Document Detail


Arterial and plethysmographic waveform analysis in anesthetized patients with hypovolemia.
MedLine Citation:
PMID:  20526193     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Respiratory-induced arterial and plethysmographic (pulse oximetry) waveform changes were shown to be good predictors of cardiac output response to increased preload. The aim of this study was to evaluate the reliability of arterial and plethysmographic waveform variables in patients with mild hypovolemia. METHODS: Patients undergoing autologous hemodilution were studied. After anesthesia induction, hemodilution was performed by withdrawing blood in steps of 2% of estimated circulating blood volume (ECBV), up to 20%. The patients who did not develop hypotension (systolic blood pressure < 80 mmHg) were studied. Arterial and plethysmographic waveforms were recorded and analyzed off-line at baseline and after each withdrawal of blood. Variations in arterial systolic and pulse pressure were analyzed using standard methods. Plethysmographic waveform variation and delta pulse oximetry plethysmography were determined by using pulse oximetry recordings. RESULTS: There were 33 study participants. Systolic blood pressure decreased by 11%, and heart rate increased from 73 to 76 beats/min after a 20% reduction of ECBV. Systolic pressure and pulse pressure variations increased (P < 0.005) after a 4% reduction of ECBV. The values of arterial pressure and pulse oximetry waveform variables almost doubled in value after a 20% reduction of ECBV. Systolic pressure variation was the most reliable variable during hypovolemia. Plethysmographic waveform variation increased significantly after a 6% reduction of ECBV and delta pulse oximetry plethysmography after an 8% reduction of ECBV. CONCLUSIONS: Arterial and pulse oximetry respiratory-induced changes in waveform variables are reliable indicators of mild hypovolemia in anesthetized patients. The pulse oximetry plethysmographic waveforms accurately reflect arterial waveforms during more progressive hypovolemia.
Authors:
Reuven Pizov; Arieh Eden; Dmitri Bystritski; Elena Kalina; Ada Tamir; Simon Gelman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  113     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-25     Completed Date:  2010-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  83-91     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Carmel Lady Davis Medical Center, Haifa, Israel. reuven@clalit.org.il
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, General / adverse effects
Blood Pressure
Blood Volume
Cardiac Output
Female
Heart Rate
Hemodilution / methods
Humans
Hypovolemia / diagnosis*,  etiology
Male
Middle Aged
Oximetry / methods*
Plethysmography / methods
Reproducibility of Results
Respiration

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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