IntroductionPatients undergoing neurosurgery are at risk of significant blood loss and resulting hemodynamic changes. In case of sudden blood loss, volume of blood in arteries is maintained at expense of that in veins, manifesting as low central venous pressure (CVP) 1 associated with tachycardia initially and, a fall in arterial pressure is a late sign of hypovolemia. Monitoring of CVP is, therefore, of great assistance during hypovolemia.CVP is the pressure within the intrathoracic venae cavae, measured by insertion of catheter via the internal jugular or subclavian vein, which is normally equal to the right atrial pressure, unless there is obstruction in the venae cavae. The value used in clinical practice is the pressure recorded at the base of c-wave, at the end of expiration, while the subject is supine. This represents the pressure in the right atrium immediately before the start of ventricular systole. 2 CVP is often used to estimate right ventricular preload, which
15Background and Objectives Central venous pressure (CVP) and peripheral venous pressure (PVP) are strongly correlated during various surgeries. This study was designed to examine the consistency of CVP-PVP relationships in circumstances of rapidly fluctuating hemodynamics in neurosurgical patients. Prime objective of this study was to determine if PVP can be an effective alternative to invasive CVP for assessing volume status during neurosurgical procedures when expertise, equipment, and patient's condition contraindicate invasive monitoring. Subjects and Methods After the approval by the Institutional Ethics Committee, CVP and PVP were measured in 50 neurosurgical patients of the American Society of Anesthesiologists grade I and II operated in supine position. Paired measurements of CVP and PVP were made every 20 minutes, from the starting of anesthesia until the end of surgery; however, in situations of hemodynamic instability, the readings were taken every 5 minutes of interval. Results The study showed a strong correlation between CVP and PVP (Pearson's correlation coefficient between CVP and PVP, r = 0.89; 95% CI: 0.81-0.93; p < 0.001). Mean CVP was 5.7 ± 0.8 mm of Hg, mean PVP was 10.4 ± 0.6 mm of Hg, and bias between CVP and PVP was 4.7 ± 0.4 (95% CI: − 4.61 to − 4.83). The Bland-Altman analysis showed that limit of agreement to be 4.0 to 5.5 mm of Hg. Conclusion This study demonstrated a strong correlation between CVP and PVP. Therefore, PVP monitoring may be a reliable alternative to CVP monitoring during neurosurgery.
BACKGROUND: Addition of adjuvant has been widely used to prolong the duration of peripheral nerve block. We evaluated the effect of adding dexamethasone to ropivacaine in supraclavicular brachial plexus block. METHODS: Sixty patients of age group 18-60 years, scheduled for various elective upper limb surgeries under supraclavicular brachial block were divided into 2 groups in a randomized, double-blinded fashion. In group R (n=30), 30ml of 0.5% ropivacaine +1.5ml saline and in group D (n=30), 30ml of 0.5% ropivacaine +1.5ml dexamethasone (6mg) were given. The time of onset of motor and sensory blockade, duration of analgesia and pain scores were recorded. RESULTS: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was earlier in group D as compared to group R (P<0.001). Duration of analgesia was longer in group D than in group R (P<0.001). Pain score in the two groups-group R had moderate to extreme pain while the group D had no pain to moderate pain in the first 24 hours postoperatively. CONCLUSION: Addition of dexamethasone to 0.5% ropivacaine in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade.
BACKGROUND: The thyroid gland is an important endocrine gland of the body placed anteriorly in the neck just in front of 3 rd , 4 th & 5 th tracheal cartilage. Enlargement of this gland causes narrowing and deviation of trachea leading to difficulty in breathing. Hence the anaesthetic management of this patient can be challenging. CASE: A 68 years old lady with cervical multinodular goiter who had left hemithyroidectomy done 20 years ago has now come with complain of a swelling in front of the right side of neck with shift of trachea to left. In order to avoid airway compromise with the induction of anaesthesia fibreoptic bronchoscope (FOB) was used to secure the airway. A wake intubation with 6mm endotracheal tube via nasal root was done. Patient was kept intubated in view of tracheomalacia and shifted to ICU. Extubated after 24 hours after demonstrating leak test using fiberoptic bronchoscope for direct visualization of trachea. CONCLUSION: FOB is considered a gold standard in this situation. Extubation in ICU is essential to rescue the airway if tracheal collapse occurred.
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