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Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The jugular veins often follow the changes in central venous pressure (CVP), which may help assess fluid status. Normal CVP is in the range 2–8mmHg. Central venous pressure measures the pressure in the right atrium or vena cava and helps to monitor the effectiveness of the heart’s pumping mechanism and vascular tone. Flat neck veins when the patient in the supine position may indicate decreased plasma volume and a low CVP, whereas distended neck veins and an elevated CVP may be seen in hypervolaemia.
Eclampsia and pre-eclampsia
Published in Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves, Clinical Protocols in Labour, 2020
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves
Central venous pressure should be recorded at least every hour. the anaesthetist is responsible for the insertion and subsequent care of the central venous line. If there are any concerns regarding central venous pressure measurement, the anaesthetist should be informed. If the central venous pressure is more than 12 cmH2O or less than 5 cmH2O, the obstetric senior house officer and the anaesthetic specialist registrar should be contacted immediately.
Ventricular Assistance for Postcardiotomy Cardiogenic Shock
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
As CPB is discontinued and the LVAD flow rate is increased, it is also important to observe the central venous pressure. If LVAD flow is suboptimal and the left atrial pressure is low, the patient may be suffering from either hypovolemia or right heart failure. Hypovolemia is readily identified by a low central venous pressure. Judicious volume administration will raise the central venous and left atrial pressure, improve LVAD filling and flow. On the other hand, the initiation of left ventricular assistance may unmask right ventricular failure (Table 5.6). Suboptimal LVAD flow in the face of a low left atrial pressure and high central venous pressure is pathognomic of right ventricular failure.
Influence of pre-peritoneal vs. epidural levobupivacaine infusion on troponin I and BNP as predictors of cardiac injury in cancer patients undergoing major upper abdominal operations: A randomized controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2023
Samy Abdelrahman Amr, Ahmed Hassan Othman, Rania Mohamed Mohamed Bakri El-Aton, Mohammed Farghaly Abd-El-Hamed, Diab Fuad Hetta
Standard general anesthesia was administered to all patients and induced, after five deep breathes, with intravenous fentanyl 1–2 μg/kg, propofol 2 mg/kg and rocuronium 0.65 mg/kg then tracheal intubation was performed. Isoflurane 1–1.5 MAC was used to maintain anesthesia, and rocuronium 0.03 mg/kg was administered according to train of four monitoring by nerve stimulator. Fentanyl 0.5–1 μg/kg was administered intraoperatively, when needed, to keep the blood pressure and heart rate within 20% of the basal value. Central venous catheter was inserted via internal jugular under complete aseptic conditions to monitor central venous pressure (CVP) pre- and postoperatively. Mechanical ventilation was used to keep end tidal CO2 levels 35–40 mmHg. Neuromuscular block was antagonized in all patients at the end of surgery with sugammadex 1–4 mg/kg, and all patients were finally extubated after fulfilling criteria of extubation and adequate train of four reading. Lowering the infusion rate and IV ephedrine 6–12 mg was given for hypotension (mean BP < 60) while atropine 0.01 mg/kg was administrated for bradycardia (heart rate < 50 beats/min).
Inferior Vena Cava Diameter is an Early Marker of Central Hypovolemia during Simulated Blood Loss
Published in Prehospital Emergency Care, 2021
Blair D. Johnson, Zachary J. Schlader, Michael W. Schaake, Moragn C. O’Leary, David Hostler, Howard Lin, Erika St. James, Penelope C. Lema, Aaron Bola, Brian M. Clemency
Long and short axis 3-second cine-loop ultrasound images of the IVC were obtained in B-mode (grayscale) with a broadband 1.5-3.6 MHz M4S phased array transducer (Vivid 7 Dimension, GE, Milwaukee, WI). Images were collected during minutes 2 to 4 of each stage. The anteroposterior (AP) diameter of the longitudinal axis view of the IVC was measured 2 cm caudal to the hepatic vein inlet in the subcostal transabdominal view. The short axis view of the IVC was measured at the level of the left renal vein. The order of IVC image acquisition (long axis first versus short axis first) was randomized for each participant. The maximum IVC diameter was measured during passive expiration. The minimum IVC diameter was measured during passive inspiration. IVC collapsibility is measure of the change in IVC size during inhalation. It has been validated as a noninvasive measure of volume status and has been shown to correlate with central venous pressure.(12–14) The IVC collapsibility index was calculated using the formula [(IVCmax diameter – IVCmin diameter)/IVCmax diameter] x 100. (12–14) Images were obtained by a board-eligible emergency medicine physician during his emergency ultrasound fellowship (HL) and reviewed by emergency ultrasound fellowship trained board-certified emergency medicine physicians (PCL, ESJ).
Preoperative left stellate ganglion block: Does it offer arrhythmia-protection during off-pump CABG surgery? A randomized clinical trial
Published in Egyptian Journal of Anaesthesia, 2020
Essam Abd Allah, Mohammed Abdelmonem Bakr, Sara Abdallah Abdelrahman, Ahmed M. Taha, Emad Zarief Kamel
Before induction, arterial line was placed under local anesthesia. Induction was achieved by fentanyl (3–4 µg/kg) and propofol (1–2 mg/kg), followed by cisatracurium (0.15 mg/kg) to facilitate endotracheal intubation, then volume-controlled ventilation was instituted with parameters set to maintain normocarbia. Central venous pressure line was applied in the right internal jugular vein. Anesthesia was maintained by isoflurane in oxygen and air (FiO2 = 0.5), fentanyl infusion (1 µg/kg/hour), and cisatracurium infusion (1–2 µg/kg/min) for maintenance of muscle relaxation. Intraoperative monitoring included electrocardiogram, invasive systemic blood pressure, central venous pressure, O2 saturation by pulse oximetry, end-tidal CO2 by capnography, arterial blood gases, core body temperature using nasopharyngeal probe, and urine output. Operative procedure was done through midline sternotomy and by the same surgical team.