We have been using general anesthesia with thoracic epidural anesthesia to manage intrao-perative and postoperative pain for thoracic and cardiac surgery patients. Hemodynamic changes due to sympathetic block with epidural anesthesia is dependent on the level of sympathetic block. Thoracic epidural anesthesia block the cardiac sympathetic innervation, so there may be changes of cardiac function and pressure dependent coronary blood flow especially in coronary artery diseases. To investigate the effects of thoracic epidural anesthesia on coronary blood flow and hemodynamic changes, we performed thoracic epidural anesthesia by injection of 0.5% bupivacaine via a surgieally introduced catheter in dogs. The results were as follows ; 1) Coronary blood flow, systolic, mean and diastolic blood pressure, heart rate and cardiac output were decreased at 5 min, 10 min, 15 min, 20 min, 30 min, 45 min, 60 min, 90 min, 120 min after epidural injection of 0.5% bupivaeaine compared to control value (p<0.05). 2) Systemie vascular resistance, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume and pulmonary vascular resistance were not changed after epidural injection of 0.5% bupivacaine.
Anesthesia, Epidural* ; Anesthesia, General ; Animals ; Blood Pressure ; Bupivacaine ; Cardiac Output ; Cardiovascular System* ; Catheters ; Central Venous Pressure ; Coronary Artery Disease ; Dogs* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Epidural ; Pain, Postoperative ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Stroke Volume ; Thoracic Surgery ; Vascular Resistance

In order to evaluate the efficacy of adenosine triphosphate (ATP) in the reduction of left ventricular afterload, we studied the hemodynamic and intrapulmonary shunt effects of intravenous ATP during ethrane-N2O anesthesia. Hemodynamic measurements and arterial and mixed venous blood gas analyses were made in ten patients before (baseline) and 10 min after. ATP infusion at 80,60,120 and 250 mcg/kg/min, respective. The results were as follows: 1) ATP produced a rapid and stable reduction in mean arterial pressure resulting from a marked decrease in systemic vascular resistance. 2) Cardiac index increased significantly by 14, 47 and 72% from baseline value after intravenous infusion of ATP at rates of 60, 120 and 250 mcg/kg/min, respectively. 3) Stroke volume index, heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure increased significantly, whereas systemic vasular resistance and pulmonary vascular resistance decreased significantly in a dose related fashion during ATP infusion. 4) Intrapulmonary ehunt fraction increased from 5.67% to 6.73, 8.28, 9.85 and 13.38% after intra- venous infusion of ATP at rates of 30, 60, 120 and 250 mcg/kg/min, respectively. 5) Arterial oxygen tension decreased significantly after ATP infusion. These results suggest that ATP might be of value in augmentation of cardiac performance in patients with low cardiac output with high peripheral vascular resistance.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Cardiac Output, Low ; Central Venous Pressure ; Enflurane* ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous ; Lung ; Oxygen ; Pulmonary Wedge Pressure ; Stroke Volume ; Vascular Resistance

Massive bleeding during pregnancy has a significant effect on the mother and the fetus. To evaluate the safety of hemodilution as a therapy for hemorrhage during pregnancy, the author compared maternal and fetal hemodynamics and oxygen carrying capacity at varying conditions in gravid ewes. Six Corriedale-breed, near-term pregnant ewes (120-140 days gestation) were anesthetized with nitrous oxide, halothane and oxygen. After the vital signs became stable, the maternal and fetal parameters of hemodynamics and oxygen carrying capacity were measured as control values. After then, 15% of total estimated matemal blood volume (12.5 ml/kg) was removed over approximately 15 minutes and infusion of the same amount of a mixture of lactated Ringer's solution and 10% pentastarch was done simultaneously (15% bleeding). Twenty minutes later the same parameters were measured. After then, a second phlebotomy was performed to remove an additional 15% of the total estimated maternal blood volume and infusion of the same amount of a mixture of the same solutions was done simultaneously (30% bleeding). And the same parameters were measured. Data collections included matemal heart rate, systolic, diastolic and mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, hemoglobin, hematocrit, serum lactate, arterial and mixed venous pH, oxygen tension, carbon dioxide tension, oxygen saturation, and fetal heart rate, systolic, diastolic and mean arterial pressure, hemoglobin, hematocrit, serum lactate, and umbilical arterial and venous blood gas analysis. Matemal arterial blood pressure, heart rate, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and carfiac output revealed no significant changes, and there was neither hypoxemia nor acidosis in gravid ewes. Serum lactate concentration at 30% bleeding increased significantly but within normal range. Oxygen flux, oxygen consumption and oxygen extraction ratio revealed no significant differences. In fetal lamb blood pressure was not changed, but heart rate, serum lactate concentration and oxygen extraction ratio were revealed significant increases in 15% bleeding and 30% bleeding cases. In conclusion, gravid ewe was well tolerated to acute hemodilution, and.fetal lamb was well compensated.
Acidosis ; Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Blood Volume ; Carbon Dioxide ; Cardiac Output ; Central Venous Pressure ; Natural Resources* ; Female ; Fetus ; Halothane ; Heart Rate ; Heart Rate, Fetal ; Hematocrit ; Hemodilution* ; Hemodynamics* ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hydroxyethyl Starch Derivatives ; Lactic Acid ; Mothers ; Nitrous Oxide ; Oxygen Consumption ; Oxygen* ; Phlebotomy ; Pregnancy ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reference Values ; Vital Signs

