Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational studyReport as inadecuate




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Perioperative Medicine

, 3:9

First Online: 30 October 2014Received: 11 June 2014Accepted: 08 October 2014

Abstract

BackgroundIn 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.

MethodsIn 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.

ResultsMean 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 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 min. After complete akinesia in all patients during surgery, a median IQR extubation time of 311 253–386 s was observed.

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

Trial registrationISRCTN20153044

KeywordsPropofol Remifentanil Cardiac output Fluid therapy Balanced anesthesia Tissue oxygenation Norepinephrine Electronic supplementary materialThe online version of this article doi:10.1186-2047-0525-3-9 contains supplementary material, which is available to authorized users.

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Author: Jaap Jan Vos - Marieke Poterman - Laura N Hannivoort - Victor W Renardel De Lavalette - Michel MRF Struys - Thomas WL S

Source: https://link.springer.com/







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