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Objectives: To evaluate the correlation between stroke volume variation (SVV) and inferior vena cava distensibility index (dIVC) as a marker for fluid responsiveness in mechanically ventilated hypotensive intensive care unit (ICU) patients.Methodology and Design: This study is designed as prospective observational study conducted in patients admitted to an ICU who were mechanically ventilated and experienced a hypotensive episode.Intervention: A fluid challenge of 10 mL/kg ringer's lactate was given over 20 min.Measurements: Hemodynamic parameters as well as SVV, IVCmax, IVCmin, dIVC, and cardiac output (CO), were recorded at a different time interval. An increase in ≥15% of CO was taken as fluid responsiveness.Results: Out of 67 patients, 67.2% responded to fluid challenge. Pearson's correlation graph at baseline showed a strong positive correlation between dIVC and SVV with r = 0.453, (P < 0.002). Non-responders also had a strong positive correlation (r = 0.474) at the baseline. Bland Altman's analysis of the correlation between dIVC and SVV post-fluid challenge showed a mean difference of - 4.444, with 1.49% of the values falling outside the limits of agreement (18.418 and -27.306). This difference was clinically significant. Pearson's correlation graph post-fluid challenge showed a moderately strong positive correlation between dIVC and SVV with r = 0.298 and P value = 0.047, which was statistically significant. Also, non-responders had a weak correlation as compared to the responder's group, r = 0.364 and P value = 0.095, which was not clinically significant. There was no significant difference in the trend of dIVC and SVV values between the non-surgical and surgical groups, nor was there any gender difference analyzed in the study.Conclusion: This study ascertains the positive correlation between dIVC and SVV and justifies its use in a clinical setting of hypotension suspected to be due to hypovolemia. [ABSTRACT FROM AUTHOR]

Introduction: Magnetic Resonance Imaging (MRI) is not painful, but frightening especially in children leading to movement and artefacts causing prolongation of the procedure. Though analgesia is not required, but being a noisy suite, deep sedation is a prerequisite for it. Dexmedetomidine (DEX) and Ketamine both anaesthetic drugs can achieve the sedation in the children but never had been compared. Aim: To compare the effect of DEX and Ketamine in paediatric patients undergoing MRI under sedation. Materials and Methods: This was a cross-sectional study carried out from August 2017 to July 2018 included 74 patients. All patients were separated into Group K for Ketamine (loading dose of 1 mg/kg, intravenous over 10 min followed by infusion of 10-15 mcg/kg/min) and Group D for DEX (loading dose of 1 mcg/kg over 10 min followed by infusion of DEX at 0.2-0.7 mcg/kg/h). Ramsay sedation score of five was considered as onset of sedation. Midazolam 0.1 mg/kg IV was decided as rescue sedation. Unpaired t-test was applied for the continuous variables. Results: Sixty-one patients were analysed, 31 in Group K, and 30 in Group D. The onset time for sedation in Group K was 6.30±1.32 minutes and 12.20±SD=2.01 minutes in Group D which was significantly shorter in Group K (p=0.001). However, the time to Modified Aldrete Score of 10/10 was higher in Group K (21.10±1.84 minutes) vs (13.73±1.89 minutes) in Group D which is statistically significant. (Mean±SD; p=0.001). No adverse events were reported in both the groups. Conclusion: Ketamine and DEX can both be used for MRI sedation in children successfully without any adverse effects. The onset of sedation is faster in Ketamine, but discharge and recovery are significantly delayed with Ketamine as compared [ABSTRACT FROM AUTHOR]

Introduction: Ringer's Lactate (RL), a crystalloid is the most common co-loading fluid used to limit haemodynamic complications following the Subarachnoid Block (SAB). Colloids like Hydroxyethyl Starches (HES) are occasionally used as the co-loading fluid despite controversies due to its better haemodynamic effect and are not written-off to date. So knowledge of the effect of co-loading fluid is of paramount importance if it contributes to hyperglycaemia, a detrimental factor for the outcome. Aim: To compare the Blood Sugar Levels (BSL) in different preparations of HES and to that of RL when administered as co-loading fluid following SAB. Materials and Methods: Eighty-nine patients were randomly allocated into three groups, namely HES 200, HES 130, and RL, and were co-loaded with either 20 mL/kg body weight of HES 200/0.5, 20 mL/kg body weight of HES 130/0.4 or 20 mL/kg body weight of RL respectively. BSL for each subject was recorded at 0, 15, 30, 45, 60, 120, 180, 240 min (post-hoc analysis was done with Tukey's test). Results: In all the three groups, there was a statistically significant rise in BSL from baseline. The BSL in the RL group reached its peak at 45 minutes and gradually dropped down to baseline. BSL increased more gradually with HES 130/0.4 reaching a peak value at 60 minutes, and at around 240 minutes for HES 200/0.5. Conclusion: HES causes an increase in BSL, though within physiological limits. [ABSTRACT FROM AUTHOR]

The 20-G iv cannula was flushed with heparin and left radial artery was now again cannulated. After taking all sterile precautions, right radial artery was palpated with nondominant hand, 1-2 cm proximal to the wrist, and a 20-G intravenous (iv) cannula was used to prick the artery. After seeing the flash of blood in the hub, needle was removed and the catheter was advanced in the artery. [Extracted from the article]