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

Perioperative Medicine

Alain F Kalmar²  Thomas WL Scheeren³  Michel MRF Struys³  Victor W Renardel De Lavalette¹  Laura N Hannivoort³  Marieke Poterman³  Jaap Jan Vos³ 

[1] Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;Department of Anaesthesiology and Intensive care medicine, Maria Middelares hospital, Ghent, Belgium;Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

关键词: Norepinephrine;    Tissue oxygenation;    Balanced anesthesia;    Fluid therapy;    Cardiac output;    Remifentanil;    Propofol;   

Others  :  1132057
DOI  :  10.1186/2047-0525-3-9

 received in 2014-06-11, accepted in 2014-10-08,  发布年份 2014

【 摘 要 】

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

【 授权许可】

   
2014 Vos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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