Application of transesophageal doppler mornitoring in early diagnosis and treatment of transurethral resection syndrome in patients undergoing transurethral resection prostate / 临床麻醉学杂志

Objective To explore the value of transesophageal doppler in transurethral resection prostate.Methods Thirty-six patients (aged 60-85 years, falling into ASA grade Ⅰ-Ⅲ) of benign prostatic hyperplasia for undergoing transurethral resection prostate were enrolled.Through multifunction monitor, CVP, Narcotrend index(NI) were monitored before anesthesia induction (T0), 20 minutes after anesthesia induction (T1), after irrigating fluid of 5 000 ml (T2) and 10 000 ml (T3) and 15 000 ml (T4) and 20 000 ml (T5).By transesophageal doppler, FTc(corrected flowtime), SV(stroke volume), ΔPV(peak flow vaviable quantity) were monitored at T1-T5.Results CVP at T1-T5 were not significantly changed compared with that at T0.Compared with T1, FTc, SV at T3-T5were significantly increased and ΔPV at T2-T5were significantly decreased (P<0.05).CVP levels correlated significantly with both FTc (r=0.702, P<0.01) and SV (r=0.595, P<0.01).CVP negatively correlated significantly with ΔPV (r=-0.351, P<0.05).Furthermore, FTc correlated significantly with the concentrationof Na+(r=0.672,P<0.01).No patient had serum sodium ion concentration less than 125 mmol/L.Conclusion FTc of transesophageal doppler is as accurate as central venous pressure in monitoring hemodynamic changes, and even more sensitive than CVP.It is useful in early diagnosis and treatment of TURS.

ransesophageal Doppler monitoring for fluid therapy and left ventricular myocardial function in patients undergoing aortic valve replacement after cardiopulmonary bypass / 医学研究生学报

Objective Transesophageal Doppler monitoring ( TDM) has been widely applied to fluid therapy in some major op-erations but rarely used in aortic valve replacement.The purpose of this study was to assess the value of TDM in fluid therapy, vasoactive drugs use, and left ventricular function in patients undergoing aorta valve replacement after cardiopulmonary bypass. Methods This study included 40 patients undergoing aotic valve replacement after cardiopulmonary bypass in Anhui Provincial Hospital from March 2014 to June 2015, which were randomly assigned to a TDM and a control group of equal number.TDM was used for the guidance of fluid infu-sion and vasoactive drug administration for the patients in the former group, while central venous pressure, mean arterial pressure, and heart rate were employed for those in the latter.The fluid volume infused, urine volume, blood loss, hemodynamics, arterial blood lac-tate, and outcomes were compared between the two groups. Results Compared with the control, the TDM group showed significantly increases in the colloidal fluid volume ([303 ±60] vs [373 ±65]mL, P<0.05), crystal fluid volume ([533 ±87] vs [596 ±83]mL, P<0.05), and urine volume ([274 ±95] vs [338 ±84]mL, P<0.05), but remarkable decreases in the red blood cell count, blood plasma vol-ume, postoperative extubation time, doses of dopamine and dobu-tamine, and length of hospital stay (all P<0.05).The hemodynamics were more stable and arterial blood lactate was lower in the TDM group than in the control (P<0.05). Conclusio n Transesophageal Doppler monitoring can timely and exactly manifest the hemodynamic changes and left ventricular function of the patient undergoing aotic valve replacement and provide precise guidance for fluid therapy and vasoactive drug administration.

The hemodynamic responses and adequacy of infusion volume in acute hypervolemic hemodilution assessed with transesophageal Doppler apparatus

BACKGROUND: Acute hypervolemic hemodilution (AHH), an alternative of acute normovolemic hemodilution (ANH) is simpler, less expensive and less time-consuming than ANH. We examined hemodynamic responses and adequacy of 15 ml/kg infusion volume with transesophageal Doppler apparatus. METHODS: We induced AHH in 26 patients undergoing major abdominal surgery by fluid administration with volume of 15 ml/kg. During AHH, we observed hemodynamic parameters of cardiac index (CI), stroke index (SI), left ventricular ejection time corrected (LVETc), acceleration (Acc), peak velocity (PV), total systemic vascular resistance (TSVR) by transesophageal Doppler device and measured central venous pressure (CVP) via subclavian catheter every 2 minutes (H0, H2, H4, H6, H8, H10). RESULTS: After AHH, hemoglobin and arterial oxygen content value were decreased about 14% and tolerable. During AHH, CVP and SI increased first from H2. CI and LVETc, representing blood flow like SI increased from H4. TSVR decreased from H4, but Acc and PV representing cardiac contractility did not change through the AHH. Through AHH by infusion volume of 15 ml/kg, hemodynamic changes were tolerable. CONCLUSIONS: AHH increased aortic blood flow, decreased afterload, but did not affect cardiac contractility at all. The volume of 15 ml/kg for AHH is acceptable in clinical situation.

