Document Detail


Cardiovascular and metabolic response to acute normovolemic anemia. Effects of anesthesia.
MedLine Citation:
PMID:  11020756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The maintenance of adequate tissue oxygenation during acute anemia depends on an increase in both cardiac output and tissue oxygen extraction. This study tested the hypothesis that anesthesia blunts the cardiac output response associated with acute normovolemic hemodilution. METHODS: Forty patients undergoing major abdominal surgery were prospectively randomized to undergo acute normovolemic hemodilution (ANH) either awake (awake group, n = 20) or with fentanyl-nitrous oxide-isoflurane anesthesia (anesthetized group, n = 20). Radial and pulmonary artery catheters were placed in all patients. After hemodynamic measurements were taken, patients in the two groups underwent hemodilution to decrease their hemoglobin concentration from 13 to 8 g/dl. A total of 1,875 +/- 222 ml (mean +/- SD) of blood was collected and simultaneously replaced by the same volume of medium molecular weight hydroxyethylstarch in both groups. RESULTS: In the awake group, ANH resulted in a significant increase in cardiac index (from 3.1 +/- 0.5 to 4.8 +/- 1.0 l. min-1. m-2) related to both an increase in heart rate and stroke index. Oxygen delivery remained unchanged, but oxygen consumption increased significantly, resulting in an increase in oxygen extraction ratio. In the anesthetized group, ANH resulted in a significantly smaller increase in cardiac index (from 2.3 +/- 0.5 to 3.1 +/- 0.7 l. min-1. m-2) related solely to an increase in stroke index. Oxygen delivery decreased but oxygen consumption was maintained as oxygen extraction increased. CONCLUSIONS: Anesthesia significantly reduces the cardiac output response associated with ANH. This could be related to the effects of the anesthetic drugs on the autonomic and the cardiovascular systems.
Authors:
B E Ickx; M Rigolet; P J Van Der Linden
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  93     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-13     Completed Date:  2000-10-27     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1011-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Erasme University Hospital, Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Neoplasms / surgery
Anemia / etiology,  metabolism,  physiopathology*
Anesthesia, General / adverse effects*
Anesthetics, Inhalation / adverse effects
Anesthetics, Intravenous / adverse effects
Blood Volume / physiology
Cardiac Output / drug effects,  physiology
Cardiovascular Physiological Phenomena* / drug effects
Cardiovascular System / drug effects
Female
Fentanyl / adverse effects
Heart Rate / drug effects,  physiology
Hemodilution* / methods
Hemoglobins / metabolism
Humans
Isoflurane / adverse effects
Male
Middle Aged
Oxygen / blood,  metabolism
Oxygen Consumption / drug effects,  physiology
Prospective Studies
Single-Blind Method
Stroke Volume / drug effects,  physiology
Thiopental / adverse effects
Vascular Resistance / drug effects,  physiology
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Hemoglobins; 26675-46-7/Isoflurane; 437-38-7/Fentanyl; 76-75-5/Thiopental; 7782-44-7/Oxygen

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


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