Background: Central venous catheters are inserted in internal jugular vein during cardiac surgeries in all patients. However, the length of the catheter should be correctly estimated and the tip of the CVC should be correctly placed to avoid various complications.
The primary objective of this study is to compare anatomical landmark technique versus using ECG-guided technique for the correct insertion length of the Central Venous Catheter.
Methods: Prospective, randomized, interventional study was conducted on 72 patients of <12 years age. Patients were randomly allotted to two groups of 36 patients each (landmark and ECG). After induction, CVC cannulation was performed using either of the techniques in right IJV in all patients. Correct position of CVC was checked by obtaining post operative chest X rays in all patients. CVC tip position within 0.5cm above/below or at carina was considered as correct position. Using student t-tests and Chi square-tests analyses were performed.
Results: In landmark group, CVC was positioned correctly in 22(61.11%) out of 36 patients as compared to 33 (91.67%) in the ECG group, (P = 0.006). The mean depth of CVC insertion was 9.05±1.66 and 8.26±1.41 in the landmark and ECG group respectively (P= 0.032). The landmark group had 12 (33.33%) patients with complications during the procedure, as compared to 3(8.33%) in the ECG-guided group, (P = 0.020).
Conclusion: ECG-guided CVC insertion, a simple bedside technique was found more accurate with lesser complications for CVC tip placement than the landmark technique. ECG-guided CVC placement is therefore relatively more accurate, efficient, and safe.
Introduction: Fiberoptic nasotracheal intubation is a prime method for managing difficult airway in patients. Besides local blocks, some sedation is required during the procedure to make it more tolerable to the patients. Dexmedetomidine (DEX) and Midazolam (MDZ) can be used for this purpose. Aim: To compare dexmedetomidine versus midazolam for sedation and intubating condition during Awake Fiberoptic Intubation (AFOI) in patients undergoing oral cancer surgeries. Materials and Methods: This was a prospective randomised double blind study on total of 60 patients randomly allocated into group 1(MDZ) and group 2(DEX). Group 1 received intravenous (i.v.) Midazolam 0.05 mg/kg bolus in 10 mL normal saline over 10 minutes followed by 0.1 mg/kg/hr infusion titrated upto 0.2 mg/ kg/hr to achieve a Ramsay Sedation Score (RSS) ≥2. Group 2 (DEX) received i.v. Dexmedetomidine 1 μg/kg bolus in 10 mL normal saline over 10 minutes followed by infusion at the rate of 0.2 μg/kg/ hr titrated upto 0.7 μg/kg/hr to achieve a RSS ≥2. Comfort Scale values, haemodynamic parameters, patient’s tolerance score and patient’s satisfaction score (24 hours after the surgery) were assessed. Significance was calculated using Student t-test. The number of patients with adverse effects was compared using Chi- square test. Results: In the total sample of 60 patients (30 subjects in MDZ group and 30 subjects in DEX group). The demographic data, blood pressure and Oxygen(O2) saturation were comparable. Significant change in Heart Rate (HR) was observed in group MDZ while HR was stable in DEX group (p<0.001). Group DEX patients were more comfortable and had greater endurance with tolerance score <2.5 compared to MDZ group >2.5 (p<0.001) and had an acceptable level of RSS. After 24 hours, DEX group patients judged their sedation more positively than MDZ group with a score of 6.16 vs. 3.6 (p<0.001). Conclusion: Both Midazolam and Dexmedetomidine are effective for AFOI. But Dexmedetomidine provided better patient comfort and satisfaction along with stable haemodynamics.
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