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Introduction- A high-risk pregnancy carries a greater risk to the mother or her fetus than an uncomplicated pregnancy. Pregnancy places additional physical and emotional stress on a woman’s body. Health problems that occur before a woman becomes pregnant or during pregnancy may also increase the likelihood for a highrisk pregnancy. Doppler is a noninvasive method for evaluation of fetoplacental circulation without any disturbance to human pregnancy. It gives valuable information about hemodynamic situation of the fetus and is an efficient diagnostic test of fetal jeopardy that helps in management of high-risk pregnancy. Doppler ultrasound technology evaluates umbilical artery (and other fetal arteries) waveforms to assess fetal wellbeing in the third trimester of pregnancy. Aims and objectives- ‘’To evaluate the cerebroplacental ratio and it’s diagnostic value in the prediction of adverse perinatal outcome’’ in patients with abnormal cerebroplacental ratio and timely intervention in these fetus to prevent adverse perinatal outcome. Material and methods- This study, Prospective observational study, was conducted in the Department of Obstetrics & Gynecology at tertiary care center at central India population periods of 1 Year and 6 Months, from January 2018 to June 2019. Patients those were attended OPD & got admitted as IPD, at 30-36 weeks of gestation comprised the study population. Only those women who fulfilled the inclusion criteria and were willing to participate in the study voluntarily were included in the study after taking an informed consent. Results and conclusion - In our study, 58% and 42% patients in control group were primigravida and multigravida respectively which was comparable to patients in Case group 56% and 44% respectively. Doppler flow velocity analysis can be valuable in antenatal assessment of SGA, FGR and even in AGA for prediction of late onset growth restriction and perinatal adverse outcome. By noninvasive hemodynamic monitoring of umbilical arteries (Feto-placental circulation) and middle cerebral arteries (fetal-circulation) has been a great help to improve perinatal outcome in pregnancy with comorbidities. For the prediction of adverse perinatal outcome in women with high-risk pregnancies, the best doppler index according to our study was cerebroplacental ratio (MCA/UA PI ratio). In cases with abnormal doppler, timely interventions lead to improved perinatal outcome. Hence, repeated doppler study in these pregnancies can help to reduce perinatal morbidity and mortality in high-risk cases. This study also suggested that CP ratio has the value for identifying those fetuses at risk for adverse perinatal outcome even their weights was greater than the 10th centile but are at risk for adverse outcome or late onset FGR because of an abnormal or lower CP ratio than 50th percentile value for age specific cutoff value. [ABSTRACT FROM AUTHOR]

Introduction: Functional haemodynamic monitoring using dynamic parameter such as Stroke Volume Variation (SVV), based on pulse contour analysis, helps in predicting fluid responsiveness in off pump Coronary Artery Bypass Grafting (CABG) surgery. This allows adequate volume replacement to achieve optimal cardiac performance. Aim: To evaluate the efficacy of SVV in predicting volume responsiveness and effect on haemodynamic variable in patients undergoing off pump CABG in both closed and open chest. Materials and Methods: This single-centre, non randomised observational study was conducted at a tertiary medical college and hospital (LokmanyaTilak Municipal Medical College and General Hospital) Mumbai, Maharashtra, India, from December 2016 to December 2018. A total of 34 patients undergoing elective off pump CABG were included. Haemodynamic measurements Stroke Volume (SV), Cardiac Output (CO), Cardiac Index (CI), and SVV, were recorded with the transducer positioned at the level of midaxillary line. If the SVV was equal to or higher than 12, 100 mL fluid aliquot was given to patients. Endpoints for fluid aliquots was increase in CO by 15%, decrease in SVV of less than 12 or an increase Central Venous Pressure (CVP) upto 15 millimeter of mercury (mmHg). Number of times SVV above 12 during the procedure was recorded. SVV was considered as fluid responsive "if there was an increase in SV by 5%". Statistical analysis was done using Student's t-test (two tailed, dependent) on continuous parameters. The p-value <0.05, was considered significant. Results: Out of 103 events of rise in SVV, 65 (63.1%) occurred when chest was open and 38 (36.9%) while chest was closed. The SVV-guided fluid response was 76.3% in closed chest and 75.4% in open chest and there was no significant difference. (p-value=0.91). There was a significant increase in SV (p-value<0.01), CO (p-value=0.04), and significant decrease in SVV (p-value<0.01) and heart rate (p-value<0.01) after fluid loading in the responsive group when compared with non responsive group. There was no statistically significant difference between percentage change in SV, CO, CI, SBP, DBP, MAP and CVP between closed and open chest conditions after fluid replacement. Conclusion: SVV is not affected by open or closed chest conditions in mechanically ventilated patients undergoing CABG and can be used as a guide for fluid replacement. Weather open or closed chest conditions, few patients do not respond to fluid replacement when SVV are more than 12 by an increase in SV, cardiac output or CI, the cause of which remains to be determined. [ABSTRACT FROM AUTHOR]

