Key findings:

The study among Resident Anesthetists in Himachal Pradesh found commendable knowledge of malignant hyperthermia (MH), anaphylaxis, and airway obstruction. They demonstrated understanding of triggers, signs, and management of these critical situations. The study highlights their readiness to manage anesthesia-related complications, emphasizing the importance of continuous educational initiatives to further enhance competence and ensure patient safety in the region.

What is known and what is new?

The study reaffirmed existing knowledge among Resident Anesthetists in Himachal Pradesh regarding malignant hyperthermia (MH), anaphylaxis, and airway obstruction, including triggers, signs, and management. However, it also provided new insights into their proficiency in recognizing airway complications, the importance of capnography, fluid resuscitation principles, and aspiration prevention, as well as their understanding of the difficult airway algorithm and the significance of teamwork in emergencies.

What is the implication, and what should change now?

The study's implications suggest that Resident Anesthetists in Himachal Pradesh are well-prepared to manage anesthesia-related complications. Continuous educational initiatives should focus on refining their knowledge of critical situations, emphasizing teamwork and adherence to protocols. This will further enhance their competence and ensure optimal patient safety in anesthesia practice.

In the realm of modern medicine, the practice of anesthesia is often compared to the art of orchestrating a complex symphony, where the anesthesiologist assumes the role of the conductor, carefully harmonizing various elements to ensure a patient's safety and comfort throughout surgical procedures. The picturesque state of Himachal Pradesh, renowned for its breathtaking landscapes and the pursuit of healthcare excellence, stands witness to this intricate ballet of care. Within this captivating backdrop, Resident Anesthetists are entrusted with the profound responsibility of safeguarding patients against the potential adversities that can arise during anesthesia administration. [1,2]

Anesthesia-related complications and emergencies pose formidable challenges, demanding swift and precise interventions to avert adverse outcomes. Among these life-threatening situations, malignant hyperthermia, anaphylaxis, and airway obstruction stand as critical adversaries that can derail even the most meticulously planned surgeries .Malignant hyperthermia, an uncommon but potentially fatal condition, manifests as a hypermetabolic crisis triggered by certain anesthetic agents. Anaphylaxis, on the other hand, is an acute, severe allergic reaction to substances like drugs or latex and can rapidly progress to a life-threatening condition if not promptly managed. Airway obstruction, while not exclusive to anesthesia practice, remains a constant concern due to its potential to impede oxygenation and ventilation during surgery. [3,4]

The competence of Resident Anesthetists in recognizing, managing, and mitigating these anesthesia-related complications and emergencies is indispensable. Proficiency in identifying the early signs, understanding the underlying mechanisms, and executing appropriate interventions can be the difference between life and death in these critical situations. Furthermore, effective crisis management necessitates seamless coordination and communication among the anesthesia team members.

This study embarks on a vital exploration, aimed at evaluating the levels of awareness and knowledge among Resident Anesthetists in Himachal Pradesh regarding potential anesthesia-related complications and emergencies, focusing on malignant hyperthermia, anaphylaxis, and airway obstruction. By scrutinizing their understanding of these critical scenarios, their ability to respond promptly, and their comprehension of the essential management strategies, we aim to shed light on areas that may benefit from additional training and education.

Objectives Of The Study:

The primary objective of this study is to gauge the levels of awareness and knowledge about potential anesthesia-related complications and emergencies, such as malignant hyperthermia, anaphylaxis, and airway obstruction, and their management among the Residents of Anesthesia in Himachal Pradesh.

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area:  Himachal Pradesh

• Study duration- between April 2023 to June 2023

• Study population: The study's target population encompassed all Junior and Senior Residents of Anesthesia working in Medical Colleges in Himachal Pradesh.

• Sample size- A robust sample size of 100 was determined using a 95% confidence level, an estimated knowledge level of 50% regarding anesthesia-related complications and emergencies, a precise 10% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding anesthesia-related complications and emergencies was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion etc.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding anesthesia-related complications and emergencies. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among all the Junior and Senior Residents of Anesthesia working in Medical Colleges in Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 100 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The primary objective of this study was to gauge the understanding of potential anesthesia-related complications and emergencies, such as malignant hyperthermia, anaphylaxis, and airway obstruction, and their management among the Residents of Anesthesia in Himachal Pradesh. A total of 100 participants took part in the study. Table: 1

Table-1: Knowledge regarding anesthesia-related complications and emergencies among study participants

In the present study 27 participants had very good knowledge (16-20 marks) towards anesthesia-related complications and emergencies, 32 had good knowledge (12-15 marks), 22 had fair knowledge  (8-11 marks) and 19 having poor knowledge  (<8 marks). Table-2

Table-2: Knowledge scores towards anesthesia-related complications and emergencies among study participants

Anesthesia practice is an intricate and vital component of modern medicine, demanding a high level of expertise and preparedness to ensure patient safety during surgical procedures. In the captivating landscapes of Himachal Pradesh, where healthcare excellence meets natural beauty, Resident Anesthetists play a pivotal role in orchestrating anesthesia care. This study aimed to assess the knowledge and awareness levels of these residents concerning anesthesia-related complications and emergencies, with a particular focus on malignant hyperthermia, anaphylaxis, and airway obstruction. The findings provide insights into their readiness to manage critical situations and highlight areas where further education and training may be beneficial.

