Catéter de Swan Ganz con marcapasos en la cirugía mini-invasiva mitral / Pacing Swan-Ganz Catheter in Minimally Invasive Mitral Valve Surgery

RESUMEN Introducción: La cirugía mediante mini-toracotomía lateral presenta ventajas comparativas sobre el acceso convencional como menor trauma quirúrgico, reducida morbimortalidad y un resultado estético superior, pero plantea dificultades en caso de necesitar estimulación eléctrica temporal. Objetivo: Valorar el empleo terapéutico del catéter de Swan-Ganz con marcapasos incorporado como solución a dicho problema y analizar sus complicaciones. Material y métodos: Se incluyeron pacientes programados para cirugía mini-invasiva mitral mediante mini-toracotomía lateral. Se definió empleo terapéutico del catéter al uso debido a bradiarritmias o trastornos de conducción o necesidad de incrementar la frecuencia cardíaca con fines hemodinámicos. Pacientes intervenidos de urgencia o emergencia, fueron excluidos del estudio. Resultados: Fueron incluidos 517 pacientes (289 de sexo masculino, con edad promedio de 68,3 ± 10,4 años); se efectuaron 115 (22,2%) reemplazos y 402 (77,7%) plásticas mitrales. Simultáneamente, se realizaron 294 (56,9%) procedimientos de Maze, 182 (35,2%) cierres de orejuela izquierda, 9 (1,7%) cierres de defectos septales y 14 (2,7%) plásticas tricuspídeas. Ciento sesenta y dos (313%) pacientes necesitaron ser marcapaseados; debido a bradiarritmias, 85 (52,47%) pacientes; por trastornos de conducción, 50 (30,86%) pacientes; mientras que otros 27 (16,66%) requirieron incrementar su frecuencia debido a bajo volumen minuto. La mortalidad resultó de 12 (2,32%) casos. Catorce (2,7%) pacientes presentaron pérdida de captura y se resolvieron con el reposicionamiento del catéter, mientras que 2 (0,6%) pacientes presentaron atrapamiento y requirieron reintervención. Conclusiones: Casi un tercio de los pacientes intervenidos mediante mini-toracotomía lateral requirieron del empleo terapéutico del catéter de Swan-Ganz con marcapasos. Dos pacientes presentaron atrapamiento y requirieron resolución quirúrgica.

ABSTRACT Background: The use of a lateral mini-thoracotomy presents several advantages over the standard access, such as less surgical trauma, reduced morbidity and mortality, shorter recovery time and better cosmetic results, but presents difficulties if temporary pacing is required. Objective: The aim of this study was to evaluate the therapeutic use of a Swan-Ganz catheter with pacing capabilities and analyze its complications. Methods: Patients undergoing scheduled minimally invasive mitral valve surgery through lateral mini-thoracotomy were included in the study. Therapeutic use of the pacing catheter was defined as the need for pacing due to bradyarrhythmias or conduction disorders or need of increasing heart rate in case of hemodynamic instability. Patients undergoing urgent or emergency surgery were excluded from the study. Results: A total of 517 patients were included in the study; mean age was 68.3 ± 10.4 years and 289 (55.9%) were men; 115 patients (22.2%) underwent mitral valve replacement and 402 (77.7%) mitral valve repair. The following concomitant procedures were carried out: 294 (56.9%) Maze procedures, 182 (35.2%) left atrial appendage closures, 9 (1.7%) atrial septal defect closures and 14 (2.7%) tricuspid valve repair surgeries. In the postoperative period 162 (31.3%) patients required pacing due to bradyarrhythmias in 85 cases (52.47%), conduction disorders in 50 (30.86%), and need to increase heart rate in 27 (16.66%) patients with low cardiac output syndrome. Postoperative mortality was 2.32% (n=12). Fourteen (2.7%) patients presented loss of capture that was resolved with catheter repositioning, while 2 (0.6%) patients presented catheter entrapment requiring reintervention. Conclusion: Almost one-third of the patients undergoing lateral mini-thoracotomy required therapeutic use of the pacing Swan-Ganz catheter. Two patients presented catheter entrapment and required surgical reintervention.

