Background:Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill patients with burns. Hemodynamic monitoring may be necessary to optimize resuscitation in serious burn patients with reasonable safety. Invasive central venous pressure (CVP) monitoring has become the corner stone of hemodynamic monitoring in patients with burns but is associated with inherent risks and technical difficulties. Previous studies on perioperative patients have shown that measurement of peripheral venous pressure (PVP) is a less invasive and cost-effective procedure and can reliably predict CVP.Objective:The aim of the present prospective clinical study was to determine whether a reliable association exists between changes in CVP and PVP over a long period in patients admitted to the Burns Intensive Care Unit (BICU).Subjects and Methods:The CVP and PVP were measured simultaneously hourly in 30 burns patients in the BICU up to 10 consecutive hours. The predictability of CVP by monitoring PVP was tested by applying the linear regression formula and also using the Bland–Altman plots of repeated measures to evaluate the agreement between CVP and PVP.Results:The regression formula revealed a reliable and significant association between CVP and PVP. The overall mean difference between CVP and PVP was 1.628 ± 0.84 mmHg (P < 0.001). The Bland–Altman diagram also showed a perfect agreement between the two pressures throughout the 10 h period.Conclusion:Peripheral venous pressure measured from a peripheral intravenous catheter in burns patients is a reliable estimation of CVP, and its changes have good concordance with CVP over a long period of time.

No abstract

Introduction: Ultrasound is gaining popularity in routine anesthetic practice both in operating room as well as in intensive care units. Brachial plexus block and peripheral nerve block in various combinations have been used successfully for upper limb surgeries. But the disadvantage of brachial plexus block is the inability to use the affected limb in the post operative period due to motor block. The present study was undertaken to assess the degree of motor sparring under USG guided peripheral nerve block as compared to USG guided brachial plexus block. Materials and Methods:The study was a randomized open label study conducted in two groups viz. group A and group B. Patients in group A received treatment A i.e peripheral nerve block (PNB) and patients in group B received treatment B i.e brachial plexus block. Results: In peripheral nerve block group the median strength loss was 23% whereas the same was 100% in brachial plexus block group. This difference was found to be statistically significant ( =0.001). The anesthetic onset time was found to be significantly shorter in peripheral nerve block group as compared to brachial plexus group (7.71+1.3 Vs 9.58 +1.91 min). Subject's satisfaction score was reported higher with peripheral nerve block than those who underwent brachial plexus block: 5 Vs 4 respectively (p = 0.012). Likewise these satisfaction scores were found to have inverse correlation with loss of strength in the operative limb (Spearman's rho −0.62 [p = 0.016] and Kendall's tau −0.55 [p = 0.025]). Conclusion: Therefore we conclude that ultrasound guided peripheral nerve block can be an effective alternative to brachial plexus block as a primary mode of anesthesia in hand surgeries of short duration.

No abstract