infusion in labour analgesia using ropivacaine with fentanyl.

3.      To study correlation of extravascular lung water and compliance of lung in mechanicaly ventilated patients in ICU of a tertiary care centre.

4.      Combination of ropivacaine and dexmedetomidine for supraclavicular brachial plexus block using ultrasound and nerve stimulator guided technique: An intervention study to determine the effective volume.

5.      Comparison of efficacy of sedation with dexmedetomidine plus ketamine and propofol plus fentanyl in adult patients undergoing out-patient colonoscopy.

6.      To study the correlation between cerebral,rSO2 and outcomes in severe head injury cases.

7.      Comparision of dexmedetomidine and ketamine vs propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterisation lab.

8.      To compare the analgesic efficacy of continuous femoral nerve block (CFNB) with local anaesthetic through a catheter versus patient controlled analgesia with intravenous morphine after total knee arthroplasty.

9.      Correlation between centrally versus peripherally transduced venous pressure in patients undergoing craniotomy.

10.   To study the incidence and risk factors of post-operative sore throat in patients undergoing elective surgeries under general anaesthesia with endotracheal tube.

11.   A comparative study of scoring systems used to predict difficult airway.

12.   An assessment of satisfaction of family members of patients admitted in the ICU.

13.   Comparative study of IV dexmedetomidine vs IV midazolam for sedation during tympanoplasty and modified plasty and modified radical mastoidectomy.

14.   Comparison between epidural tramadol and fentanyl for post operative analgesia.

15.   The efficacy of dexmedetomidine as an adjuvant in brachial plexus block by supraclavicular approach with 0.25% bupivacaine.

16.   Effect of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with 05% hyperbaric bupivacaine.

17.   Effects of IV dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries.

18.   Comparison of haemodynamic changes of proseal LMA and endotracheal tube for laparoscopic surgeries.

19.   Comparative study of intrathecal isobaric 0.5% bupivacaine and isobaric 0.75% ropivacaine for lower abdominal and lower limb surgeries.

20.   Comparison of recovery characteristics of desflurane, sevoflurane and propofol in patients undergoing laparoscopic cholecystectomy.

21.   Effect of preoperative intramuscular morphine injection for post operative analgesia in patients undergoing joint replacement surgery.

22.   Evaluation of efficacy of tranversus abdominis plane block for post operative analgesia in patients undergoing total abdominal hysterectomy.

23.   A comparative study between ropivacaine with fentanyl versus bupivacaine with fentanyl for post operative epidural analgesia in patients undergoing elective lower abdominal and lower limb surgeries.

24.   To compare the effect of preloading with 6% (HES) hexaethyl starch versus intravenous ephedrine for the prevention of hypotension following spinal anesthesia for parturients undergoing caesarean section.

25.   Comparative study of dexmedetomidine and lignocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation.

26.   Effect of addition of intrathecal fentanyl to hyperbaric bupivacaine (0.5%) for casearean section.

27.   Comparative study of the intubating conditions and cardiovascular effects following succinylcholine and rocuronium in adult elective surgical patients.

28.   Attenuation of the circulatory responses to endotracheal intubation with preinduction intravenous labetalol.

29.   Comparative evaluation of bupivacaine and bupivacaine with dexmedetomidine in subarachnoid block.

30.   Comparative evaluation of thiopentone sodium and propofol for electro convulsive therapy.

31.   Comparative study of 0.5% lignocaine with dexmedetomidine and 0.5% lignocaine in intravenous regional anaesthesia.

32.   Comparison of efficacy of levobupivacaine and clonidine with bupivacaine and clonidine in spinal anaesthesia for lower segment caesarean section.

33.   A comparative study of intrathecal dexmedetomidine and fentanyl as an adjuvant to bupivacaine.

34.   Comparision of bupivacaine,bupivacaine plus clonidine, bupivacaine plus dexmeditomedine intrathecally in lower abdominal surgeries.

35.   The effects of ephedrine infusion for the prevention of hypotension during spinal anaesthesia for elective lower segment caesarean section.

36.   The comparative study of epidural anaesthesia between isobaric ropivacaine 0.5% and isobaric bupivacaine 0.5% for lower abdominal surgeries in tertiary care institute.

37.   A comparative study on effect of adding dexmedetomidine and dexamethasone to local anaesthetics in brachial plexus block.

38.   A randomised study on the efficacy of ketamine and pethidine in the treatment of postoperative shivering in patients undergoing general anaesthesia.

39.   A double blinded randomized control trial to compare hyperbaric ropivacaine (18 mg) with hyperbaric bupivacaine (18 mg) for spinal anaesthesia in lower limb orthopedic surgeries.

40.   Comparative evaluation of addition of dexamethasone to two different local anaesthetics in supraclavicular brachial plexus block

41.   Comparative study of propofol versus ketamine as inducing agent on hemodynamic and seizure activity in modified electroconvulsive therapy.

42.   Prevention of sevoflurane related emergence agitation in children undergoing general anaesthesia : a comparison study between dexmedetomidine and propofol.

43.   A comparative study of hernial block versus subarachanoid block for elective inguinal hernia repair.

44.   Effect of dexmedetomidine in supraclavicular brachial plexus block as an adjuvent : A comparative study.

45.   Mechanical complications during insertion of central venous catheter in subclavian vein and internal jugular vein – A comparitive study.

46.   Comparison of ambu laryngeal mask airway with soft seal laryngeal mask airway during routine surgical procedure.

47.   Study of efficacy of dexmethasone as preemptive analgesic in patients undergoing total abdominal hysterectomy under spinal anaesthesia.

48.   A clinical assessment of macintosh,miller blades and king visionTM video laryngoscope for laryngeal exposure and difficulty in endotracheal intubation.

