In fact anesthesia related critical incidents and deaths are usually due to one of the following causes5;1) circulatory failure due to
hypovolaemia in combination with overdosage of anesthetic agents 2) hypoxia or failed intubation or equipment failure or aspiration of gastric content, 3) anaphylactoid reactions and 4) human negligence or error of judgment.
The elevated temperature is due to the loss of thermoregulation and systemic inflammatory response with
hypovolaemia compounds the blood pressure changes.9 A total of 12.7% suffered heat related mortality, which is much higher compared to findings reported in a systematic review by Basuon in USA.11 In order to reduce mortality, it is important to identify the heat stroke and heat exhaustion earlier on and institute effective management as soon as possible.12
Cardiovascular complications of acute pancreatitis include shock,
hypovolaemia, pericardial effusion and non-specific ST-T changes (2).
Hypovolaemia and circulation failure are also among the main reasons for cardiovascular collapse (Brodbelt, 2009; Muir et al., 2007).
[10] A shock index (pulse/systolic BP) of >0.9 is an early sign of
hypovolaemia. It is also an indication to call a doctor and for intervention.
Our exclusion criterias were not prepared to participate in the procedure, under 18 years - over 45 years of age, low platelet count, infection at the puncture site, progressive neurological disease, increased intracranial pressure, presence of
hypovolaemia. The cases who had received epidural catheter and had cesarean section were excluded from the study.
Hypotension or
Hypovolaemia: Hypotension can negatively influence outcome.
IVC Aorta Vessel wall Thinner Thicker (hyperechoic) Pulsates outwards No Yes Shape Rather slightly curved Rather straight Enters right atrium Yes No (RA) Hepatic vein visible Yes No Collapses during Yes No inspiration Location Rather to the patient's Rather to the patient's right side left side Table1: Anatomical differences between the IVC and aorta Definition of cut-offs IVCCI:
Hypovolaemia (IVCCI > 50% and IVC[d.sub.max] < 2.1 cm) Euvolaemia (IVCCI > 50% and IVC[d.sub.max] > 2.1 cm) or (IVCCI < 50% and IVC[d.sub.max] < 2.1 cm) Hypervolaemia (IVCCI < 50% and IVC[d.sub.max] > 2.1 cm) Table 2: IVCCI cut-offs according to the 'Guidelines for the Echocardiographic Assessment of the Right Heart in Adults' (Rudski et al., 2010)
A product of anaerobic metabolism related to
hypovolaemia and hypoxia, serum lactic acid levels is a known parameter for the early identification of sepsis in general.
Blackmon, "Hypotension induced by central
hypovolaemia and hypoxaemia," Clinical Physiology, vol.