Malignant hyperthermia (MH), though rare, remains a life-threatening condition triggered by specific anesthetic agents. The majority of participants exhibited commendable knowledge about MH, recognizing its triggers, clinical signs and symptoms, and the importance of dantrolene in its management. This level of awareness is essential, as MH requires prompt identification and immediate intervention to prevent fatalities. The high awareness of MH is encouraging and suggests that Resident Anesthetists in Himachal Pradesh are well-prepared to address this rare but critical complication.[2,3]

Anaphylaxis during anesthesia is another potential crisis that necessitates swift and accurate management. Participants displayed an excellent understanding of anaphylaxis, including its triggers, early signs, and immediate management steps. Their knowledge of administering medications to treat anaphylaxis reflects preparedness to handle this severe allergic reaction effectively. This high level of awareness is reassuring, as anaphylaxis can escalate rapidly and requires a coordinated response to prevent adverse outcomes. [3,4]

Airway-related complications, including bronchospasm, laryngospasm, and the "can't intubate, can't ventilate" scenario, were areas where participants demonstrated substantial knowledge. Recognizing the causes and clinical presentations of these complications is crucial for timely intervention and preventing hypoxia. Additionally, participants displayed proficiency in understanding the significance of capnography in monitoring patients during anesthesia, which is essential for early detection of airway issues.Fluid resuscitation principles in cases of hypotension during surgery were well-understood by participants, underscoring their ability to manage hemodynamic instability effectively. Aspiration pneumonia, its risk in the context of anesthesia, and preventive strategies were also areas where participants exhibited commendable knowledge. Preventing aspiration is vital for avoiding potentially severe pulmonary complications .The difficult airway algorithm, which aids in managing challenging airway situations, was recognized by participants, emphasizing their preparedness for handling airway emergencies. Effective teamwork and communication were identified as crucial elements in anesthesia-related emergencies, aligning with established best practices in crisis management. [2-3]

Comparing these findings with existing literature on anesthesia knowledge among anesthesia residents, this study aligns with prior research in identifying varying levels of knowledge and proficiency. However, the overall high level of awareness regarding anesthesia-related complications and emergencies is encouraging. It suggests that Resident Anesthetists in Himachal Pradesh are equipped to respond effectively to critical situations.

In conclusion, this study provides valuable insights into the knowledge and awareness levels of Resident Anesthetists in Himachal Pradesh regarding anesthesia-related complications and emergencies. While there are areas that may benefit from further education and training, the overall preparedness of these residents to manage critical situations is commendable. These findings underscore the importance of continuous educational initiatives to enhance the competence of Resident Anesthetists, ultimately contributing to improved patient safety and healthcare standards in the captivating landscapes of Himachal Pradesh.

Funding: No funding sources 

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of CH Ghumarwin, Distt Bilaspur

1. Larach, Marilyn Green, et al. "Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007–2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States." Anesthesia & Analgesia 119.6 (2014): 1359-1366. DOI: 10.1213/ANE.0000000000000421

2. Laxenaire, M. C., P. M. Mertes, and Groupe d’Etudes des Réactions Anaphylactoïdes. "Anaphylaxis during anaesthesia. Results of a two‐year survey in France." British Journal of Anaesthesia 87.4 (2001): 549-558. https://doi.org/10.1093/bja/87.4.549

3. Walls, Ron M., and Michael Francis Murphy, eds. Manual of emergency airway management. Lippincott Williams & Wilkins, 2008. https://books.google.co.in/books?hl=en&lr=&id=k08EuDyQEwcC&oi=fnd&pg=PA1&dq=3.%09Walls,+R.+M.,+Murphy,+M.+F.,+%26+Schneider,+R.+E.+(2010).+Manual+of+emergency+airway+management.+Lippincott+Williams+%26+Wilkins.&ots=f1FOYvYXIq&sig=YFy7WCP88MeP863QEjY37nhrjQc&redir_esc=y#v=onepage&q&f=false

4. Scheller, M.S., & Kuczkowski, K.M. "Awake Intubation Revisited: Fast, Safe, and Effective." Journal of Clinical Anesthesia, vol. 20, no. 5, 2008, pp. 351-357.