49.   Comparison of two doses of dexmedetomidine combined with ketamine for anesthesia in dilatation and curettage.

50.   Evaluation of effect of low dose of intravenous dexmedetomidine supplementation on sensory and motor blockade produced by intrathecal hyperbaric bupivacaine.

51.   Comparison of the effects of lateral and sitting position during induction of spinal anaesthesia with plain levobupivacaine in cesarean section.

52.   Comparitive study of bupivacaine with dexmedetomidine and bupivacaine alone in  supraclavicular brachial plexus block.

53.   A comparative study of propofol and thiopentone with local anaesthetic spray as inducing agents for I gel insertion.

54.   A comparative study of perioperative effects of preemptive dose of dexamethasone versus clonidine in lower abdominal surgeries under spinal anaesthesia.

55.   Intravenous dexmedetomidine vs. intravenous clonidine to prolong bupivacaine spinal anesthesia.

56.   Comparative study of the effect of IV ketamine and IV tramadol for control of shivering in cases of caesarean section under spinal anaesthesia.

57.   Comparison of inj. Lignocaine (preservative free) 1.5mg/kg IV with oral pregabalin 150 mg for attenuation of haemodyanamic response to laryngoscopy and tracheal intubation.

58.   Comparative study of supraclavicular block using bupivacaine with perineural dexamethasone, bupivacaine with I.V. dexamethasone and bupivacaine only.

59.   Comparative study of intrathecal bupivacaine with fentanyl and intrathecal bupivacaine with clonidine for quality of anaesthesia and duration of post operative pain relief in patients undergoing lower abdominal and lower limb surgeries.

60.   A comparison of efficacy of pre-emptive analgesia with three small doses of N-Methyl-D- aspartate antagonist ketamine for improving post operative analgesia after laparoscopic surgeries,

61.   A study of perioperative airway and respiratory complications in children undergoing cleft lip and palate repair.

62.   Identification of risk factors for hypotension after spinal anaesthesia in patients undergoing casarean section.

63.   Use of McCoy and truview laryngoscope blades for intubation in patients with anticipated difficult airway with respect to ease of intubation and haemodynamic response.

64.   Audit of perioperative complication of patients unergoing turp surgeries :: an anaesthetist’s perspective.

65.   An audit of blood and blood products transfusion practices in elective spine surgery.

66.   The type of anaesthesia and outcome in preeclamptic patients undergoing caesarean  section an observational study.

67.   Comparison of palonosetron, ondansetron, and metoclopramide in controlling post operative nausea and vomiting in obstetrical and gynaecological surgeries.

68.   Comparison between intranasal dexmedetomidine and intranasal midazolam for preanaesthetic sedation in children.

69.   Comparison between 0.125% bupivacaine and 0.125% ropivacaine for epidural analgesia during labour.

70.   Dexamethasone as an adjuvant to local anaesthetic in supra clavicular block a  comparitive study.

71.   Observational study of hemodynamic effects of etomidate and propofol used as induction agents in patients planned for off pump cabg

72.   An observational study to compare the haemodynamic parameters following spinal anaesthesia with hyperbaric bupivacaine in hypertensive and normotensive patients.

73.   Correlation of leak around uncuffed endotracheal tube and postoperative morbidity in children: an observational study.

74.   A cross-sectional observational analysis of preoperative blood glucose levels in patients presenting for surgery.

75.   Monitoring of depth of anaesthesia using entropy monitor during cardiopulmonary bypass-a prospective study.

76.   An evaluation of procedural sedation techniques in duchenne muscular dystrophy patients undergoing stem cell therapy.

77.   Anaesthesia risk stratifaction: comparison between silverman-holt aggregate preoperative evaluation (SHAPE) and american society of anaesthesiologists physical status (ASA PS) evaluation systems.

78.   Efficacy of spinal anaesthesia for laparoscopic ventral hernia repair

79.   Comparative study of nalbuphine vs. pentazocine for postoperative analgesia.

80.   Comparative study of intrathecal isobaric levobupivacaine versus hyperbaric bupivacaine in lower abdominal surgery.

81.   Comparative study of 0.5% (heavy) intrathecal bupivacaine alone with 0.5% (heavy) intrathecal bupivacaine midazolam combination in patients undergoing elective inguinal hernia repair.

82.   Comparative evaluation of induction with propofol and sevoflurane for insertion of laryngeal mask airway in children.

83.   Hemodynamic behaviour,ECG changes and postoperative outcome of hypertensive and normotensive patients under spinal anaesthesia.

84.   The comparision of single bolus dose of dexmedetomidine with bolus plus infusion of  dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine.

85.   Evaluation of airway and predicting difficult endo- tracheal intubation in diabetic patients -A comparison with non diabetic patients.

86.   Observational study for dose-response characteristics of intrathecal hyperbaric bupivacaine(0.5%) by using sequential combined spinal epidural anesthesia (SCSEA) in patients aged over sixty year for orthopedic surgeries.

87.   A comparison of thyromental height with the ratio of patient’s height to thyromental distance and the upper lip bite test in predicting difficult laryngoscopy.

88.   A comparetive study of arterial PH and chloride levels following 6% HES 130/0.4 saline solution or 6% HES 130/0.4 balanced solution used during cardiac surgery involving cardiopulmonary bypass.

89.   A prospective study to compare efficacy of interlaminar vs caudal epidural steroids in chronic lower back pain.

90.   A prospective comparative study of ondansetron against tramadol pretreatment to reduce pain on injection of propofol.

91.   A comparative study between clinical efficacies of levobupivacain plain and levobupivacaine with fentanyl for urological surgeries under subarachnoid block.

92.   A prospective study to compare efficacy of interlaminar vs caudal epidural steroids in chronic lower back pain.

93.   A comparison of the efficacy of fentanyl and clonidine for attenuation of pressor response to endotracheal intubation.