Comparison of Cardiac Output from the Thermodilution Method versus a Transesophageal Doppler Ultrasound Monitor (Hemosonic 100(TM)) / 대한마취과학회지

BACKGOUND: The measurement of cardiac output (CO) is an important part of anesthetic practice in patients undergoing major surgery. The thermodilution method (TDM), using a pulmonary artery catheter, is still accepted as the standard procedure. However, the use of the method is associated with several limitations and severe complications. The use of a transesophageal Doppler ultrasound monitor (EDUM; Hemosonic 100(TM)) is less invasive and calculates CO from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. The aim of this study was to compare the cardiac output measured by the use of the TDM and an EDUM. Methods:In 20 patients undergoing major abdominal surgery, CO and other hemodynamic profiles were measured simultaneously by the use of the TDM and an EDUM. RESULTS: The cardiac output, cardiac index, and the systemic vascular resistance monitored by both devices were highly correlated (correlation coefficients range from 0.63 to 0.88). Bland and Altman analysis showed a consistently negative mean bias for an EDUM and the TDM. This finding indicates an overestimation of the hemodynamic profile by the use of an EDUM. CONCLUSIONS: Although Bland and Altman analysis showed a significant bias, the use of an EDUM results in cardiac output, cardiac index, and total systemic vascular resistance measurements that are considerably similar to those obtained using the TDM, and a strong correlation exists for the use of the two methods.

Comparison of Transesophageal Doppler Monitor vs. Pulmonary Artery Catheter in the Hemodynamic Indices of Major Burn Patients Undergoing an Extensive Escharectomy / 대한마취과학회지

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.

Evaluation of Coronary Flow Reserve by Transesophageal Doppler Echocardiography in Patients with Chest Pain and Normal Coronary Angiogram

BACKGROUND: The measurement of coronary flow reserve(CFR) is essential for assessing the flow capacity in patients with angina and normal coronary angiogram. Transesophageal Doppler echocardiography(TEE) is a noninvasive method of assessing coronary flow velocity in the proximal portion of left anterior descending coronary artery. This study was designed prospectively to evaluate the usefulness of measurement of CFR by TEE in patients with chest pain and normal coronary angiogram. METHODS: We studied 49 subjects with chest pain and normal coronary angiogram. Exercise treadmil test by Bruce's protocol was positive in 26 subjects (TMT+group, M : F=8 : 18, mean age 55+/-8) and negative in 23 subjects (TMT-group, M : F=7 : 16, mean age 50+/-12). None of these subjects had previous history of myocardial infarction, atrial fibrillation, significant valvular heart disease, variant angina, wall motion abnormality on ventriculogram and ejection fraction below 50%. After transthoracic echocardiography(H-P Sonos 1000, 2.5 MHz), peak diastolic(PDV) and peak systolic coronary flow velocity(PSV) of proximal portion of left anterior descending coroanry artery by TEE(H-P Sonos 1000, 5 MHz, Single plane) were obtained in resting condition, 4 and 6 minutes after dipyridamole injection(DPY, 0.56mg/kg i.v.), and 2 minutes after aminophyline injection(100mg i.v.). CFR was computed as ratio of the average PDV after DPY to resting PDV. RESULTS: 1) TMT(+) group showed higher incidence of history of typical angina and greater wall thickness than TMT(-) group(P < 0.005). 2) The PDV, PSV and PDV/PSV ratio were significantly increased 6min after DPY IV in both groups as compared to rest(P < 0.05) and decreased to previous level after APL IV. 3) There was no significant difference in double products between rest and DPY IV. 4) CFR was significantly greater in TMT(-) group than in TMT(+) group(P < 0.0005). CONCLUSIONS: TEE using DPY is a useful noninvasive method to evaluate the coronary flow reserve in patients with chest pain and normal coronary angiogram. The influences of physiologic variables in measuring CFR by TEE should be investigated further.