BACKGROUND: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. METHODS: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. RESULTS: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). CONCLUSION: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.
Analgesics ; Anesthesia, General ; Blood Pressure ; Cardiac Output ; Central Venous Pressure ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Hemodynamics ; Humans ; Hypertension* ; Lidocaine* ; Methods ; Pain, Postoperative ; Pneumoperitoneum* ; Stroke Volume ; Vascular Resistance

Background: Cardiac tamponade results in a hemodynamic disorder associated with decreased cardiac output and blood pressure. To improve cardiac output in a subject with cardiac tamponade, cardiotonic drugs and vasodilators with blood volume expander can be used. The purpose of this study was to observe the hemodynamic effects of cardiotonic drugs and vasodilators following administration of plasma expander in the dogs with cardiac tamponade. Method: Three groups of dogs were studied during the induced cardiac tamponade. Following infusion of pentastarch, group I received dobutamine by dripping of 10 microg/kg/min, followed by injection of 20 microg/kg/min, group II received hydralazine (20 mg, 40 mg) and group III received sodium nitroprusside (5 microg/kg/min, 10 microg/kg/min). The heart rate, blood pressure, cardiac output and pulmonary arterial occluded pressure were measured. The atrial transmural pressure was calculated by subtracting intrapericardial pressure from mean atrial pressure. Results: Cardiac output was increased in the groups I and II, but mean arterial pressure was increased in only the group I. Atrial transmural pressure was not changed in all three groups. Conclusion: The most pronounced hemodynamic improvements during the cardiac tamponade is observed in group I with pentastarch-dobutamine combination.
Animals ; Arterial Pressure ; Atrial Pressure ; Blood Pressure ; Blood Volume ; Cardiac Output ; Cardiac Tamponade* ; Cardiotonic Agents ; Dobutamine* ; Dogs* ; Heart Rate ; Hemodynamics* ; Hydralazine* ; Hydroxyethyl Starch Derivatives* ; Nitroprusside* ; Plasma ; Vasodilator Agents

BACKGROUND: In major burn patients, many invasive monitors including a pulmonary artery catheter (PAC) are often required to assess hemodynamic status. An esophageal Doppler monitor (EDM), as a noninvasive method of measuring hemodynamic parameters, may be a substitute for a PAC in this clinical circumstance. This study was conducted to evaluate the validity of Doppler derived hemodynamic indices in comparison to that of a PAC. METHODS: A total of 20 critically ill, severe burn patients, scheduled for an elective escharectomy and application of artificial dermis, were enrolled for the placement of a PAC and EDM. Simultaneous data was collected in regular intervals and the various parameters were compared between the two methods. RESULTS: A total of 158 pairs of data in 20 patients were gathered. Among all the parameters, cardiac output (CO) and stroke volume (SV) showed consistently 20% less in EDM. Correlation coefficients of heart rate (HR), CO, SV and systemic vascular resistance (SVR) were 0.97, 0.54, 0.62, and 0.68 respectively. Corrected flow time (FTc) had poor correlations with central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). In the mean time, significant, but very weak correlations with FTc vs. CO and SV were demonstrated. CONCLUSIONS: EDM may be a substitute for a thermodilution (TD) PAC technique, it can be used with usefulness for hemodynamic and preload assessment in major burn patients.
Burns* ; Cardiac Output ; Catheters* ; Central Venous Pressure ; Critical Illness ; Dermis ; Heart Rate ; Hemodynamics* ; Humans ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Stroke Volume ; Thermodilution ; Vascular Resistance

