Aims Arterial blood gas (ABG) analysis is a frequently ordered test in intensive care unit (ICU) and can analyze electrolyte in addition to pH and blood gases. Venous blood gas (VBG) analysis is a safer procedure and may be an alternative for ABG. Electrolyte estimation by auto analyzer usually takes 20–30 minutes. This study was aimed to investigate the correlation of pH, PCO 2 , bicarbonate, sodium, potassium, and chloride (electrolytes) between ABG and central VBG in ICU patients. Materials and methods This was a prospective observational study conducted in medical college hospital ICU. Adult patients requiring ABG and electrolyte estimation as a part of their clinical care were consecutively included in the study. Patients having any intravenous infusion or who were pregnant were excluded. Venous samples were taken within 2 minutes of arterial sampling from in situ central line. Data were analyzed using Bland-Altman methods. Results A total of 110 patients' paired blood samples were analyzed. The mean difference between arterial and central venous values of pH, PCO 2 , bicarbonate, sodium, potassium, and chloride was 0.04 units, –5.84 mm Hg, 0.89 mmol/L, –1.8 mEq/L, –0.04 mEq/L, and –0.89 mEq/L, respectively. The correlation coefficients for pH, PCO 2 , HCO 3 − , sodium, potassium, and chloride were 0.799, 0.831, 0.892, 0.652, 0.599 and 0.730, respectively. Limits of agreement (95%) were within acceptable limits. Conclusion Central venous pH, PCO 2 , and bicarbonate may be an acceptable substitute for ABG in patients admitted in the ICU. However caution should be exercised while applying electrolyte measurements. How to cite this article Bijapur MB, Kudligi NA, Asma S. Central Venous Blood Gas Analysis: An Alternative to Arterial Blood Gas Analysis for pH, PCO 2 , Bicarbonate, Sodium, Potassium and Chloride in the Intensive Care Unit Patients. Indian J Crit Care Med 2019;23(6):258–262.
SUMMARYA 1-year-old child with no pre-existing cardiac or respiratory disease developed frank pulmonary oedema after administration of a neostigmine-glycopyrrolate mixture to reverse neuromuscular blockade during general anaesthesia. Possible cardiac and extra-cardiac factors that could cause pulmonary oedema in this child were ruled out by appropriate investigations. As the pulmonary oedema manifested shortly after administration of the neostigmine-glycopyrrolate mixture, we concluded that neostigmine was the most probable cause. This article briefly reports the occurrence of events and successful management of perioperative pulmonary oedema. BACKGROUND
We describe a case of acute uterine inversion that occurred during a lower uterine segment caesarean section in a 20year-old primigravida under subarachnoid block that was managed successfully. During the extraction of the placenta with controlled cord traction inversion of uterus was observed. After several unsuccessful attempts, the inversion was corrected by gradual reversion of the uterus done by rolling the lower edge over the uterine fundus (first part to invert, first reverted) followed by extraction of the placenta. A blood loss of about 1000 mL was estimated and corrected with two pints of compatible blood transfusion. The patient was shifted to the postoperative room in a stable condition. The postoperative period was uneventful. We concluded that uterine inversion is a serious complication, of which both the anaesthesiologist and the obstetrician should be aware of since its prompt diagnosis and early management are of utmost importance in preventing maternal morbidity and mortality.
Background: Pregabalin is gamma amino butyric acid (GABA) structural analogue, effectively used in management of different neuropathic pain, incisional and inflammatory injuries. Current study aimed to evaluate the efficacy of pregabalin 75 mg with a placebo as premedication for post-operative analgesia in patients posted for open Appendicectomy under regional anesthesia. Methods: A randomized controlled trial was conducted on 90 patients undergoing open Appendicectomy under regional anesthesia. The patients were divided in two groups of 45 each: group C (placebo); group P (75 mg pregabalin), drug was administered orally 60 minutes before surgery. The Ramsay sedation scale (RSS) was used for assessment of sedation and the visual analog scale (VAS) was used to determine pain at rest and cough, along with assessment of time required for rescue analgesics on the first post-operative day. Results: The RSS scores were significantly higher in groups P as compared to the controls (p<0.001). Postoperative VAS scores for pain both at rest and on cough were significantly reduced in group P (p<0.001). Rescue analgesic consumption decreased significantly in group P (p<0.001). The time at which first dose of rescue analgesia administered was 4.50±3.04 hours in group C, 10.90±5.37 hours in group P (p<0.001). Conclusions: Pregabalin as premedication prolong the postoperative analgesia in addition to decreased consumption of analgesics.
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