We evaluated the ability of perfusion index (PI) to predict vasopressor requirement during early resuscitation in patients with severe sepsis. All consecutive patients with clinically suspected severe sepsis as defined by the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference were included. Perfusion variables included PI, arterial lactate level, central venous oxygen saturation, and the difference between central venous carbon dioxide and arterial carbon dioxide pressures, and were recorded before resuscitation and 6 h thereafter. We enrolled 36 patients with severe sepsis. Twenty-one patients required vasopressors, whereas 15 did not. The cut-off of the PI value for predicting vasopressor requirement was ≤0.3. This cut-off value had a sensitivity of 100% and a specificity of 93%; the area under the curve was 0.96 (95% confidence interval 0.8-0.99, P < 0.0001). The cut-off of the arterial lactate level for predicting vasopressor requirement was ≥1.8 mg dL. This cut-off value had a sensitivity of 82% and a specificity of 80%; the area under the curve was 0.84 (95% confidence interval 0.68-0.94, P < 0.0001). Other perfusion variables failed to predict vasopressor requirement in patients with severe sepsis. We concluded that PI and arterial lactate level are good predictors of vasopressor requirement during early resuscitation in patients with severe sepsis. Further studies are warranted to investigate whether monitoring PI during resuscitation improves the outcome of patients with septic shock.

No abstract

No abstract

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Percutaneous nephrolithotomy PCNL surgeries are usually associated with acute postoperative pain. Ultrasound guided nerve block is considered a recent technique for pain management. it provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Erector spinae plane (ESP) block is a novel method of delivering postoperative analgesia after PCNL surgery, technique involves injecting local anaesthetic into the interfascial plane between the erector spinae muscle and the transverse processes.and is therefore devoid of major adverse effects like pneumothorax, spinal cord trauma, and hypotension that can occur with other types of blocks like thoracic paravertebral block (TPVB). The goal of this research was to determine the analgesic efficacy and safety of ultrasound-guided ESP. block done at T8 transverse process level in patients undergoing PCNL surgeries for intraoperative and postoperative analgesia.