Consistency of TEE technique and PAC method in monitoring cardiac volume load and cardiac hemodynamic changes / 心血管康复医学杂志

Objective: To evaluate the consistency of transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) method in monitoring cardiac volume load and cardiac hemodynamic indexes.Methods: A total of 45 patients undergoing coronary artery bypass grafting in our hospital were selected.The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were monitored during surgery by TEE and PAC respectively.Consistency of monitored data was compared between two methods.Results: Both TEE and PAC indicated that compared with baseline level, after loading, there were significant rise in RVEDV [TEE: (38±6)ml vs.(51±9ml), PAC: (153±17)ml vs.(188±19)ml], RVESV [TEE: (19±4)ml vs.(33±5)ml, PAC: (92±16)ml vs.(110±23)ml], P0.05.Before therapy, RVEDV, RVESV and RVEF monitored by PAC and TEE showed significant positive correlation, and all relevant coefficients were >0.8 (r=0.844, 0.862, 0.916, P0.8 (r=0.892, P<0.01).Conclusion: In clinical monitor, the consistency of TEE and PAC is high,the former is non-traumatic,and is more convenient for clinical use.

Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization / 대한중환자의학회지

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization / 대한구급학회지

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Monitorização hemodinâmica em unidade de terapia intensiva: uma perspectiva do Brasil / Hemodynamic monitoring in the intensive care unit: a Brazilian perspective

Objetivo: No Brasil, não há dados sobre as preferências do intensivista em relação aos métodos de monitorização hemodinâmica. Este estudo procurou identificar os métodos utilizados por intensivistas nacionais, as variáveis hemodinâmicas por eles consideradas importantes, as diferenças regionais, as razões para escolha de um determinado método, o emprego de protocolos e treinamento continuado. Métodos: Intensivistas nacionais foram convidados a responder um questionário em formato eletrônico durante três eventos de medicina intensiva e, posteriormente, por meio do portal da Associação de Medicina Intensiva Brasileira, entre março e outubro de 2009. Foram pesquisados dados demográficos e aspectos relacionados às preferências do entrevistado em relação à monitorização hemodinâmica. Resultados: Responderam ao questionário 211 profissionais. Nos hospitais privados, foi evidenciada maior disponibilidade de recursos de monitorização hemodinâmica do que nas instituições públicas. O cateter de artéria pulmonar foi considerado o mais fidedigno por 56,9%, seguido do ecocardiograma, com 22,3%. O débito cardíaco foi considerado a variável mais importante. Outras variáveis também julgadas relevantes foram débito cardíaco, saturação de oxigênio venoso misto/saturação de oxigênio venoso central, pressão ...

Objective: In Brazil, there are no data on the preferences of intensivists regarding hemodynamic monitoring methods. The present study aimed to identify the methods used by national intensivists, the hemodynamic variables they consider important, the regional differences, the reasons for choosing a particular method, and the use of protocols and continued training. Methods: National intensivists were invited to answer an electronic questionnaire during three intensive care events and later, through the Associação de Medicina Intensiva Brasileira portal, between March and October 2009. Demographic data and aspects related to the respondent preferences regarding hemodynamic monitoring were researched. Results: In total, 211 professionals answered the questionnaire. Private hospitals showed higher availability of resources for hemodynamic monitoring than did public institutions. The pulmonary artery catheter was considered the most trusted by 56.9% of the respondents, followed by echocardiograms, at 22.3%. Cardiac output was considered the most important variable. Other variables also considered relevant were mixed/central venous oxygen saturation, pulmonary artery occlusion pressure, and right ventricular end-diastolic volume. Echocardiography was the most used method (64.5%), followed by pulmonary artery catheter (49.3%). Only half of respondents used treatment protocols, and 25% worked in continuing education programs in hemodynamic monitoring. ...