Hemodynamic assessment along with continuous monitoring and appropriate therapy forms an integral part of management of critically ill patients with acute circulatory failure. In India, the infrastructure in ICUs varies from very basic facilities in smaller towns and semi-urban areas, to world-class, cutting-edge technology in corporate hospitals, in metropolitan cities. Surveys and studies from India suggest a wide variation in clinical practices due to possible lack of awareness, expertise, high costs, and lack of availability of advanced hemodynamic monitoring devices. We, therefore, on behalf of the Indian Society of Critical Care Medicine (ISCCM), formulated these evidence-based guidelines for optimal use of various hemodynamic monitoring modalities keeping in mind the resource-limited settings and the specific needs of our patients. When enough evidence was not forthcoming, we have made recommendations after achieving consensus amongst members. Careful integration of clinical assessment and critical information obtained from laboratory data and monitoring devices should help in improving outcomes of our patients. [ABSTRACT FROM AUTHOR]

Purpose  Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery. Methods  This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone. Results  The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p  < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use. Conclusion  Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period. Registration number of Clinical Trial  The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018). [ABSTRACT FROM AUTHOR]

Background: COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus -2 has proven to be the deadliest pandemic till date. Multiple covid waves have hit people hard on each part of the continent throughout the world. The second wave in India turned out to be highly infectious and virulent. Sudden surge in cases of mucormycosis after recovery of COVID surprised many clinician. Mucormycosis being a rapidly progressive and fulminant fungal infection required surgical debridement of necrotic tissue on emergency basis. The fatal combination of immunocompromised status, multisystemic involvement, and difficult airway in these patients pose numerous new challenges regarding anesthetic management. The present study was conducted to outline major concerns and the anesthetic management of patients undergoing surgical resection for rhinoorbital mucormycosis (ROM). Materials and Methods: A retrospective observational study was conducted in our institute for a duration of 2 months (June and July 2021). The data of all the cases posted for ROM was collected from the ENT and Anesthesia record register. Total 70 patients presented with mucormycosis, for surgical debridement out of which 25 patients were posted for surgery under general anesthesia or monitored anesthesia care (MAC). Demographic characteristics, comorbidities, duration of COVID illness, treatment taken during COVID (oxygen therapy/steroid intake), hemodynamic parameters, monitoring methods, and surgical procedures were recorded for each patient. Statistical Evaluation: SPSS version 21.0 was used for data analysis. Mean and SD were used to analyze the difference in mean values, and independent Student's t-test were utilized to compare the quantitative variables. Frequency distribution and percentage were used for qualitative parameters. Significant difference was accepted at P ≤ 0.05 with 95% CI (confidence interval) in the study. Results: Demographic data were comparable with respect to age, gender distribution, and ASA status. Mean duration of Covid illness was (12.18 ± 3.68) days. The mean HbA1C measured was (10.8 ± 1.42). Strong correlation was found between steroid intake and raised HbA1c in all patients (r = 0.77). Regarding the comorbidities, 24 (96%) patients had associated type 2 diabetes mellitus, 16 patients (64%) had pneumonitis, and 1 patient had pulmonary TB and hepatitis. Conclusion: Considering the perioperative risk associated with high HbA1C and pneumonitis, MAC was preferred in majority of cases. Strict hemodynamic monitoring, perioperative glucose control, difficult airway cart, metabolic and electrolyte balance and vigilant peri-operative monitoring are cornerstone for better outcome and short length of hospital stay. [ABSTRACT FROM AUTHOR]

Background: Simulation is to imitate or replicate real-life scenarios in order to improve cognitive, diagnostic and therapeutic skills. An ideal model should be good enough to output realistic clinical scenarios and respond to interventions done by trainees in real time. Use of simulationbased training has been tried in various fields of medicine. The aim of our study was to prospectively evaluate the effectiveness of simulation model "CRITICA"™ (MEDUPLAY systems) in training critical care physicians. Materials and methods: The advanced intensive care unit (ICU) simulator "CRITICA"™ (MEDUPLAY systems) was developed as a joint collaboration between the Indian Institute of Science, Bengaluru and St John's Medical College, Bengaluru. Two-day workshop was conducted. Intensive didactic and case-based scenarios were simulated to formally teach principles of advanced ICU scenarios. The physicians were tested on clinical scenarios in hemodynamic monitoring and mechanical ventilation displayed on the simulator. Assessment of the analytical thinking and pattern recognition ability was carried out before and after the display of the scenarios. Pre- and posttest scores were collected. Results: The postsimulation test scores were higher than pretest scores and were statistically significant in hemodynamic monitoring and mechanical ventilation module. [Hemodynamic monitoring pre- and posttest scores 4.41 (2.06) vs 5.23 (2.22) p < 0.001] [Mechanical ventilation pre- and posttest scores 4 (2-5.5) vs 7.5 (6.5-8.5) p < 0.001]. A greater increase in posttest scores was seen in the mechanical ventilation module as compared to hemodynamic module. There was no effect of specialty or designation of a trainee on difference in pre- and posttest scores. Conclusion: Simulator-based training in hemodynamic monitoring and mechanical ventilation was effective. Comparison of routine classroom teaching and simulator-based training needs to be evaluated prospectively. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted to examine the compliance and effectiveness of the Surviving Sepsis Campaign (SSC) resuscitation, along with lactate clearance bundle item, in China, India and Singapore. It states that hemodynamic monitoring was achieved by central venous catheter insertion, and intra-arterial blood pressure monitoring with insertion of femoral arterial catheter was preferred. It mentions that lactate has been associated with improved 60-day survival.