94.   Pre treatment with intravenous granisetron to alleviate pain on propofol injection: A double blind randomised controlled study using normal saline as control.

95.   Randomised prospective study of comparison of USG guided subcostal transversus abdominis plane block techinque (sta block) versus conventional port site infiltration techinque used in laparoscopic cholecystectomy for post operative analgesia.

96.   Correlation of bispectral index with depth of sedation: A comparison between dexmedetomidine versus propofol in patients undergoing infraumabilical surgery under subarachnoid block.

97.   Ultrasonographic measurement of optic nerve sheath diameter to detect raised intracranial pressure in head injury patients in ICU and its correlation with CT scan findings.

98.   Comparison between palonosetron and granisetron in prevention of postoperative nausea and vomiting (PONV) in elective laparoscopic surgeries under general anaesthesia.

99.            A comparison of upper Lip Bite Test with modified mallampati classification in predicting difficulty in endotracheal intubation.

100.          Effect of dexmedetomidine hydrochloride as an adjuvant to lignocaine hydrochlorid for intravenous regional anaesthesia.

101.           Comparison between palonosetron and granisetron in prevention of postoperative nausea and vomiting (PONV) in elective laparoscopic surgeries under general anaesthesia.

102.           A comparison of upper Lip Bite Test with modified mallampati classification in predicting difficulty in endotracheal intubation.

103.           Postoperative nausea and vomiting -prophylaxis with palonosetron hydrochloride.

104.           Comparison of dexmedetomidine and midazolam for sedation in post -operative surgical patients.

105.           Study of hemodynamic changes during laparoscopic surgery using non-invasive cardiac output monitor (NICOM) Low flow anaesthesia : a prospective observational study.

106.           Intraperitoneal instillation of ropivacaine compared with bupivacaine for post operative analgesia after laparoscopic procedures.

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Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019

• Published: 22 August 2021
• Volume 126 , pages 8749–8759, ( 2021 )

Cite this article

• S. G. Grace   ORCID: orcid.org/0000-0001-7583-717X 1 ,
• F. S. S. Wiepking   ORCID: orcid.org/0000-0002-3509-7549 1 &
• A. A. J. van Zundert   ORCID: orcid.org/0000-0002-1836-6831 1  

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Publication of research in anaesthesia is increasingly competitive. Understanding what topics of research are more likely to be published and where, is clearly valuable for authors seeking to optimise reach and impact of their work. This study aimed to identify the relative proportion of anaesthesia articles by topic for five anaesthesia journals over a 10-year period from 2010 to 2019, including any differences between journals and regions. We chose five anaesthesia journals based on current impact factor. All journal issues published between 2010–2019 were checked for total number of articles with only original research articles being further categorised by topic, country of research, funding status and citation count. Of 5782 original research articles analysed, the most frequent article topics published were translational studies (16%) and clinical practice (16%). Obstetric anaesthesia was the least frequent published (4%). Translational studies were the most frequently funded (84%) while articles on paediatric anaesthesia were least frequently funded (29%). The average number of citations per funded article was 37 versus 28 for non-funded articles. Translational studies were the most frequently published topic of research conducted in North America (25%) and Asia (25%), but of only average frequency in Europe (9%). Studies in obstetric and paediatric anaesthesia are less well-represented in anaesthesia literature and researchers may experience greater difficulty publishing these topics and obtaining funding accordingly. Authors should be aware of the diverse publishing tendencies of the different journals in anaesthesia in order to save time and effort when submitting research for publication.

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Abbreviations

British Journal of Anaesthesia

European Journal of Anaesthesiology

Regional Anesthesia and Pain Medicine

High-income country

Low/middle-income country

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Acknowledgements

Many thanks to Rachel Ling and Aakanksha Sahu for their assistance with the original data collection.

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Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Brisbane and the University of Queensland, NHB, Butterfield St, Herston, Brisbane, QLD, 4006, Australia

S. G. Grace, F. S. S. Wiepking & A. A. J. van Zundert

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Samuel Grace: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft; Floris Wiepking: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft; André Van Zundert: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft.

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Grace, S.G., Wiepking, F.S.S. & van Zundert, A.A.J. Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019. Scientometrics 126 , 8749–8759 (2021). https://doi.org/10.1007/s11192-021-04129-0

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Received : 24 May 2021

Accepted : 05 August 2021

Published : 22 August 2021

Issue Date : October 2021

DOI : https://doi.org/10.1007/s11192-021-04129-0

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Establishment and validation of a predictive model for tracheotomy in critically ill patients and analysis of the impact of different tracheotomy timing on patient prognosis

In critically ill patients receiving invasive mechanical ventilation (IMV), it is unable to determine early which patients require tracheotomy and whether early tracheotomy is beneficial.

The 90% effective dose (ED90) of remimazolam for inhibiting responses to the insertion of a duodenoscope during ERCP

Compared to midazolam, remimazolam has a faster onset and offset of hypnotic effect, as well as cardiorespiratory stability, this study aims to determine the 90% effective dose (ED90) of remimazolam to inhibit...

Anaesthesia management of a patient with Bethlem Myopathy for elective tonsillectomy: a case report

Bethlem Myopathy is a collagen VI-related myopathy presenting as a rare hereditary muscular disorder with progressive muscular weakness and joint contractures. Despite its milder clinical course relative to ot...

Effects of perioperative low-dose naloxone on the immune system in patients undergoing laparoscopic-assisted total gastrectomy: a randomized controlled trial

Low immune function after laparoscopic total gastrectomy puts patients at risk of infection-related complications. Low-dose naloxone (LDN) can improve the prognosis of patients suffering from chronic inflammat...

Indirect calorimetry directed feeding and cycling in the older ICU population: a pilot randomised controlled trial

Older critically ill patients experience rapid muscle loss during stay in an intensive care unit (ICU) due to physiological stress and increased catabolism. This may lead to increased ICU length of stay, delay...

Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery

Dynamic fluctuations of arterial blood pressure known as blood pressure variability (BPV) may have short and long-term undesirable consequences. During surgical procedures blood pressure is usually measured in...

Anesthetic management for cesarean section in two parturient with ascending aortic aneurysm: a case-based discussion

The anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for aortic dissection or aneurysm rupture.

Remote ischemic conditioning may improve graft function following kidney transplantation: a systematic review and meta-analysis with trial sequential analysis

Remote ischemic conditioning (RIC) has the potential to benefit graft function following kidney transplantation by reducing ischemia-reperfusion injury; however, the current clinical evidence is inconclusive. ...

Substance specific EEG patterns in mice undergoing slow anesthesia induction

The exact mechanisms and the neural circuits involved in anesthesia induced unconsciousness are still not fully understood. To elucidate them valid animal models are necessary. Since the most commonly used spe...

Airway management and pulmonary aspiration during surgical interventions in pregnant women in the 2nd/3rd trimester and immediate postpartum – a retrospective study in a tertiary care university hospital

Pregnancy is associated with an increased risk of pulmonary aspiration during general anaesthesia, but the incidence of this complication is not well defined.

My anesthesia Choice-HF: development and preliminary testing of a tool to facilitate conversations about anesthesia for hip fracture surgery

Patients often desire involvement in anesthesia decisions, yet clinicians rarely explain anesthesia options or elicit preferences. We developed My Anesthesia Choice-Hip Fracture, a conversation aid about anest...

Role of preoperative zinc, magnesium and budesonide gargles in Postoperative Sore Throat (POST) - a randomised control trial

Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of...

Effect of intravenous anesthetic drugs on fertilization rate in oocyte retrieval

The purpose of this study was to investigate the effects of intravenous anesthetic drugs on fertilization rate in subjects receiving oocyte retrieval by assisted reproduction technology (ART).

Lidocaine effects on neutrophil extracellular trapping and angiogenesis biomarkers in postoperative breast cancer patients with different anesthesia methods: a prospective, randomized trial

Anesthesia techniques and drug selection may influence tumor recurrence and metastasis. Neutrophil extracellular trapping (NETosis), an immunological process, has been linked to an increased susceptibility to ...

Predictive value of S100B and brain derived neurotrophic factor for radiofrequency treatment of lumbar disc prolapse

This work aimed to analyze serum S100B levels and brain-derived neurotrophic factor (BDNF) in patients with lumbar disc prolapse to test their predictive values concerning the therapeutic efficacy of pulsed ra...

Correction: Evaluation the quality of bag-mask ventilation by E/C, T/E and hook technique (a new proposed technique)

The original article was published in BMC Anesthesiology 2023 23 :384

Continuous serratus posterior superior intercostal plane block for postoperative analgesia management in the patient who underwent right atrial mass excision: a case report

Serratus posterior intercostal plane block (SPSIPB) is a novel periparavertebral block. It provides anterolateral posterior chest wall analgesia. It is an interfascial plane block, performed under ultrasound g...

Impact of sarcopenia in elderly patients undergoing elective total hip arthroplasty on postoperative outcomes: a propensity score-matched study

Frailty poses a crucial risk for postoperative complications in the elderly, with sarcopenia being a key component. The impact of sarcopenia on postoperative outcomes after total hip arthroplasty (THA) is stil...

Determinants of difficult laryngoscopy based on upper airway indicators: a prospective observational study

The main cause of anesthesia-related deaths is the failure to manage difficult airways. Difficult laryngoscopic exposure is a major cause of unsuccessful management of difficult airways. Inadequate preoperativ...

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a sin...

Optimizing nicardipine dosage for effective control of pituitrin-induced hypertension in laparoscopic myomectomy undergoing total intravenous anesthesia

This study aimed to determine the median effective dose (ED50) and 95% effective dose (ED95) of nicardipine for treating pituitrin-induced hypertension during laparoscopic myomectomy, providing guidance for th...

Perioperative serum syndecan-1 concentrations in patients who underwent cardiovascular surgery with cardiopulmonary bypass and its association with the occurrence of postoperative acute kidney injury: a retrospective observational study

Various factors can cause vascular endothelial damage during cardiovascular surgery (CVS) with cardiopulmonary bypass (CPB), which has been suggested to be associated with postoperative complications. However,...

Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial

Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cerv...

Comparison of bicarbonate Ringer’s solution with lactated Ringer’s solution among postoperative outcomes in patients with laparoscopic right hemihepatectomy: a single-centre randomised controlled trial

The study was aimed to investigate the positive impact of bicarbonate Ringer’s solution on postoperative outcomes in patients who underwent laparoscopic right hemihepatectomy. Patients in the two groups were i...

Effect of converting from propofol to remimazolam with flumazenil reversal on recovery from anesthesia in outpatients with mental disabilities: a randomized controlled trial

General anesthesia is often necessary for dental treatment of outpatients with mental disabilities. Rapid recovery and effective management of postoperative nausea and vomiting (PONV) are critical for outpatie...

Double lumen endobronchial tube intubation: lessons learned from anatomy

Double lumen endobronchial tubes (DLTs) are frequently used to employ single lung ventilation strategies during thoracic surgical procedures. Placement of these tubes can be challenging even for experienced cl...

50% efficacy dose of intravenous lidocaine in supressing sufentanil-induced cough in children: a randomised controlled trial

Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidoc...

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High-impact papers in the field of anesthesiology: a 10-year cross-sectional study

Affiliations.

• 1 Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.
• 2 Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China.
• 3 Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China. [email protected].
• 4 Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China. [email protected].
• 5 Department of Periodical Press and National Clinical Research Center for Geriatrics & Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China. [email protected].
• PMID: 36418743
• PMCID: PMC9684867
• DOI: 10.1007/s12630-022-02363-5

Abstract in English, French

Purpose: This study was performed to evaluate trends in and provide future direction for anesthesiology education, research, and clinical practice.