BACKGROUNDS: This study was to evaluate the hemodynamic effects of esmolol and propranolol in the isoflurane-anesthetized dogs. METHODS: Ten dogs were anesthetized with isoflurane, N2O and O2. The hemodynamic parameters were measured as control values and were also measured after 500, 1000, 2000 microgram/kg of esmolol and 0.25, 0.5, 1.0 mg of propranolol were bolus injected intravenously. RESULTS: Heart rate and cardiac output were significantly decreased in both groups compared with control value, but there were no significant differences between two groups. Blood pressure was significantly decreased in the dosage of 1000, 2000 microgram/kg of esmolol group compared with control value and propranolol group, but in propranolol group, no significant changes were found. Systemic and pulmonary vascular resistance were not changed significantly in both groups compared to control value, but in propranolol group, SVR was significantly increased in the dosage of 0.5 and 1.0 mg compared with esmolol group. Central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, arterial and mixed venous blood pH, oxygen tension, CO2 tension and O2 saturation were not significantly changed and O2 flux, O2 consumption, O2 extraction ratio were also unchanged. CONCLUSIONS: In conclusion, esmolol and propranolol of the usual dosages are less likely to depress the myocardium profoundly during isoflurane anesthesia, and esmolol, compared to propranolol, decreases the blood pressure but changes 2 of cardiac output were not significant between two groups, so it can be used in the hypertensive state or induced hypotensive anesthesia usefully and can also be used conveniently during anesthesia because of its ease of controllability.
Anesthesia ; Anesthetics ; Animals ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Heart Rate ; Hemodynamics* ; Hydrogen-Ion Concentration ; Isoflurane ; Myocardium ; Oxygen ; Propranolol* ; Pulmonary Wedge Pressure ; Vascular Resistance

BACKGROUND: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. METHODS: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. RESULTS: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). CONCLUSIONS: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine-induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity.
Anesthesia, General ; Animals ; Arterial Pressure ; Blood Pressure ; Bupivacaine ; Cardiac Output ; Central Venous Pressure ; Depression* ; Dogs* ; Epinephrine* ; Heart Rate ; Hemodynamics ; Insulin* ; Pulmonary Wedge Pressure ; Resuscitation* ; Vascular Resistance

BACKGROUND: Hemodynamic optimization improves postoperative outcomes in high-risk surgery patients. The monitoring of cardiac output (CO) and dynamic parameters of fluid responsiveness can guide hemodynamic optimization. We conducted a survey to assess the current hemodynamic monitoring and management practices of Korean anesthesiologists during high-risk surgery. METHODS: E-mails containing a link to our survey, which consisted of 33 questions relating to hemodynamic monitoring during high-risk surgery, were sent to 3,943 members of the Korean Society of Anesthesiologists (KSA). The survey web page was open from December 30, 2011 to March 31, 2012. RESULTS: A total of 139 anesthesiologists responded during the survey period. Invasive arterial pressure (97.2%) and central venous pressure (93.4%) were routinely monitored. CO was monitored in 58.5% of patients; stroke volume variations were monitored in 50.9% of patients. However, CO was consistently optimized by < 20% of anesthesiologists. An arterial pressure waveform-derived CO monitor was the most frequently used device to monitor CO (79.0%). Blood pressure, urine output, central venous pressure, and clinical experience were considered to be the best indicators of volume expansion than CO or dynamic parameters of fluid responsiveness. CONCLUSIONS: The survey revealed that KSA members frequently monitor CO and dynamic parameters of fluid responsiveness during high-risk surgery. However, static indices were used more often to judge volume expansion. The current study reveals that CO is not frequently optimized despite the relatively high incidence of CO monitoring during high-risk surgery in Korea.
Aluminum Hydroxide ; Arterial Pressure ; Blood Pressure ; Carbonates ; Cardiac Output ; Central Venous Pressure ; Electronic Mail ; Hemodynamics ; Humans ; Incidence ; Korea ; Organothiophosphorus Compounds ; Stroke Volume ; Treatment Outcome

BACKGROUND: Arteriovenous malformations (AVMs) are increasingly treated by radiologists using various embolic materials. Because of pain and significant hemodynamic changes that may be associated with this treatment, anesthesiologists are frequently asked to provide anesthesia and supportive care. We evaluated the hemodynamic changes that occurred after absolute alcohol embolization. METHODS: Fourteen patients between 15 and 50 years of age who had arteriovenous malformation were included in this study. 2 to 4 ml of alcohol was injected each time. The hemodynamic parameters were measured before alcohol injection (control) and after 1st to 10th alcohol injection. RESULTS: Blood pressure, heart rate, and cardiac output were significantly increased after 1st to 10th alcohol injection compared with control value. Central venous pressure, pulmonary capillary wedge pressure and systemic vascular resistance were not significantly changed. But pulmonary vascular resistance was significantly increased after 9th and 10th alcohol injection. Systolic pulmonary artery pressure was significantly increased after 4th, 8th, 9th and 10th alcohol injection. CONCLUSIONS: Bolus injection of absolute ethyl alcohol induces short-term significant increases in blood pressure, heart rate and cardiac output probably by severe pain and sympathetic activation that appear to be centrally mediated. The underlying mechanism of cardiovascular event and other systemic effects of intravascular ethanol in this setting need further study.
Anesthesia ; Arteriovenous Malformations* ; Blood Pressure ; Cardiac Output ; Central Venous Pressure ; Ethanol ; Heart Rate ; Hemodynamics* ; Humans ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sclerotherapy* ; Vascular Resistance