Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia

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Vol 5 | Issue 1 | January-June 2024 | Page 24-29| S. Narmatha Yangste, S. Shankar Raju, Bhaskar

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.087

Authors: S. Narmatha Yangste [1], S. Shankar Raju [2], Bhaskar [3]

[1] Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Anesthesiology, ESI medical college, Coimbatore, Tamil Nadu, India.
[3] Department of Anesthesiology, Dharmapuri Medical College, Dharmapuri, Tamil Nadu, India.

Address of Correspondence
Dr. S. Narmatha Yangste,
Associate Professor, Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
E-mail: nyangtse75@gmail.com

Abstract

Background and Aim: Ultrasound-guided inferior vena cava collapsibility index (IVCCI) is used for assessing the volume status of the patient in critical care but for emergency cases taken up under spinal anesthesia this index helps to assess the adequacy of resuscitation. In our study, we aimed to evaluate the usefulness of ultrasound in adequately resuscitating patients requiring subarachnoid block for emergency lower limb orthopedic surgeries.
Methods: After obtaining approval from the Coimbatore Medical College institutional ethical committee, 60 adults aged between 20 and 60 comprising both sexes requiring emergency lower limb [shaft of femur] orthopedics surgeries were included in this randomized clinical study. After a complete pre-anaesthetic assessment, IVCCI by ultrasound is measured. The patient was resuscitated to a target IVCCI of ≤30% before performing the subarachnoid block from the USG group. The other group of patients was resuscitated till the mean arterial pressure (MAP) was≥65 mm Hg from the MAP group. Then spinal anaesthesia was performed in a sitting position via L3 – L4 interspace using a 25 G Quincke’s needle. The parameters were monitored every 5 minutes for 30 minutes post-spinal.
Results: The incidence and severity of hypotension are lesser in the ultrasound group compared to the MAP group which was statistically significant (p=0.004).
Conclusion: Our study concludes that the USG-guided fluid resuscitation with a target IVCCI ≤30% for emergency surgeries under spinal anaesthesia does reduce the severity of hypotension and its adverse outcomes.
Keywords: Inferior vena cava, Lower limb, Fracture, Mean arterial pressure, Ultrasound, Spinal anesthesia

References

1) B Ayyanogouda, BC Ajay, Chhaya joshi et al., Role of ultrasonographic inferior venacaval assessment in averting spinal anaesthesia-induced hypotension for hernia and hydrocele surgeries-A prospective randomised controlled study, Indian J Anaesth2020 Oct;64(10): 849-854. 1.
2) Ceruti S, Anselmi L, Minotti B, Franceschini D, Aguirre J, Borgeat A, Saporito A. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth. 2018 Jan;120(1):101-108. doi: 10.1016/j.bja.2017.08.001. Epub 2017 Nov 23. PMID: 29397116.
3) M J Kaptein,Elaine M Kaptein, Inferior Vena Cava Collapsibility Index: Clinical Validation and Application for Assessment of Relative Intravascular Volume,Adv Chronic Kidney Dis. 2021 May 28(3): 218-226..
4) Zhang J, Critchley LA. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology. 2016 Mar 1;124(3):580-9.
5) E R Salama, Mohamed Elkashlan, Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study, Eur J anesthesiol 2019 Apr;36(4):297-302.
6) M Szabo,Anna Bozo, Katalin Darvas et tal,. Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study BMC anaesthesiology 2019 Aug 7;19(1):139.
7) T Saranteas,H spiliotaki,L koloantzaki et tal ,The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player, J cardiothoracic Vasc Anesth 2019 Sep; 33(9): 2421-2127.
8) Shyam Sundar Purushothaman , Ani Alex , Rajesh Kesavan , Sindhu Balakrishnan Sunil Rajan , Lakshmi Kumar , Ultrasound Measurement of Inferior Vena Cava Collapsibility as a Tool to Predict Propofol-Induced Hypotension, Anesth Essays Res. Apr-Jun 2020;14(2):199-202.
9) Arthur K Au , Dean Steinberg , Christopher Thom , Maziar Shirazi , Dimitrios Papanagnou et tal, Ultrasound measurement of inferior vena cava collapse predicts propofol-induced hypotension, Am J Emerg Med. 2016 Jun;34 (6):1125-8.
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How to Cite this Article: Raju SS, Yangste SN, Kalyanasundaram K | Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 24-29 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.87

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Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region

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Vol 5 | Issue 1 | January-June 2024 | Page 30-31| Pooja Jadhao, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.088

Authors: Pooja Jadhao [1], Sandeep Diwan [1]

[1] Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.

