Background: To determine the effect of high dose tranexamic acid in decreasing immediate postoperative bleeding in children less than ten kilo body weight after complex cardiac surgery and also to evaluate the safety of high dose in small children. Methods: Between January-December 2015, 25 children weighing less than ten kilogram body weight underwent complex cardiac surgery for cyanotic congenital heart disease. All children were given dose of 100 mg/kg tranexamic acid at the time of anaesthetic induction and also 100 mg/kg into the CPB prime. The Median age and weight was 80 days (3-365) and 4.69 kg (2.4-7.8) respectively. The Median preoperative Hb was 10 g/dl (9.6-19.5 g/dl). Cardiac surgery included total intracardiac repair for TOF in 10 pts (40%), TAPVC repair in 6 (24%), arterial switch operation in 6 pts (24%), BD glenn in 1, repair of DORV with VSD in 1 and VSD closure with scimitar vein reimplantation in 1 pt. Median CPB time was 127 minutes (97-343) and cross clamp time was 99 (67-200) minutes. Moderate to deep hypothermia was maintained in all with median temperature of 24˚C (18-32). Three children (12%) had elective open chest in view of anticipated bleeding. Results: The Median postoperative drainage was 127 ml, (range 10-1250 ml). The median postoperative use of whole blood was 95 ml (range 10-275), packed cell was 187 ml (range 50-400 ml), frozen plasma was 88 ml (range 30-170), platelet concentrate was 57 ml, (range 10-100 ml) and cryoprecipitate was median 47.5 ml, (range 30-80 ml). No neurological dysfunction and renal dysfunction has been observed in any of the pts.

Background-Internal jugular vein cannulation (IJV) is a routinely done procedure in indicated patients. This procedure has been associated with many complications. We have assessed the utility of ultrasound in our hospital setup. Aims and objectives-To compare the success rate in right and left internal jugular vein cannulation using surface anatomy or ultrasound guidance. The time taken from initial puncture to successful insertion of guidewire was compared. The number of attempts and incidence of complications were also compared. Study design-A prospective randomized study in 106 patients from all patients indicated for internal jugular vein cannulation during the study period. Methods and materials-After approval from the ethics committee, consent was obtained for the study. 106 patients were randomly assigned into 4 groups-Group 1 right IJV cannulation using surface anatomy, Group 2-right IJV cannulation using USG guidance, Group 3 left IJV cannulation using surface anatomy, Group 4-left IJV cannulation using USG guidance. Data on time taken, number of attempts and incidence of associated complications was taken. Results-The mean time taken in group 1, group 2, group 3 and group 4 were 172.45213.60, 136.47122.86 seconds, 273.87127.59 seconds, and 135.25105.09 seconds respectively. There was no statistically significance between Group 1 and Group 2 (p value >0.05) and between Group 2 and Group 4(p value >0.05). There was a statistically significant difference (p value <0.001) between Group 3 and Group 4.The average attempts in group 1, group 2, group 3 and group 4 were 2.05 1.22, 1.46 0.64, 2.781.41, and 1.690.18 respectively. There was a difference in number of attempts between Group 1 and Group 2 and between Group 3 and Group 4that was statistically significant (p value <0.05, p value <0.01, respectively). But there was no statistically significance between Group 2 and Group 4(p value>0.05).Statistic evaluation of the incidences of carotid puncture shows no statistically significance between Group 1 (5.3%) and Group 2(nil) (p value>0.05) but there was statistical significance between Group 3(34.8%) and Group 4(nil) (p value <0.01) Conclusion-Ultrasound helps in safer successful cannulation of the internal jugular vein with lesser incidence of complications of carotid punctures especially for left sided internal jugular vein cannulations. Moreover, ultrasound guided internal jugular vein cannulation helps in reducing the average time duration