Rashmi Ramachandran

Background and Aims: The increasing demand for day-care surgeries highlights the necessity for efficient anesthesia techniques. While general anesthesia is often preferred to prevent prolonged motor blockades, spinal anesthesia offers notable advantages, such as enhanced pain management and fewer postoperative complications. Newer local anesthetics such as ropivacaine have renewed the interest in subarachnoid block due to shorter duration of motor blockade and improved safety profile. Our study aimed to determine the effective dosage of intrathecal ropivacaine for lower abdominal surgeries using the biased coin up-and-down method. Our goal was to find a dose that allowed patients to be discharged on the same day. Material and Methods: Forty male patients aged 18–60 years (American Society of Anesthesiologists 1 and 2), with heights between 150 and 160 cm, weighing 50–80 kg, participated in the study. Exclusion criteria included spinal abnormalities, infections, and an expected duration of surgery of more than 2 h. After obtaining informed consent, comprehensive preoperative assessment was conducted. In the operating room, standard monitoring protocols were established, and the first patient received 1.5 mL of 0.75% isobaric ropivacaine. Sensory and motor block levels were assessed, and subsequent doses were adjusted using the biased coin method, with dosage information kept confidential from both patients and surgeons. Results: The estimated 90% effective dose for 0.75% ropivacaine was 1.91 mL (95% confidence interval: 1.78–1.98 mL). Mean recovery times for sensory and motor functions were 186.4 min (52.07) and 39.2 min (16.68), respectively, with a mean time to meet post anesthesia care unit discharge criteria of 195.7 (41.87) min. Conclusion: Intrathecal ropivacaine enabled rapid recovery, facilitating same-day discharge.

Digital literacy is increasingly integral to medical education, yet gender disparities may affect faculty engagement. This exploratory study examined gende

Introduction: Ultrasound-guided diagnostic and needle navigation procedures are integral to modern medical practice, yet structured competency-based training remains limited within the Indian medical education system. This paper describes the development and early implementation of a simulation-enhanced blended learning curriculum delivered through the institutional Learning Management System (SARAL) at AIIMS, New Delhi. Methods: The program combined asynchronous online modules with simulation-based and supervised hands-on training. Formative evaluation was conducted via a cross-sectional survey of faculty involved in programme delivery ( n = 12), assessing course design, pedagogy, perceived learner applicability, and feasibility using Likert-scale items and open-ended feedback. Results: Formative feedback from 12 expert faculty involved in programme design and delivery indicated strong agreement on the curriculum's relevance, coherence, and clinical applicability, as well as its feasibility for broader implementation. Key recommendations included increasing hands-on exposure, reducing group sizes, and integrating advanced digital learning tools. Conclusions: These findings reflect early expert appraisal of a curriculum in its initial implementation phase and do not represent learner-level outcomes. Formal evaluation of educational impact is planned in future phases. The report provides a context-specific account of curriculum development and implementation that may inform similar efforts in resource-constrained settings like India.

Early research exposure (ERE) amongst undergraduate (UG) medical students in a participant-centered approach can foster critical thinking skills for profes

Recent sepsis guidelines recognize myocardial dysfunction as a major contributor to the pathophysiology of septic shock. Sepsis-induced cardiomyopathy (SIC) is typically characterized by acute onset and potential reversibility. The present study aimed to determine the incidence, spectrum, and prognostic significance of myocardial dysfunction in patients with septic shock. We included patients aged 18 years or older diagnosed with septic shock. We excluded those having an improper window for transthoracic echocardiography, known cardiac diseases, pregnancy, or postcardiac arrest status. Eligible patients underwent transthoracic echocardiography within the first 24 hours of intensive care unit (ICU) admission. Echocardiography was used to assess systolic and diastolic function of both ventricles based on the criteria recommended by the American Society of Echocardiography (ASE). For patients with abnormal findings, a follow-up echocardiogram was conducted on day 7 to assess the reversibility of myocardial dysfunction. Myocardial dysfunction was identified in 39 of 71 patients, yielding an incidence of 54.9% (95% CI: 42.6–66.7). Mortality was significantly higher among patients with SIC, with 29 out of 39 succumbing to the condition. Sepsis-induced cardiomyopathy was characterized by various patterns, including left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and right ventricular (RV) dysfunction, with LV diastolic dysfunction being the most prevalent. Multivariable regression analysis, adjusting for potential confounders, demonstrated that the presence of SIC was an independent predictor of mortality. Sepsis-induced cardiomyopathy was present in over half of the patients with septic shock, with diastolic dysfunction being the predominant subtype. Sepsis-induced cardiomyopathy was associated with increased mortality. Nadaf ZM, Ravikumar RH, Anand RK, Ramachandran R, Trikha A, Wig N, et al. Incidence and Prognostic Impact of Myocardial Dysfunction in Septic Shock: An Observational Cohort Study. Indian J Crit Care Med 2026;30(1):56–61.

Background: Simulation-based training has emerged as a critical modality in medical education, particularly for areas like point-of-care ultrasound. The effectiveness of the training is heavily influenced by instructional design. Design-based research offers a framework to iteratively develop, implement, and refine educational interventions, particularly in real-world settings, ensuring both practical and theoretical foundation. Objective: This study employed a design-based research approach to develop, evaluate, and implement a blended ultrasound education program for in-service medical professionals, integrating asynchronous e-learning with high-fidelity simulation. Methods: The study was conducted at a single academic institution and involved 51 practicing healthcare professionals. The course was designed, including needs assessment, iterative curriculum development, and multiple cycles of implementation and evaluation. Online module performance, pre- and post-test assessments, and subgroup analysis of curriculum completers were used to evaluate learning outcomes. Instructional decisions were revised based on observed performance trends. Suitable interventions in the design framework were also planned according to all the feedback and data captured. Results: Participants showed a statistically significant improvement in knowledge post-intervention (mean score increase: 10.24%, p = 0.0033). Lung and ocular ultrasound modules showed low variability and high scores, according to module-wise analysis, suggesting good instructional design. Subgroup analysis confirmed the significance of structured progression by showing a correlation between full curriculum engagement and improved performance and consistency. The cardiac ultrasound module showed high variability and lower mean scores, guiding a redesign recommendation for scaffolded instruction. Conclusion: The design-based approach enabled the systematic development of the ultrasound-guided diagnostics course, ensuring alignment between instructional strategies and learner needs. This study highlights the value of evidence-informed design in enhancing clinical competency in ultrasound procedures and offers a scalable simulation-integrated model for future medical education.

