Innovative research and technological advancements: Oars of the boat of progress

Abstract

“Water loses its purity from stagnation”…. Leonardo da Vinci New knowledge needs to flow into any speciality of science to keep it vibrant. The flow of new knowledge starts from original research and observations. Novel research questions are tested in research studies and the results bring to light newer and useful strategies that can be applied in clinical practice. The recent advances in a speciality are portrayed by the contents of the journals of that speciality, some of which are translated into clinical practice. Postgraduate (PG) students in anaesthesia have to read their textbooks and do clinical work to acquire knowledge. However, textbooks are a compilation of chapters with material taken from published journal articles. They do not really depict the most recent developments in the field. As per the PG curriculum of the National Medical Commission, the students need to be aware of the recent advances pertaining to their speciality. The fourth paper of the theory examination for the degrees of both, Doctor of Medicine (MD) and Diplomate of National Board (DNB) includes questions on recent advances in anaesthesia.[1] Students often complain that there is a dearth of reading material related to this topic. Furthermore, what was recent yesterday, may not remain recent today. Ours is an ever-evolving branch. The consultants in anaesthesia, too, are yearning to know about the recent advances in the speciality and this often makes them start googling. Keeping this in mind, this PG issue of the Indian Journal of Anaesthesia (IJA) is designed with the novel theme of ‘Recent Advances’. The current areas of major progress in different specialities of our subject are discussed elaborately in this issue by academic experts from different parts of our nation. It is beyond doubt that anaesthesiology has progressed from the speciality of ‘wine and opium’ to the current era where a major part of it is driven by technology. Technology today plays an important role in almost every branch of anaesthesia. Airway algorithms, second-generation supraglottic airway devices, video laryngoscopes, fibreoptic techniques, extubation catheters, transnasal humidified rapid-insufflation ventilatory exchange, and sugammadex and rocuronium for rapid sequence induction have changed the face of airway management and improved patient safety. The use of ultrasound for preoperative airway and gastric assessment sounds the bugle of the supremacy of technology. Checklists are now being used to improve patient safety in perioperative care and improve surgical outcomes. Intraoperative haemodynamic monitoring with 3D echocardiography allows the real-time monitoring of valve function, ventricular filling, and cardiac contractility.[2] Point-of-Care ultrasound (POCUS) is the new magic wand of the anaesthesiologist. The modern anaesthesiologist neither struggles to secure an intravenous line or give a landmark-guided nerve block nor gropes blindly for a difficult lumbar/epidural puncture. He quickly gets the ultrasound probe and smoothly manages the case. From the facilitation of venous cannulation to guiding peripheral nerve blocks, fascial plane blocks, and central neuraxial blocks and predicting intraoperative hypotension with the inferior vena cava collapsibility index, ultrasound is an invaluable asset of the anaesthesiologist.[3-8] In the intensive care unit (ICU) too, the ultrasound plays a major role with its ability to diagnose extravascular lung water in the lungs at an early stage, increased intracranial pressure, conditions such as pneumothorax, pneumonia, and pulmonary embolism and in mechanical ventilation.[9,10] In addition to ultrasound, the modern anaesthesiologist is equipped with modern tools such as risk prediction tools, models, and indices which can be applied to identify the high-risk surgical patient.[11,12] The postoperative behaviour and outcomes of the patient are thus no longer a suspense to the operating team and the patient’s attende