Impacto en el diagnóstico y tratamiento del monitoreo hemodinámico con catéter de Swan Ganz en el paciente grave inestable / Impact of hemodynamic monitoring with Swan-Ganz catheter in the diagnosis and treatment in unstable seriously ill patients

FUNDAMENTO: el catéter de la arteria pulmonar o de Swan Ganz es un método técnico de diagnóstico y se desarrolla en los laboratorios de fisiología y hemodinámica, en el mismo se perfeccionó a punto de proporcionarle un recurso incuestionable para el control y seguimiento por el anestesiólogo en el período perioperatorio de pacientes de cirugía de alto riesgo. OBJETIVO: evaluar la repercusión del monitoreo hemodinámico invasivo con catéter de Swan Ganz. MÉTODO: se realizó un estudio prospectivo descriptivo en la sala de Cuidados Intensivos del Hospital Universitario Manuel Ascunce Domenech desde enero de 1992 a enero de 2014. Se estudió un universo de 500 pacientes, con edad comprendida entre 15 y 70 años y con diagnóstico de inestabilidad hemodinámica de origen cardiogénico 298 pacientes y no cardiogénico 202. RESULTADOS: su uso motivó cambios en el diagnóstico o adición de otro en 317 pacientes 63,4 %. En relación al tratamiento se realizaron cambios o modificaciones en 450 pacientes en total, lo que significó un 90 %. CONCLUSIONES: el uso racional y bien discutido del catéter de Swan Ganz resultó de suma utilidad para el manejo de pacientes graves con inestabilidad hemodinámica, lo que permitió una mejor interpretación de estados fisiopatológicos confusos y modalidades terapéuticas oportunas y de difícil decisión.

OBJECTIVE: to evaluate the repercussion of the invasive hemodynamic monitoring with Swan-Ganz catheter; to show the benefits and repercussions of its hemodynamic use in the diagnosis and treatment of unstable seriously ill patients in the first 72 hours of evolution. METHOD: a prospective, descriptive study was conducted in the Intensive Care room of the Manuel Ascunce Domenech Teaching Hospital from January, 1992 to January 2014. A universe of 500 patients aged 15-70 years old was studied; 298 of them were diagnosed with hemodynamic instability of a cardiogenic origin and 202 with hemodynamic instability of a non-cardiogenic origin. RESULTS: its use motivated changes in the diagnosis, or the addition of another diagnosis, in 317 patients 63, 4 %. Regarding the treatment, changes or modifications were made in a total of 450 patients, which represented a 90 %. CONCLUSIONS: the rational and well-discussed use of the Swan-Ganz catheter was very useful for the handling of very ill patients with hemodynamic instability difficult to handle. This allowed a better interpretation of confusing physiopathological conditions, as well as applying opportune therapeutic methods and of difficult decision.

Efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental / Hemodynamic effects of experimental acute right ventricular overload / Efectos hemodinámicos de la sobrecarga ventricular derecha aguda experimental

FUNDAMENTO: A sobrecarga ventricular direita aguda está associada a situações clínicas de elevada morbimortalidade, tais como: ressecções pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar e edema pulmonar das altitudes. Alguns pontos de sua fisiopatologia permanecem obscuros. OBJETIVO: Avaliar os efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental em suínos. MÉTODOS: A sobrecarga ventricular direita foi induzida pela oclusão das artérias pulmonares através de ligaduras. Vinte porcos foram utilizados no estudo, sendo alocados em 04 grupos: um controle, não submetido à oclusão vascular pulmonar, e três de sobrecarga ventricular direita submetidos à oclusão das seguintes artérias pulmonares: SVD1 (artéria pulmonar esquerda); SVD2 (artéria pulmonar esquerda e do lobo inferior direito) e SVD3 (artéria pulmonar esquerda, do lobo inferior direito e do lobo mediastinal), obstruindo a vasculatura pulmonar em 42, 76 e 82,0 por cento respectivamente. Variáveis de hemodinâmica foram medidas a cada 15 minutos durante a uma hora do estudo. Na análise estatística, foram utilizados ajustes de modelos lineares mistos com estrutura de variâncias e covariâncias. RESULTADOS: Nas comparações intergrupais, houve aumento significativo da frequência cardíaca (p = 0,004), pressão arterial pulmonar média (p = 0,001) e pressão capilar pulmonar (p < 0,0001). Houve redução significativa da pressão arterial média (p = 0,01) e do índice sistólico (p = 0,002). Não houve diferença significativa no índice cardíaco (p = 0,94). CONCLUSÃO: Apesar da intensa sobrecarga ventricular direita promovida pela obstrução de 82,0 por cento da vasculatura pulmonar e pelo aumento significativo da pressão arterial pulmonar não houve disfunção cardiovascular severa e/ou choque circulatório no período estudado.