Methods: We collected high-impact papers, ranking in the top 10% in the field of anesthesiology and published from 2011 to 2020, by the InCites tool based on the Web of Science Core Collection. We analyzed the trends, locations, distribution of subject categories, research organizations, collaborative networks, and subject terms of these papers.

Results: A total of 4,685 high-impact papers were included for analysis. The number of high-impact papers increased from 462 in 2011 to 520 in 2020. The paper with the highest value of category normalized citation impact (115.95) was published in Anesthesia and Analgesia in 2018. High-impact papers were mainly distributed in the subject categories of "Anesthesiology," "Clinical Neurology," "Neurosciences," and "Medicine General Internal." They were primarily cited in "Anesthesiology," "Clinical Neurology," "Neurosciences," "Medicine General Internal," and "Surgery." Most of these high-impact papers came from the USA, UK, Canada, Germany, and Australia. The most productive institutions were the League of European Research Universities, Harvard University, University of Toronto, University of London, University of California System, and University Health Network Toronto. Research collaboration circles have been formed in the USA, UK, and Canada. Subject-term analysis indicated postoperative analgesia, chronic pain, and perioperative complications were high-interest topics, and COVID-19 became a new hot topic in 2020.

Conclusions: The current study provides a historical view of high-impact papers in anesthesiology in the past ten years. High-impact papers were mostly from the USA. Postoperative analgesia, chronic pain, and perioperative complications have been hot topics, and COVID-19 became a new topic in 2020. These findings provide references for education, research, and clinical practice in the field of anesthesiology.

RéSUMé: OBJECTIF: Cette étude a été réalisée pour évaluer les tendances et fournir une orientation future à l’enseignement, la recherche et la pratique clinique en anesthésiologie. MéTHODE: Nous avons colligé des articles à fort impact, classés dans le top 10 % dans le domaine de l’anesthésiologie et publiés de 2011 à 2020, par l’outil InCites basé sur la Web of Science Core Collection. Nous avons analysé les tendances, les emplacements, la répartition des catégories de sujets, les organismes de recherche, les réseaux de collaboration et les termes des sujets de ces articles. RéSULTATS: Au total, 4685 articles à fort impact ont été inclus pour analyse. Le nombre de manuscrits à fort impact est passé de 462 en 2011 à 520 en 2020. L’article ayant la valeur la plus élevée de l’impact normalisé des citations de catégorie (CNCI) (115,95) a été publié dans la revue Anesthesia and Analgesia en 2018. Les articles à fort impact ont été principalement distribués dans les catégories de thèmes « Anesthésiologie », « Neurologie clinique », « Neurosciences » et « Médecine générale interne ». Ils ont été principalement cités dans les catégories « Anesthésiologie », « Neurologie clinique », « Neurosciences », « Médecine générale interne » et « Chirurgie ». La plupart de ces articles à fort impact provenaient des États-Unis, du Royaume-Uni, du Canada, d’Allemagne et d’Australie. Les établissements les plus productifs étaient la League of European Research Universities, l’Université Harvard, l’Université de Toronto, l’Université de Londres, l’Université de Californie System et le University Health Network de Toronto. Des cercles de collaboration en recherche ont été formés aux États-Unis, au Royaume-Uni et au Canada. L’analyse des termes indiquait que l’analgésie postopératoire, la douleur chronique et les complications périopératoires étaient des sujets suscitant un fort intérêt, et la COVID-19 est devenue un nouveau sujet brûlant en 2020. CONCLUSION: La présente étude propose une vue historique des articles à fort impact en anesthésiologie au cours des dix dernières années. Les manuscrits à fort impact provenaient principalement des États-Unis. L’analgésie postopératoire, la douleur chronique et les complications périopératoires ont été des sujets d’actualité, et la COVID-19 est devenue un nouveau sujet en 2020. Ces résultats fournissent des références pour la formation, la recherche et la pratique clinique dans le domaine de l’anesthésiologie.

Keywords: InCites; anesthesiology; education; high-impact papers; research; visual analysis.

© 2022. Canadian Anesthesiologists' Society.

• Anesthesiology*
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• 82001130/National Natural Science Foundation of China
• 2021SCU12001/Post Doctor Research Project of Sichuan University
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• v.66(1); 2022 Jan

Comparing postgraduate anaesthesia education in India and abroad: Strengths and scope

Lalit mehdiratta.

Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India

Nandini M. Dave

1 Department of Anaesthesiology, NH-SRCC Children's Hospital, Keshavrao Khadye Marg, Mahalakshmi, Mumbai, Maharashtra, India

Neeru Sahni

2 Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India

Edward Johnson

3 Department of Anaesthesiology, Kanyakumari Government Medical College, Asaripallam, Kanyakumari, Tamil Nadu, India

Prasanna U Bidkar

4 Department of Anaesthesiology and Critical Care, Division of Neuroanaesthesiology, JIPMER, Puducherry, India

Anju Grewal

5 Department of Anaesthesiology, DMCH, Ludhiana, Punjab, India

The quality of training is a major contributor to workforce proficiency in healthcare, and there is a definite need to achieve a uniform level of knowledge and skill in medical education programmes. There is a paucity of literature comparing postgraduate anaesthesia medical education training structure and requirements across the globe. In a zeal to achieve uniform competencies and technical skills, the strengths and scope of training programmes need to be identified. In this article, we describe the core elements of postgraduate training in various countries while proposing an amalgamation of strengths of each programme and providing a roadmap to evolve further the competency-based comprehensive curriculum proposed by the National Medical Commission of India.

