Background:Whether use of ultrasound (USG) to cannulate dorsalis pedis artery (DPA) increases first pass successful cannulation, decreases the number of attempts and complications as compared to palpation technique was assessed in this study.Design:Randomized controlled trial.Setting:Operating room.Patients:About 60 adult patients undergoing any head–neck or faciomaxillary surgery requiring arterial cannulation were enrolled.Intervention:DPA was cannulated either by USG-guided technique (USG group) or by palpation technique (palpation group) with 30 patients in each group.Measurement:Data were assessed for “first-attempt success” of cannulation, number of attempts, assessment time, cannulation time, cannulation failure, and incidence of complications.Main Results:Successful first pass DPA cannulation was similar between the groups (ultrasound group vs. palpation group, 76.7% vs. 60%, respectively) [relative risk (95% confidence interval (CI) = 0.69 (0.43, 1.13), P = 0.267)] as was the number of attempts required for successful cannulation [median (interquartile range (IQR) number of attempts 1 (1–2) in palpation group P and USG group U 1 (1–1); P = 0.376]. Median (IQR) assessment time was significantly less (P < 0.0004) in palpation group [palpation group 12 (9–17) vs. USG group U 19 (15–21)]. However, cannulation time was significantly higher (P = 0.0093) in Group P [median (IQR) 17.5 (12–36 s) and 11.5 (9–15)]. Although the total procedure time (sum of both assessment time and cannulation time) remain statistically similar between two groups (P = 0.8882).Conclusions:Use of USG for the cannulation of DPA is feasible, but it is not associated with significant increase in first-attempt success rate, decrease in total number of cannulation attempts or total procedure time.

Background:Postspinal anesthesia hypotension (PSH) in pregnant women is common and may lead to poor maternal and fetal outcome. Fluid loading in pregnant women before spinal anesthesia to prevent hypotension is of limited ability. We hypothesized that those women who are hypovolemic before spinal anesthesia may be at risk of PSH and inferior vena cava collapsibility index (IVCCI) will be able to identify hypovolemic parturients.Methods:In this prospective observational study, n = 45 women undergoing elective lower segment cesarean section with singleton pregnancy were recruited and IVCCI in left lateral tilt (with wedge) and supine position (without wedge) were noted by M-mode ultrasound (USG) before spinal anesthesia. After spinal anesthesia, changes in blood pressure were noted till 15 min after spinal anesthesia.Results:USG measurements were obtained in 40 patients and 23 of 40 patients (57.5%) had at least one episode of hypotension. Area under the ROC curve of IVCCI with wedge to predict PSH was 0.46 (95% CI 0.27, 0.64) and best cut-of value was 25.64 with a sensitivity and specificity of 60.9% and 35.5%, respectively. Area under the ROC curve of IVCCI without wedge to predict PSH was 0.38 (95% CI 0.19, 0.56) and best cut-of value was 20.4 with a sensitivity and specificity of 69.6% and 23.5%, respectively.Conclusion:We conclude that IVCCI is not a predictor of PSH in pregnant women undergoing elective cesarean section.

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