BACKGROUND: Acute right ventricular overload is associated with high morbidity and mortality clinical situations such as: extensive lung resection, pulmonary thromboembolism, lung transplantation and high altitude pulmonary edema. Some points of its pathophysiology remain unclear. OBJECTIVE: To assess the hemodynamic effects of experimental acute right ventricular overload in pigs. METHODS: Right ventricular overload was induced through the occlusion of the pulmonary arteries using ligationss. Twenty pigs were used in the study, divided into 04 groups: one control group not subject to pulmonary vascular occlusion, and three right ventricular overload groups subject to occlusion of the following pulmonary arteries: SVD1 (left pulmonary artery); SVD2 (left pulmonary artery and right lower lobe) and SVD3 (left pulmonary artery, right lower lobe and mediastinal lobe), obstructing the pulmonary vasculature in 42, 76 and 82.0 percent respectively. Hemodynamic variables were measured every 15 minutes during one hour of study. The statistical analysis employed mixed linear models with variance and covariance structures. RESULTS: Group comparisons revealed significant increases in heart rate (p = 0.004), mean pulmonary artery pressure (p = 0.001) and pulmonary capillary wedge pressure (p < 0.0001). There was no significant difference in cardiac index (p = 0.94). CONCLUSION: Despite the severe right ventricular overload promoted by 82.0 percent obstruction of the pulmonary vasculature and the significant increase in pulmonary arterial pressure, there was no severe cardiovascular dysfunction and/or circulatory shock during the study period.

FUNDAMENTO: La sobrecarga ventricular derecha aguda está asociada a situaciones clínicas de elevada morbimortalidad, tales como: resecciones pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar y edema pulmonar de las alturas. Algunos puntos de su fisiopatología permanecen obscuros. OBJETIVO:Evaluar los efectos hemodinámicos de la sobrecarga ventricular derecha aguda experimental en porcinos. MÉTODOS:La sobrecarga ventricular derecha fue inducida por la oclusión de las arterias pulmonares a través de ligaduras. Veinte cerdos fueron utilizados en el estudio, siendo divididos en 4 grupos: uno control, no sometido a la oclusión vascular pulmonar, y tres de sobrecarga ventricular derecha sometidos a la oclusión de las siguientes arterias pulmonares: SVD1 (arteria pulmonar izquierda); SVD2 (arteria pulmonar izquierda y del lóbulo inferior derecho) y SVD3 (arteria pulmonar izquierda, del lóbulo inferior derecho y del lóbulo mediastinal), obstruyendo la vasculatura pulmonar en 42, 76 y 82,0 por ciento respectivamente. Variables de hemodinámica fueron medidas cada 15 minutos durante una hora del estudio. En el análisis estadístico, fueron utilizados ajustes de modelos lineares mixtos con estructura de variancias y covariancias. RESULTADOS:En las comparaciones intergrupales, hubo aumento significativo de la frecuencia cardíaca (p = 0,004), presión arterial pulmonar media (p = 0,001) y presión capilar pulmonar (p < 0,0001). Hubo reducción significativa de la presión arterial media (p = 0,01) y del índice sistólico (p = 0,002). No hubo diferencia significativa en el índice cardíaco (p = 0,94). CONCLUSIÓN:A pesar de la intensa sobrecarga ventricular derecha promovida por la obstrucción de 82,0 por ciento de la vasculatura pulmonar y por el aumento significativo de la presión arterial pulmonar no hubo disfunción cardiovascular severa y/o shock circulatorio en el período estudiado.

