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Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational study.

Vos JJ, Poterman M, Hannivoort LN, Renardel De Lavalette VW, Struys MM, Scheeren TW, Kalmar AF - Perioper Med (Lond) (2014)

Bottom Line: In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management.The median (range) norepinephrine administration rate was 0.05 (0.0-0.10) μg kg(-1) min(-1).After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253-386) s was observed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

ABSTRACT

Background: In particular surgical conditions, a balanced anesthesia with a high-antinociceptive contribution is required. This may induce cardiovascular impairment and thus compromise tissue oxygenation. In this prospective observational study, we investigated the hemodynamic stability and tissue oxygen saturation (StO2) in 40 patients with a high-antinociceptive general anesthesia, goal-directed fluid therapy, and norepinephrine. In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management.

Methods: In high-antinociceptive propofol/remifentanil anesthesia with bispectral index (BIS) between 40 and 60, norepinephrine was administered to maintain mean arterial pressure (MAP) above 80% of individual baseline. Fluid was administered if the ∆ plethysmographic waveform amplitude exceeded 10%. Surgical and recovery conditions, hemodynamic responses, and tissue oxygenation were investigated.

Results: Mean (SD) StO2 at the left thenar eminence increased from 83 (6)% before to 86 (4)% 20 min after induction of anesthesia (p <0.05). Cardiac index dropped from 3.0 (0.7) to 2.1 (0.4) L min(-1) (p <0.05), MAP from 109 (16) to 83 (14) mm Hg, and heart rate from 73 (12) to 54 (8) bpm (p <0.05). Thirteen out of 40 patients received a fluid bolus. The median (range) norepinephrine administration rate was 0.05 (0.0-0.10) μg kg(-1) min(-1). After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253-386) s was observed.

Conclusions: This high-antinociceptive balanced anesthesia with goal-directed fluid and vasopressor therapy adequately preserved StO2 and hemodynamic homeostasis.

Trial registration: ISRCTN20153044.

No MeSH data available.


Related in: MedlinePlus

Evolution of individual values (grey), mean value (black), and 10th and 90th percentile (blue). (A) Mean arterial pressure. (B) Heart rate. (C) Cardiac index. (D) Tissue oxygen saturation. (E) Bispectral index. Values are shown from the moment of induction of anesthesia up to the end of the procedure. Mean and percentiles are shown for the first 90 minutes.
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Figure 1: Evolution of individual values (grey), mean value (black), and 10th and 90th percentile (blue). (A) Mean arterial pressure. (B) Heart rate. (C) Cardiac index. (D) Tissue oxygen saturation. (E) Bispectral index. Values are shown from the moment of induction of anesthesia up to the end of the procedure. Mean and percentiles are shown for the first 90 minutes.

Mentions: Figure 1A,B,C,D,E shows the time course of both the individual and mean values (in bold) of the investigated variables for the first 90 min. All data were synchronized at the start of induction of anesthesia. Figure 2 shows the mean values of all the investigated variables with a time interval of 1 min.


Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational study.

Vos JJ, Poterman M, Hannivoort LN, Renardel De Lavalette VW, Struys MM, Scheeren TW, Kalmar AF - Perioper Med (Lond) (2014)

Evolution of individual values (grey), mean value (black), and 10th and 90th percentile (blue). (A) Mean arterial pressure. (B) Heart rate. (C) Cardiac index. (D) Tissue oxygen saturation. (E) Bispectral index. Values are shown from the moment of induction of anesthesia up to the end of the procedure. Mean and percentiles are shown for the first 90 minutes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4309299&req=5

Figure 1: Evolution of individual values (grey), mean value (black), and 10th and 90th percentile (blue). (A) Mean arterial pressure. (B) Heart rate. (C) Cardiac index. (D) Tissue oxygen saturation. (E) Bispectral index. Values are shown from the moment of induction of anesthesia up to the end of the procedure. Mean and percentiles are shown for the first 90 minutes.
Mentions: Figure 1A,B,C,D,E shows the time course of both the individual and mean values (in bold) of the investigated variables for the first 90 min. All data were synchronized at the start of induction of anesthesia. Figure 2 shows the mean values of all the investigated variables with a time interval of 1 min.

Bottom Line: In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management.The median (range) norepinephrine administration rate was 0.05 (0.0-0.10) μg kg(-1) min(-1).After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253-386) s was observed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

ABSTRACT

Background: In particular surgical conditions, a balanced anesthesia with a high-antinociceptive contribution is required. This may induce cardiovascular impairment and thus compromise tissue oxygenation. In this prospective observational study, we investigated the hemodynamic stability and tissue oxygen saturation (StO2) in 40 patients with a high-antinociceptive general anesthesia, goal-directed fluid therapy, and norepinephrine. In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management.

Methods: In high-antinociceptive propofol/remifentanil anesthesia with bispectral index (BIS) between 40 and 60, norepinephrine was administered to maintain mean arterial pressure (MAP) above 80% of individual baseline. Fluid was administered if the ∆ plethysmographic waveform amplitude exceeded 10%. Surgical and recovery conditions, hemodynamic responses, and tissue oxygenation were investigated.

Results: Mean (SD) StO2 at the left thenar eminence increased from 83 (6)% before to 86 (4)% 20 min after induction of anesthesia (p <0.05). Cardiac index dropped from 3.0 (0.7) to 2.1 (0.4) L min(-1) (p <0.05), MAP from 109 (16) to 83 (14) mm Hg, and heart rate from 73 (12) to 54 (8) bpm (p <0.05). Thirteen out of 40 patients received a fluid bolus. The median (range) norepinephrine administration rate was 0.05 (0.0-0.10) μg kg(-1) min(-1). After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253-386) s was observed.

Conclusions: This high-antinociceptive balanced anesthesia with goal-directed fluid and vasopressor therapy adequately preserved StO2 and hemodynamic homeostasis.

Trial registration: ISRCTN20153044.

No MeSH data available.


Related in: MedlinePlus