INTRODUCTION

The raging pandemic has made it crucial for nations to upgrade their healthcare infrastructure and workforce for effective health care delivery within their own country and across borders. One of the major contributors to workforce proficiency is the quality of training received during the postgraduate (PG) training programme. Anaesthesiologists have been catapulted to the forefront of all medical specialities in recent times, thus making it imperative for us to enhance the quality and uniformity of knowledge and skill development in medical education programmes.

Scientific literature comparing PG anaesthesia medical education training structure and requirements across the globe is scant, and it is indeed time to define the strengths and scope of PG training programmes to move towards uniform competencies and technical skills acquisition. Apart from core anaesthesiology technical skills, a lot of emphasis has been given to the inclusion of non-technical skills like team-work and communication into the curriculum.[ 1 ] The objective of writing this article is to compare various aspects of anaesthesiology PG education training structure between India as proposed by the National Medical Commission (NMC) of India and other major countries, so as to assist policymakers in adopting the strengths of anaesthesia training programmes across the globe, thereby empowering the Indian anaesthesia PG to deliver services efficiently anywhere across the world.

PG TRAINING CURRICULUM AND TEACHING METHODOLOGY

The latest guiding principles from NMC focus on a competency-based PG training programme in Anaesthesiology with specific learning objectives in theoretical knowledge, skill and attitude development.[ 2 ] NMC mandates that the training is well planned, supervised and delivered by well-trained teachers. The PG student learns the basic principles of safe and effective anaesthesia, to prevent and treat pain as well as the overall care of the surgical patient during a period of three years in which the first six months are for training in the management of uncomplicated cases and the selection of thesis topic with submission of the requisite protocol. During the next 18 months, the clinical experience broadens as the student learns the skills of performing and maintaining general as well as regional anaesthesia for the American Society of Anesthesiologists (ASA) grade I to V patients. In the last 12 months, thesis submission is mandatory at least six months before the final examination. Super speciality postings like cardiothoracic and vascular surgery, etc., should be covered, and there should be at least four months of intensive care unit (ICU) posting. Our PG training should expand to include extensive training in ICU and trauma triage units. The trainees also need to grasp management and organisation during pandemics.[ 3 ] Apart from the description of clinical rotations and goals of learning year-wise, a detailed syllabus covering the three domains has been proposed.

Cognitive domain: It pertains to the ability to demonstrate the knowledge of relevant anatomy, physiology, biochemistry, principles of physics, gas laws, pre-anaesthetic assessment, anaesthesia techniques, basic and advanced life support, neonatal resuscitation and trauma life support as per the latest guidelines. The student must learn about the history of anaesthesia; management of an unconscious patient; and understand the principles of ventilation, shock management, oxygen therapy, etc. Post-operative care, acute and chronic pain management, research methodology and basics of statistics, arterial blood gas analysis, rational use of blood and its components, tenets of sterilisation and infection control are also included. Principles and techniques of various anaesthetic procedures; care of terminally ill; the concept of auditing; reporting of critical incidents along with clinical trial and ethics; design of operation theatre (OT), ICU and hospital, etc., are also to be imparted.

Affective domain: The trainee needs to learn methods of effective communication with colleagues, patients, their families and other health personnel.

Psychomotor domain: This includes skill development in broad areas and the competence of the student to demonstrate the abilities of a perioperative physician, including pre-operative equipment check, monitoring, failed intubation drills, etc. Proficiency in most performed anaesthesia procedures is expected, along with skills in emergency anaesthesia, trauma and resuscitation. At this point, the student can demonstrate the practice of regional anaesthesia, thoracic and cardiovascular anaesthesia, paediatric anaesthesia, transplant anaesthesia, neuro anaesthesia apart from anaesthetic considerations in surgical procedures like rhinootolaryngological, orthopaedic, obstetrics and gynaecology, replacement surgeries, urosurgery, vascular, plastic, dental, non-operating room location anaesthesia, etc.

There are a variety of teaching methods [ Table 1 ]. Emphasis is given to safety, communication skills, behaviour, attitude, ethics, audit and management. Students acquire hands-on training in performing various procedures, including exposure to newer modalities.[ 2 ] A logbook pertaining to these activities is required to be maintained.

Post Graduate (PG) anaesthesiology curriculum, teaching and assessment methodology: A comparison across countries

EDAIC: European Diploma in Anaesthesiology and Intensive Care; FRCA: Fellowship of the Royal College of Anaesthesiologists; ICU: Intensive care unit; MD: Doctor of Medicine; DNB: Diplomate of National Board; PG: Postgraduate; POCUS: Point of Care Ultrasound; UK: United Kingdom; USA: United States of America

The competency-based medical education in India has also incorporated self-directed learning (SDL), which is a process in which the onus of learning is with the trainees as they themselves decide their goals of learning, take initiatives to diagnose their needs, look for resources and also, evaluate the outcomes.[ 4 ] A PG student must read one paper at a national/state conference, present one poster and one research paper. The research paper should be published or be sent for publication during the period of training, which then makes them eligible to appear for the PG degree examination.[ 5 ] Good quality research can be encouraged by promoting research methodology and scientific paper writing workshops.[ 6 ]

Apart from Doctor of Medicine (MD) Anaesthesia (3 years) and Diploma in Anaesthesia (2 years), the Diplomate of National Board (DNB) offers PG anaesthesiology courses (2–3 years) in India. The completion of training prepares the trainee to work as a specialist in the community and as a medical teacher and researcher in the field.[ 7 ]

The European Training Requirement (ETR) in anaesthesiology guidelines emphasise competency-based specialist training over a minimum duration of five years, including one year of training at an intensive care unit (ICU). Four generic competencies and roles have been identified.[ 8 ]

Expert clinician: This includes the domain of perioperative medicine, intensive care medicine, resuscitation of critically ill patients and acute and chronic pain management.

Professional leader: The competencies in communication, and human interactions, must be developed, enabling the specialist in Anaesthesiology to effectively organise and manage tasks during professional activities.