Address of Correspondence
Dr. Pooja Jadhao,
Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.
E-mail: poojajadhao533@gmail.com

Abstract

The brachial plexus at supraclavicular division level is superior and lateral to the subclavian artery. Thus needle tip positions are already published in literature. However we report the brachial plexus divisions on the medial side of the subclavian artery. This might result in inadequate or failed blocks with landmark guided technique. Moreover with ultrasound needle tip needs to advance medial to artery making it more difficult in expert hands too. Ultrasound imaging of brachial plexus helps in identifying anamolous position of brachial plexus divisions.
Keywords- Brachial plexus divisions, Subclavian artery, Ultrasound

References

1. Kessler J, Gray AT. Sonography of scalene muscle anomalies for brachial plexus block. Reg Anesth Pain Med. 2007; 32:172-3.
2. Chin KJ, Niazi A, Chan V. Anomalous brachial plexus anatomy in the supraclavicular region detected by ultrasound. Anesth Analg.2008;107:729-31
3. Padur AA, Kumar N, Shanthakumar SR, Shetty SD, Prabhu GS, Patil J. Unusual and unique variant branches of lateral cord of brachial plexus and its clinical implications ‒ A cadaveric study. J Clin Diagn Res. 2016;10:AC01-4.
4. Royse CF, Sha S, Soeding PF, Royse AG. Anatomical study of the brachial plexus using surface ultrasound. Anaesth Intensive Care 2006; 34:203–10.
5. Ramanujam V, Kirk PV. Anatomy variation of brachial plexus trunks during supraclavicular nerve block: clinical image. Braz J Anesthesiol. 2022 Nov-Dec;72(6):834-835.
6. Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg 2003;97: 1514–7.

How to Cite this Article: Jadhao P, Diwan S | Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 30-31 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.88

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The Ever-Evolving Landscape of Modern Communication

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The Ever-Evolving Landscape of Modern Communication

In today’s interconnected world, communication has transcended geographical boundaries and evolved at an unprecedented pace. From the simple act of exchanging letters to the complex realm of digital interactions, the ways in which we connect with one another are constantly being reshaped by technological advancements and societal shifts. Understanding this ever-evolving landscape is crucial for navigating personal relationships, professional endeavors, and the broader global community.

The Rise of Digital Communication

The advent of the internet revolutionized communication, ushering in an era of instant messaging, email, and video conferencing. These tools have not only streamlined business operations but have also transformed personal relationships, allowing individuals to stay connected with loved ones across vast distances. Social media platforms have further amplified this trend, providing avenues for individuals to share their thoughts, experiences, and perspectives with a global audience.

However, the rise of digital communication has also presented challenges. The anonymity afforded by the internet has contributed to the spread of misinformation and online harassment. The sheer volume of information available online can be overwhelming, making it difficult to discern credible sources from unreliable ones. Furthermore, the constant connectivity demanded by digital communication can lead to burnout and a sense of being perpetually “on.”

Social Media’s Impact on Society

Social media has become an undeniable force in modern society, influencing everything from political discourse to consumer behavior. Platforms like Facebook, Twitter, and instagram have provided individuals with unprecedented opportunities to connect with like-minded people, organize social movements, and promote their businesses or personal brands. News and information now spread virally, often bypassing traditional media outlets. This immediacy can be both beneficial and detrimental, allowing for rapid responses to crises but also contributing to the spread of unverified or misleading content.

The curated nature of social media profiles can also contribute to unrealistic expectations and social comparison. The constant exposure to carefully crafted images and narratives can lead to feelings of inadequacy and anxiety, particularly among young people. It’s important to remember that social media often presents a highly filtered version of reality and to cultivate a healthy perspective on the information we consume online.

The Art of Effective Communication in a Digital Age

In a world saturated with information, the ability to communicate effectively is more important than ever. Whether you’re crafting an email, giving a presentation, or engaging in a social media conversation, clear, concise, and compelling communication can make all the difference. Here are some tips for honing your communication skills in the digital age:

  • Know your audience: Tailor your message to the specific interests and needs of your audience.
  • Be clear and concise: Get to the point quickly and avoid unnecessary jargon.
  • Use visuals: Incorporate images, videos, and infographics to enhance your message.
  • Be engaging: Ask questions, tell stories, and encourage interaction.
  • Be respectful: Engage in respectful dialogue, even when you disagree with someone’s perspective.
  • Proofread your work: Errors in grammar and spelling can undermine your credibility.

Looking Ahead: The Future of Communication

The future of communication is likely to be shaped by emerging technologies such as artificial intelligence (AI), virtual reality (VR), and augmented reality (AR). AI-powered chatbots are already being used to provide customer service and personalized recommendations. VR and AR technologies have the potential to create immersive and interactive communication experiences. Imagine attending a virtual meeting where you can interact with colleagues as if you were in the same room, or using AR to overlay digital information onto the real world.

