Background: Invasive hemodynamic monitoring of central venous pressure (CVP) is a useful guide in directing early resuscitative efforts and assists in reducing the morbidity and mortality of the patients with septic shock. Dynamic parameters like ultrasonographic evaluation of the inferior vena cava (IVC) diameters are becoming increasingly popular method to assess the intravascular volume status. Objectives: The objective of this study was to evaluate the relation between CVP and IVC collapsibility in cases of fluid refractory shock. Methods and Materials: This was a prospective observational study. Pediatric patients between 1 and 14 years with fluid refractory shock were evaluated. Their CVP was recorded and IVC diameter was measured by ultrasonography during inspiration and expiration. This was calculated as IVC collapsibility index (IVC-CI). Data analysis was done with descriptive statistics, coefficient of correlation, and analysis of variance, as appropriate using SPSS for Windows software (SPSS Inc. Version 20). Results: A total of 107 patients with shock were included in the study with the mean age of 7.6 years. Septic shock (93%) was the most common cause of shock and the maximum patients (63%) were in cold shock. Most of these patients had acidosis (mean pH 7.22±0.2), high lactate levels (mean 6.3±3.50 mmol/l), and decreased bicarbonate levels (mean 16.98±5.95 mmol/l). When CVP range was ?8 mmHg, the mean IVCCI value was >40% and when the CVP range was ?12 mmHg, the mean IVCCI value was around 20%. Inverse relation between CVP and IVCCI was observed (r=?0.690, p<0.01). Conclusions: There was a strong negative correlation between CVP and IVC collapsibility.

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Women with cardiovascular diseases may present for cesarean delivery. We present a case of anesthetic management for cesarean section in a patient with uncorrected tetralogy of Fallot complicated with preeclampsia. No definite guideline or information is available in the textbook or literature about the management of such a case. A 21 year primigravida was admitted in our institute with breathlessness on normal day to day life activity. Her blood pressure was 160/100 mmHg, oxygen saturation 85-86% in room air and she had ejection systolic murmur of grade three intensity along the left sternal border. Her echocardiography which was done in the first trimester revealed tetralogy of Fallot with moderate to severe right ventricular outlet obstruction with hypoplastic pulmonary artery and pulmonary valve. Proteinurea was detected on bedside urine examination. The patient was posted for emergency cesarean section due to non-reassuring fetal heart rate associated with preeclamsia. Magnesium sulfate 10 gm intramuscularly was given for seizure prophylaxis and general anesthesia was administered using etomidate as induction agent. The objective of anesthetic management mainly depends on maintaining of systemic vascular resistance and decreasing pulmonary vascular resistance. In preeclampsia systemic vascular resistance is already elevated. Thus treatment of preeclampsia may worsen cyanosis, so we avoided labetalol to reduce blood pressure. Intra-operative and post-operative periods were uneventful and baby had good apgar scores. So we can conclude that cesarean section in patient with both tetralogy of Fallot and preeclampsia can be managed successfully with general anesthesia using techniques which maintain systemic vascular resistance.

Introduction: Central Venous Pressure (CVP) measurement is the recommended method for assessment of intravascular status in paediatric shock. The role of Ultrasonography guided measurement of respiratory collapsibility in inferior vena cava diameter (IVC-CI) as a newer, non-invasive adjunct to CVP measurement has been evaluated. This study was done to determine the effectiveness of CVP and IVC-CI in predicting fluid responsiveness in cases of paediatric shock. Material and Methods:This prospective observational study was done in 107 fluid refractory shock patients aged 1-14 years. An informed consent was obtained. Baseline vitals, CVP and IVC-CI were measured before and after a crystalloid Fluid Bolus of 20ml per Kg BW. The changes in CVP and IVC-CI were noted and were correlated to the clinical response. A rise of ≥15% in Cardiac Output was taken as positive fluid response.Results: Mean age of the patients was 7.6years (±4.153). The mean CVP in fluid responders and non-responders was 6.58 (±2.64) and 11.22 (±6.12), while the mean IVC-CI was 46.57% (±23.34) and 25.62% (±23.28) respectively. There was significant inverse correlation between CVP and IVC-CI (P<0.01) in both fluid responders and non-responders. At CVP ≤8.25, sensitivity was 80% and specificity was 99% for predicting fluid responsiveness. When IVC-CI was ≥ 33.5%, sensitivity was 87% and specificity was 86%. Thus IVC-CI has better sensitivity put poor specificity to predict fluid responsiveness than CVP. Conclusion:Both CVP and IVC-CI are good predictors of volume responsiveness. A shift from hypovolemic to euvolemic status was associated with gradual fall in mean IVC-CI values with progressive rise of CVP values. IVC-CI can provide a useful guide for non-invasive intravascular volume status assessment in critically ill patients.

An Intra-operative Transesophageal Echocardiographic Study to Compare The Effect of Sevourane and Isourane on Left Ventricular Dysfunction In Patients With Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting Using Cardiopulmonary Bypass Context : Diastolic dysfunction has been increasingly recognized as an important cause of congestive heart failure (CHF) and resultant morbidity. About 50% patients with CHF have 'diastolic heart failure' in spite of a normal systolic function with preserved ejection fraction. The widely used volatile anesthetic agents, Isourane and Sevourane, are considered important components of balanced anesthesia technique. However their effects on left ventricular (LV) systolic and diastolic function have not been precisely dened. This study was designed to quantify and compare their effects on left ventricular function by TEE before start of CPB. Aims : To compare the effects of Isourane and Sevourane on echocardiographic LVsystolic and diastolic parameters. Settings and design : After obtaining institutional ethics committee clearance and informed consent from 60 patients operated within my study period was included . Data were collected after induction and just before going on bypass. Materials and Methods : After inducing the patients with institutional protocol one group was given isourane(Group I) and another group was given sevourane(Group S), both at 1MAC. TEE parameters measuring LVsystolic and diastolic functions were done. Statistical analysis : Data were analysed by Epi Info (TM) 7.2.2.2. Result and conclusion :Isourane was better than sevourane in comparism of systolic and diastolic dysfunction.