Measurement of Coronary Flow Velocity by Transesophageal Doppler Echocardiography: Preliminary Study for Clinical Application

BACKGROUND: The estimation of coronary flow velocity(CFV) is essential for assessing the impaired coronary flow reserve in patients whith angina pectoris and normal coronary arteries. But, intracoronary blood flow velocity measurement remains invasive,requiring cardiac catheterization and can not be repeated without risk during serial follow-up study. Transesophageal Doppler echocardiography(TEE) is a new noninvasive method of assessing CFV in the proximal portion of left anterior descending coronary artery. This study was performed to clarify the value of TEE in evaluating CFV, to compare the coronary flow patterns among various cardiac diseases, to estimate the coronary flow dynamics according to change of blood pressure, and to evaluate the parameters influencing CFV. METHODS: We studied 95 subjects, 51 men and 44 women, mean age 46. Normotensive subjects were 29, hypertensive patients 41, aortic stenosis 5, aortic regurgitation 4, mitral stenosis 8, and others 8. After transthoracic echocardiography(H-P Sonos 1000,2.5 MHz), transesophageal echocardiography was performed using a 5-Hz(omniplane)transesophageal probe connected to a H-P Sonos 1000 to assess CFV in the proximal portion of left anterior descending coronary artery. Doppler evaluation of left anterior descending coronary blood flow velocity was obtained in restiong conditions and after sublingual administraion of nitroglycerim(0.6mg), Blook pressure and heart rate were monitored thoughout the entire procedure. RESULTS: 1) The detection rate of CFV by TEE was 89.5%. 2) The morphology of CFV in proximal left anterior descending coronary artery was biphasic(greater diastolic and smaller systolic). 3) The baseline CFV in hypertensive patients was greater than in normotensive subjects(p<0.05) but there was no difference between two groups in diastolic/systolic CFV ratio. 4) The diastolic CFV and diastolic/systolic CFV ratio in patients with aortic stenosis were greater than in normotensive subjects(p<0.05). 5) The CFV was significantly decreased after administration of nitroglycerin(p<0.05) and the decrement of CFV correlated closely with the decrement of systolic(r=0.65, p<0.05) and diastolic blood pressure(r=0.57, p<0.05). 6) Major parameters influencing CFV were systolic blood pressure and heart rate. CONCLUSION: The CFV is influenced by various parameters and the TEE may be a useful, noninvasive tool to investigate the coronary flow dynamics.

Simultaneous Measurements of Cardiac Output by Thoracic Electric Bioimpedance , Transesophageal Doppler , and Thermodilution in Anesthetized Patients / 대한마취과학회지

Simultaneous intraoperative measurements of eardiac output were obtained in twenty one patients with thoracic electric bioimpedance(TEB) and transesophageal Doppler, two patients with transesophageal Doppler and thermodilution, one patient with TEB and thermodilution, and three patients with TEB, transesophageal Doppler and thermodilution techniques to evaluate the utility of noninvasive methods. Pairs of measurments were obtained 6S times with TEB and thermodilution, 109 times with transesophageal Doppler and thermodilution, and 373 times with TEB and transesophageal Doppler techniques. Correlation of the measurements was poor, with r=0.39 for TEB and thermodilution, r=0.44 for transesophageal Doppler and thermodilution, and r=0.39 for TEB and transesophageal Doppler. The mean difference between TEB and thermodilution, transesophageal Doppler and thermodilution, and TEB and transesophageal Doppler values was -2.41+/-1.79 L/min(mean+/-SD), -0.98+/-1.70 L/min, and -0.69+/-1.01 L/min, respectively. The scattergrams with confidence band lines showed that 22.0% of the scattergram points fell within +/-20% band and 51.5% within +/-40% band in TEB and thermodilution, 55.0% of the scattergram points fell within +/-20% band and 77.9% within +/-40% band in transesophageal Doppler and thermodilution, and 63.6% of the scattergram points fell within +/-20% band and 90.9 within +/-40% band in TEB and transesophageal Doppler. Therefore, it is concluded that neither noninvasive technique reliably estimated cardiac output as determined by thermodilution.