As these technologies continue to evolve, it’s important to consider their potential impact on society. Will they further enhance our ability to connect and collaborate, or will they exacerbate existing inequalities and contribute to social isolation? The answer will depend on how we choose to develop and deploy these technologies. By prioritizing ethical considerations and focusing on human-centered design, we can ensure that the future of communication is one that fosters understanding, empathy, and connection.

In conclusion, the landscape of modern communication is constantly changing, presenting both opportunities and challenges. By embracing new technologies, honing our communication skills, and remaining mindful of the potential impacts of these changes, we can navigate this evolving landscape and build a more connected and informed world.

The Enduring Appeal of Simple Pleasures in a Complex World

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The Enduring Appeal of Simple Pleasures in a Complex World

In today’s fast-paced, technologically advanced world, it’s easy to get caught up in the pursuit of success, material possessions, and constant stimulation. We are bombarded with information, notifications, and demands on our attention, leaving us feeling overwhelmed and disconnected. But amidst this complexity, there lies a profound and enduring appeal in the simple pleasures that life has to offer. These are the small, often overlooked moments that can bring genuine joy, contentment, and a sense of grounding in the present moment. Rediscovering and appreciating these simple pleasures is not just a nostalgic yearning for a bygone era, but a crucial element in cultivating a balanced and fulfilling life.

The Power of Nature’s Embrace

One of the most readily available and universally appreciated simple pleasures is the connection with nature. Whether it’s a leisurely stroll through a park, a hike in the mountains, or simply sitting by a lake, immersing ourselves in the natural world can have a profound impact on our well-being. The fresh air, the sounds of birds singing, the vibrant colors of flowers, and the gentle breeze against our skin – these sensory experiences can soothe our minds, reduce stress, and reconnect us with our inner selves. Even something as simple as tending to a small garden or watching the sunrise can be incredibly rewarding. The natural world offers a constant reminder of the beauty and wonder that surrounds us, inviting us to slow down, appreciate the present moment, and find solace in its embrace. For those seeking a thrilling experience to balance the peace of nature, sekabet giriş can offer a different kind of excitement.

The Comfort of Human Connection

In an increasingly digital age, genuine human connection is becoming more precious than ever. While social media can provide a sense of connection, it often lacks the depth and authenticity of face-to-face interactions. Spending quality time with loved ones, sharing a meal, engaging in meaningful conversations, and offering support to those in need are simple yet powerful ways to nurture our relationships and foster a sense of belonging. A warm hug, a listening ear, or a shared laugh can be incredibly uplifting and provide a sense of comfort and security. Reaching out to friends and family, volunteering in our communities, or simply engaging in small acts of kindness can create a ripple effect of positivity, enriching not only our own lives but also the lives of those around us. True connection transcends superficiality and reminds us that we are all interconnected, sharing a common humanity.

The Joy of Simple Activities

Sometimes, the most fulfilling experiences are not the grand adventures or the expensive luxuries, but the simple activities that we engage in with intention and enjoyment. Reading a good book, listening to music, cooking a delicious meal, practicing a hobby, or simply relaxing with a cup of tea can be incredibly satisfying. These activities allow us to disconnect from the pressures of daily life, engage our creativity, and cultivate a sense of inner peace. The key is to approach these activities with a sense of mindfulness, fully immersing ourselves in the experience and savoring each moment. Whether it’s the aroma of freshly baked bread, the melody of a favorite song, or the satisfaction of completing a challenging puzzle, these simple activities can bring a sense of joy and fulfillment that transcends material possessions or external validation. Finding your niche and indulging in it is what makes life exciting.

The Importance of Gratitude and Mindfulness

Underlying all of these simple pleasures is the practice of gratitude and mindfulness. Taking the time to appreciate the good things in our lives, no matter how small, can shift our perspective and cultivate a sense of contentment. Keeping a gratitude journal, expressing appreciation to others, or simply reflecting on the blessings we have can help us to focus on the positive aspects of our lives and reduce feelings of stress and negativity. Mindfulness, on the other hand, involves paying attention to the present moment without judgment. By being fully present in our experiences, we can savor the simple pleasures that life has to offer and appreciate the beauty that surrounds us. Whether it’s the taste of a delicious meal, the warmth of the sun on our skin, or the sound of laughter, mindfulness allows us to fully engage with our senses and appreciate the richness of life’s everyday moments. It’s about finding joy in the ordinary and recognizing the extraordinary in the mundane.

In conclusion, the enduring appeal of simple pleasures lies in their ability to connect us with nature, foster human connection, provide a sense of joy and fulfillment, and cultivate gratitude and mindfulness. In a world that often prioritizes complexity and achievement, rediscovering these simple pleasures is essential for cultivating a balanced, meaningful, and fulfilling life. By slowing down, appreciating the present moment, and focusing on the small joys that surround us, we can find happiness and contentment in the simplest of things.