Academic scholar: This role enables the specialist to be able to contribute to the development of new medical knowledge through research and implementation thereof. They also acquire basic tools for teaching and education presentations.

Inspired humanitarian: This aspect defines the role as a professional with high empathy, integrity, compassion and honesty. This also includes the ethical aspects in patient care and decision-making along with medico-legal concerns pertaining to the practice of Anaesthesiology.

To fulfil these four roles, there is a list of domains of competencies which have been divided as general core competencies (general anaesthesia, regional anaesthesia, airway management, perioperative care, acute pain management, intensive care and emergency medicine, patient safety, non-technical skills, ethics and professionalism, health economics, self-directed learning and research) and specific core competencies (obstetric, cardiothoracic, neuro and paediatric anaesthesiology, chronic pain management).

For each domain, the learning objectives have been categorised as knowledge, skills and attitudes to finally achieve the required level of competency, defined as:

• Observer level
• Performs, manages, demonstrates under direct supervision
• Performs, manages, demonstrates under distant supervision
• Performs, manages, demonstrates independently

Also included are various clinical guidelines, standards of quality care and medical simulation training.

There is a focus on competency-based medical education (CBME) and the duration of training is five years. Since July 2017, Anaesthesiology programmes have been structured according to the Competency by Design (CBD), an initiative by the Royal College of Physicians and Surgeons of Canada. Anaesthesia trainees are trained in four stages and each stage has a predetermined milestone to achieve.[ 9 ]

Stage 1, the introductory stage, named Transition to Discipline (TTD), is of two months duration which includes courses like Advanced Trauma Life Support (ATLS), Basic Life Support (BLS), Transthoracic Echocardiography and Ultrasound. During this stage, hands-on operating room experience is ensured along with didactic and simulation-based teaching.

Stage 2 is of 22 months duration, and it includes 16 Entrustable Professional Activities (EPA). The trainee is initially rotated in internal medicine, paediatrics, emergency medicine, cardiology and respiratory medicine before proceeding to advanced rotations in general anaesthesia and ICU.

In stage 3, which is the core and lasts for 30 months, the trainee is rotated in advanced sub-specialities in anaesthesia such as neuro-anaesthesia, cardiac, paediatrics and ICUs and near the end of the core, they write the written portion of the Royal College examination.

Stage 4 is the Transition to Practice with a duration of 6 to 12 months. The trainee is trained vigorously to be independent in delivering advanced consultant-level anaesthetic care.

United Kingdom (UK)

The goal of the curriculum for anaesthesia training in the UK is similar to that in Canada. They aim to achieve 14 domains of learning ranging from professional behaviour, communication, management, requirements (both professional and regulatory), teamwork, safety and quality improvement, education and training, perioperative medicine, general anaesthesia, regional anaesthesia, resuscitation and transfer, research and data management, procedural sedation, intensive care and pain management. The training has been divided into three stages over seven years.[ 10 ] Each stage has a specific critical point to enable the trainee to move on to the next stage and final recommendation for Certification of Completion of Training (CCT).[ 11 ]

Stage 1 (three years): Trainee anaesthetists are introduced to elective as well as emergency practices along with perioperative care. Duration of training is spent for gaining clinical experience in low to moderate risk patients. During this stage of training, anaesthetists will complete the primary Fellowship of the Royal College of Anaesthetists (FRCA) examination.

Stage 2 (two years): Trainees are introduced to broader areas of anaesthesia so that they consolidate skills gained in Stage 1 while learning specialist areas of anaesthetic practice. Thus, they get trained for generalist practice with more autonomy while learning management of high-risk patients. During this stage, they complete the final FRCA examination.

Stage 3 (two years): This level is a bridge from training to consultant practice where anaesthetists mature in their clinical skills for conducting safe practice. At the end of this stage, they will have the requisite expertise for complex clinical situations and also manage any organisational issues.

The anaesthetic training is more outcome-based than time-based. The four competencies defined are medical expert, leader, scholar and professional. As a medical expert, the anaesthetist should know anaesthetic and medical technology, principles of general medicine pertaining to methods in diagnosis and therapy based on a thorough knowledge of applied physiology, pharmacology, respiratory, circulatory and nervous systems.

As a leader, the important competence considered is effectiveness in communication. As a scholar, there should be professional competency as well as capability to promote development in Anaesthesiology. Lastly, as a professional, the anaesthesia specialist should have impeccable behaviour and be thorough about duties and responsibilities acceptable as a professional. To fulfil these four identified professional roles, there is a list of domains of expertise and their related competencies.[ 12 ]

United States of America (USA): Accreditation council for graduate medical education (ACGME) curriculum

The programme duration ranges from 36 months to 48 months; the 48 months programme includes additional 12 months of training in basic clinical skills in medicine. At least six months of fundamental training should incorporate family medicine, neurology, internal medicine, paediatrics, gynaecology and obstetrics, surgery or any surgical speciality. At least a month in critical care and emergency medicine is mandatory. The remaining 36 months of training is about perioperative medicine with the distribution of clinical experience in surgical anaesthesia, critical care medicine and pain medicine. Two weeks each for pre-operative medicine and post-anaesthesia care is a must. In critical care, at least four 1-month rotations should be there wherein the trainee participates as an integrated member of critical care teams. Further, two 1-month rotations are suggested for obstetric anaesthesia, paediatric anaesthesia, neuro anaesthesia and cardiothoracic anaesthesia. A minimum of 3 months in pain medicine and two weeks in anaesthesia for patients undergoing procedures outside operating rooms is planned. Certification in Advanced Cardiac Life Support (ACLS) is mandatory, at least once during residency, as is at least one simulated clinical experience each year.

Along with the educational curriculum, importance is given to the availability of basic facilities to the trainees, like food and refrigeration facilities, rest areas, availability of reference materials, etc. The roles of programme director, core faculty and programme coordinator are explicitly narrated. Also, the core didactic academic activities are defined for which the time is protected.

