A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound-guided internal jugular vein cannulation in adult cardiac surgical patients.

Background: Ultrasound (US)-guided internal jugular vein (IJV) cannulation is a widely accepted standard procedure. The axillary vein (AV) in comparison to the subclavian vein is easily visualized, but its cannulation is not extensively studied in cardiac patients. Aims: This study is an attempt to study the efficacy of real-time US-guided axillary venous cannulation as a safe alternative for the time-tested US-guided IJV cannulation. Design: This is a prospective randomized controlled study. Materials and Methods: A total of 100 adult patients scheduled for cardiac surgery were divided equally in Group A-US-guided IJV cannulation, and Group B-US-guided axillary venous cannulation. Under local anesthesia and real-time US guidance the IJV or AV was secured. The access time, guidewire time, and procedure time were noted. Furthermore, the number of needle attempts, malposition, change of site, and complications were noted. Results: The data were analyzed for 49 patients in Group A and 48 patients in the Group B due to exclusions. The access time and the guidewire time were comparable in both groups. The first attempt needle puncture was successful for the IJV group in 98% of patients in comparison to 95% of patients in Group B. Guidewire was passed in the first attempt in 94% in Group A and 89% in the Group B. Except for arterial puncture in one case in group A, the complications were insignificant in both groups. Conclusion: The study shows that the US-guided AV cannulation may serve as an effective alternative to the IJV cannulation in cardiac surgery.

The brain-dead donor: An anaesthesiologist's perspective.

The brain-dead organ donation programme is slowly gathering momentum in India. There is a long way to go before our cadaver donor numbers, currently at 0.35 per million reaches 35 per million as is the case in countries like Spain. Each donor, therefore, has to be managed immaculately. The anaesthesiologists will be well served by familiarising themselves with the challenges during the crucial period preceding and during the actual harvest of organs in a brain-dead donor. There are significant opportunities for anaesthesiologists to make great contributions in this cause due to their unique skill sets and perspective. A robust brain-dead cadaver programme will go a long way in saving numerous lives as well as reduce the requirements of the living donor programme. A well-managed harvest will ensure good quality organs and an overall superior outcome in the recipients.