We prospectively compared four techniques of cardiac output measurement: bolus thermodilution cardiac output (TDCO), continuous cardiac output (CCO), pulse contour cardiac output (PiCCO), and Flowtrac (FCCO), simultaneously in fifteen patients undergoing off-pump coronary artery bypass grafting (OPCAB). All the patients received pulmonary artery catheter (capable of measuring both bolus thermodilution cardiac output and CCO), PiCCO arterial cannula in the left and FCCO in the right femoral artery. Cardiac indices (CI) were obtained every fifteen minutes by using all the four techniques. TDCO was treated as 'control' and the rest were treated as 'test' values. Interchangeability of techniques with TDCO was assessed by Bland and Altman plotting and mountain plot. Four hundred and thirty eight sets of data were obtained from fifteen patients. The values of cardiac output varied between 1 to 6.9 L/min. We found that the values of all the techniques were interchangeable. At certain times, the values of CI measured by both PiCCO and FCCO appeared erratic. The values of CI measured simultaneously appeared in the following descending order of accuracy; TDCO>CCO>FCCO>PiCCO (the % times TDCO correlated with CCO, FCCO, PiCCO was 93, 86 and 80 respectively). The bias and precision (in L/min) for CCO were 0.03, 0.06, PiCCO 0.13, 0.1 and flowtrac 0.15, 0.04 respectively suggesting interchangeability. We conclude that the cardiac output measured by CCO technique and the pulse contour as measured by PiCCO and FCCO were interchangeable with TDCO more than 80% of the times.
The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.
Objectives: Though external jugular vein is superficial, adequate sized, isolated from major neurovascular structures and its cannulation fairly simple and comfortable to patients, it is not commonly used. Internal jugular vein cannulation on the other hand is routinely used with reasonable success. This technique is not devoid of complications. In order to make the central venous cannulation safer, the author sought to explore the possibility of using external jugular venous route as the route of first choice to pass the vascular catheters. Design: A prospective observational study, Setting: Tertiary referral hospital Participants: Interventions: External jugular venous route as the choice of central venous cannulation Measurements and Main Results: The type of the catheter required for the procedure-single, multi lumen, Swan Ganz, dialysis or pacing catheters were inserted via the external jugular vein. Inability to advance the catheter or the guide wire was considered a failed procedure. In the event of a failure to insert and or advance the catheter, from the same point of insertion, internal jugular vein was cannulated. Ultrasound image assistance was taken if needed by the operator. In 411 subjects, the desired catheter was inserted through the EJV. In 378 patients, the catheter was inserted in the first attempt. No life threatening complications occurred even among the cases, where external jugular vein cannulation was not successful. A few malpositions occurred when the external jugular route was chosen. In very obese patients, ultrasound was used to visualize the vein.
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