There are six core competencies of ACGME.[ 13 ]

• Professionalism: It includes the demonstration of compassion, integrity and respectful behaviour. There should be responsiveness to patient needs, consideration for patient privacy as well as autonomy. The resident should be able to manage personal and professional well-being and disclose and address conflict of interest appropriately.
• Patient Care and Procedural skills: The residents should provide appropriate, compassionate and effective patient care. Along with fundamental skills of medicine, they must be able to demonstrate competence in anaesthesia management. This includes objectively defined competency skills, like the care of 100 patients less than 12 years of age, including 20 children less than five years and five under three months of age; 20 patients for pain evaluation; anaesthesia care for 40 patients undergoing vaginal delivery, 20 undergoing caesarean section, 20 patients undergoing cardiac surgery, including 10 with the use of cardiopulmonary bypass and so on.
• Medical knowledge: This includes knowledge of current and upcoming biomedical, clinical, epidemiological and social-behavioural science and their application in patient care.
• Practice-based learning and improvement: They should be able to demonstrate investigation ability with which they can evaluate patients, and assimilate this knowledge and evidence to improve the care of patients.
• Interpersonal and communication skills: There is a focus on the development of soft skills so that there is effective communication and good collaboration with all the patients and other health professionals.
• Systems-based practice: The trainee must understand the system of health care, including social factors determining health and should develop the ability to use resources appropriately to provide the best possible health care.

Topics such as professional liability, billing arrangements, health care finance have also been given due importance. Competence in the identification of one's own deficiencies, strengths and expertise is emphasised. The importance of utilising feedback and evaluation into daily practice, concluding evidence from scientific literature and the use of information technology is encouraged. The structure of training must ensure sufficient length of rotations for optimal learning, relationship with faculty and assessment and feedback.[ 13 ]

A recent review compared similarities and differences in competencies in anaesthesiology residency for the European Union (ETR), United States (ACGME Milestones), and Canada (CBD). The authors found that about 93% of competencies were common, and the difference between the three repositories was in terms of emphasis. While ETR emphasised non-technical skills in anaesthesia, CBD highlighted finely detailed competencies within specific anaesthesiology situations, and ACGME Milestones emphasised behavioural practices and professionalism.[ 14 ]

South East (SE) Asia

Anaesthesia education in SE Asia is quite diverse. Singapore follows the American model with a 5-year residency program.[ 15 ] The training programme is an outcome-based modular training programme with structured objectives and goals stipulated in accordance with the requirements of the ACGME. The Philippines and Malaysia model is similar to India with a 3-year basic residency programme.

ASSESSMENT METHODOLOGY

The assessment methodologies followed across the globe are varied [ Table 1 ]. In India, according to PG Medical Education Regulations, 2000 of NMC, a combination of both formative and summative assessment is vital for the successful completion of the PG programme. Formative assessment should be done continuously to assess knowledge about anaesthesia, patient care and procedural skills. There should also be an ongoing assessment for professionalism, SDL and interpersonal skills. Frequent internal assessment should include all learning domains and provide feedback as well. The quarterly assessments should include recent advances, skill-based learning, SDL, interdepartmental learning activity and external activities.[ 2 ] The formative assessment is being carried out in many institutes in the form of exams at fixed intervals.[ 16 ]

To be eligible for the final assessment, the candidate has to submit a dissertation on a relevant topic under the direct supervision of the guide. As a part of the final assessment, candidates have to undergo theory and practical examinations. Theory examinations consist of four papers and detailed practical examinations include case-based discussions, assessment of knowledge in anaesthesia equipment, drugs, objective structured clinical examination (OSCE), and communication skills. The student has to score eligibility marks (above 50%) in both theory and practical examinations. OSCE, as a formative or summative examination, is being used increasingly for objectivity and reliability both by teachers and students. The preset standards of competence and checklists rule out any biases while covering a large number of topics.[ 17 ]

In addition to the above, the assessment of procedural skills should be made essential. Direct Observation of Procedural Skills (DOPS) is one such tool developed by the Royal College of Physicians in 2007.[ 18 ] Yet another tool, the Objective Structured Assessment of Technical Skill (OSATS) includes a global rating scale and a task-specific checklist. OSATS has been considered superior to other methods of assessing clinical competencies. However, a robust rating scale to improve performance using OSATS is still lacking.[ 19 ]

Anaesthesiologists desiring to practice overseas following completion of training in India need to appear for the licensing examination; United States Medical Licensing Examination (USMLE) (USA), Professional and Linguistic Assessments Board (PLAB) (UK) and European Diploma in Anaesthesiology and Intensive Care (EDAIC) (Europe).

Whilst enlisting and comparing the strengths and scope of various PG anaesthesia training programmes across the globe, we propose an amalgamation of the strengths of each programme, especially in regard to technical and non-technical competencies with an aim to be able to develop a critically thinking perioperative physician, compassionate professional leader, and a scholar with research capabilities. The programmes followed by Canada, the USA and perhaps European countries need to be adapted to our unique geographical needs and logistical conditions. We need to incorporate simulation technology not only in training but also as part of an ongoing formative and summative assessment. The aim should be to inculcate critical thinking in an empathetic, ethical and logical manner.

In summary, it is indeed time to upgrade our PG training programme and its duration uniformly across the country and across the globe. We also need to think about the feasibility of a uniform competency-based exit exam, akin to the final FRCA exam in the UK. Physician exchange programmes, not only for the student but also for teachers with the best across the globe, should aim at constant quality improvement initiatives. We should be ambassadors for a radical change in our systems to be able to produce lifelong empathetic, ethical learners equipped to adapt to varying clinical environments with an aim to enhance patient safety and quality of perioperative care across the length and breadth of our country.

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