Background: Blended learning (BL) for skill acquisition is an integral part of the undergraduate curriculum. Teachers may be trained in BL using physical or virtual platforms. Training of Trainers (ToT) using a virtual platform was adopted during the Covid-19 pandemic. We report our experience in conducting virtual training to impart hands-on knowledge to trainers about the BL technique. Methods: We conducted a virtual ToT workshop to train trainers on a blended model for skill teaching. A moderator and a list of trainers were identified at the host institution. Invitations were sent to other institutions. The moderator briefed the participants through email. They were required to identify a topic for creating an e-learning module and asked to develop learning objectives, a standard operating procedure, and multiple-choice questions for the same. A 1.5-day programme was developed that included didactic lectures and small-group discussions on developing eModules. A feedback form using Google Forms was distributed among the participants to be completed after the programme. Results: Thirty participants were enrolled. All were highly satisfied with the content of the workshop. Didactic lectures were completed on time. The duration in the breakout room for small group discussion was considered short. Twenty-eight participants felt that the workshop had sufficient learning points to keep the learner engaged for 1.5 days on a virtual platform. Only 3 participants were not satisfied with the use of a digital platform for this workshop. The content of the workshop regarding functioning and utility of the skill laboratory was perceived as useful for their institutional practice by 27 participants. Conclusion: Virtual platforms can be used to conduct ToT workshops focusing on BL for skill acquisition.

Background and Aims: Both dexmedetomidine and midazolam-ketamine are known for their minimal respiratory depressant effects. While many studies have documented the use of dexmedetomidine in providing conscious sedation during awake fiberoptic-guided nasal intubation (AFNI), the use of midazolam-ketamine combination for this procedure has not been reported. The aim of this study was to compare the efficacy of dexmedetomidine with midazolam-ketamine combination for AFNI in patients with difficult airways undergoing oromaxillofacial surgery. Material and Methods: This study involved 60 patients undergoing oromaxillofacial surgery. They were randomized to receive either dexmedetomidine (1 μg/kg) (group D) or a combination of midazolam (0.02 mg/kg) and ketamine (0.5 mg/kg) (group MK) for sedation during awake fiberoptic nasotracheal intubation. Both groups received topical local anesthesia during the procedure using the spray-as-you-go technique. The primary outcome measured was cough score during intubation. Secondary outcomes included overall intubation, post-intubation, and sedation scores. Incidences of side effects such as hypoxemia and bradycardia were also measured. Results: The cough score (group D: 1.33 ± 0.61, group MK: 1.3 ± 0.53; P = 0.822), overall intubation score, and post-intubation score were comparable between the two groups. Patients receiving dexmedetomidine were significantly more sedated than patients receiving midazolam-ketamine. Patients receiving dexmedetomidine had significantly lower heart rates and blood pressure than patients receiving midazolam-ketamine. Four patients in group D had hypoxemia, while no patient in group MK developed hypoxemia. Conclusions: Both dexmedetomidine and midazolam-ketamine combinations were equally effective for sedation during AFNI in patients with difficult airways scheduled for orofacial maxillary surgery. Patients receiving dexmedetomidine were more sedated, but the incidence of side effects was similar in both groups.

Background and Aims: Sepsis-associated acute kidney injury (SA-AKI) significantly contributes to morbidity and mortality. Current biomarkers have limitations, necessitating the exploration of alternative indicators. This study aims to evaluate various urinary electrolyte parameters to predict SA-AKI. Methods: A prospective observational study included 111 sepsis patients within 24 h of admission. Urinary electrolyte samples were collected, and indices were calculated. Patients were monitored for 7 days to assess for acute kidney injury (AKI) according to Kidney Disease Improving Global Outcomes (KDIGO) definition criteria, mortality rates, and the need for renal replacement therapy. Mann-Whitney U test and Chi-squared test were used to analyse continuous and categorical variables, respectively. Receiver-operating characteristic (ROC) curves were constructed to determine to discriminatory ability of various parameters in predicting AKI. Results: Of 111 patients, 42.3% developed AKI, with a mortality rate of 59.5%. When evaluating urinary parameters, the product of urine sodium and urine creatinine exhibited the maximum full form [area under the receiver operating characteristic (AUROC): 0.66; 95%CI: 0.56, 0.77)], and the parameter of fractional excretion of potassium (FeK) exhibited an AUROC of 0.62 (95%CI: 0.51, 0.72). Furthermore, 2-hour excretion of potassium revealed a statistically significant correlation with 2-hour creatinine clearance (r = 0.62, P < 0.001). Logistic regression models, incorporating Sequential Organ Failure Assessment (SOFA) score, FeK, and urine sodium concentration as variables (P = 0.020, 0.044, and 0.033, respectively), achieved an AUROC of 0.751 in predicting AKI. Conclusion: Urine sodium levels and fractional potassium excretion moderately effectively predict AKI in sepsis patients. Urine potassium excretion correlates with glomerular filtration rate.