Evaluation of cardiac function of patients with liver cirrhosis before orthotopic liver transplantation using Swan-Ganz catheter / 中华麻醉学杂志

Objective To evaluate the cardiac function of the patients with liver cirrhosis before orthotopic liver transplantation(OLT)using Swan-Ganz catheter.Methods Sixty ASAⅡ-Ⅳ patients aged 45-64 yr with liver cirrhosis scheduled for OLT without veno-venous bypass were allocated into 2 groups according to preoperative liver function:compensated group(group C,n=28)and decompensated group(group H,n=32).Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propofol 1 mg/kg and vecuronium 0.1 mg/ks and maintained with 0.5%-3.0% isoflurane,fentanyl 0.05-0.10 mg and vecuronium 4 mg/h.The patients were mechanically ventilated after tracheal intubation,and P_(ET)CO_2 was maintained at 30-45 mm Hg.Radial artery was cannulated and Swan-Ganz catheter was placed via right internal jugular vein for monitoring of mean arterial pressure(MAP),cardiac output(co),cardiac index(CI),right ventricular ejection fraction(RVEF),mean pulmonary arterial pressure(MPAP),pulmonary arterial wedge pressure(PAWP),right atrial pressure(RAP),right ventricular end-diastolic volume(RVEDV),fight ventricular end-systolic volume(RVESV)and stroke volume index(SVI).Right and left ventricular stroke work index(RVSWI,LVSWI)and systolic and pulmonary vascular resistance(SVR,PVR)were calculated.Results CO,CI,SVI,MPAP,PAWP,RVEDV,RVESV,RVSWI and LVSWI were significantly elevated in group H as compared with group C indicating hyper-hemodynamic state.The SVR and PVR were significantly decreased in group H.There was no significant difference in HR,MAP,RAP and RVEF between the two groups.Conclusion The patients with decompensated liver function before OLT are in a hyper-hemodynamic state.More attention should be paid to perioperative myocardial protection.

Ruptura da artéria pulmonar pelo cateter de Swan-Ganz: relato de caso / Pulmonary artery rupture by the Swan-Ganz catheter: case report

O cateter de artéria pulmonar é frequentemente usado na monitorização de pacientes durante o transplante hepático. O advento de métodos menos invasivos para estimar o débito cardíaco e a pressão de oclusão da artéria pulmonar, aliado ao fracasso de estudos randomizados em demonstrar redução da mortalidade com o uso do cateter de artéria pulmonar, reduziu sua aplicabilidade. A ruptura de artéria pulmonar pelo uso do cateter de artéria pulmonar é complicação rara, porém grave. Objetivamos relatar a ruptura de artéria pulmonar como complicação do cateter de artéria pulmonar, revendo a abordagem clínica e discutindo a monitorização hemodinâmica com o cateter de artéria pulmonar no transplante hepático. Paciente do sexo feminino, 56 anos, portadora de vírus da hepatite C e cirrose (escore MELD 26), apresentou quadro de encefalopatia hepática. Foi realizado transplante hepático sob monitorização invasiva com cateter de artéria pulmonar. Nas primeiras 24 horas pós-operatórias apresentou instabilidade hemodinâmica, queda do hematócrito e parada cárdio-respiratória. Após a ressuscitação cárdio-pulmonar, foi solicitado um ecocardiograma trans-torácico que evidenciou hemopericárdio. Mesmo após a pericardiocentese a paciente evoluiu com hemopericárdio recidivo. A angiografia pulmonar não evidenciou lesões e o diagnóstico de ruptura de artéria pulmonar só foi feito através da esternotomia exploratória. As complicações pelo uso do cateter de artéria pulmonar são infrequentes, entretanto associadas a grande morbimortalidade. A redução do uso do cateter de artéria pulmonar diminuiu as complicações em diversas situações clínicas, entretanto o risco-benefício do uso do cateter de artéria pulmonar para transplante de fígado não é conhecido. Novos estudos comparando o cateter de artéria pulmonar a métodos não invasivos da avaliação da pressão de oclusão da artéria pulmonar devem ser realizados no transplante hepático.

Pulmonary artery catheter is frequently used to monitor patients during liver transplantation. Recently developed less invasive methods for estimating cardiac output and pulmonary capillary wedge pressure together with the failure of randomized studies to demonstrate reduced mortality in pulmonary artery catheter-monitored patients, has restricted its applicability. Pulmonary artery rupture by pulmonary artery catheter is a rare, but dangerous complication. The purpose of this report is to describe a pulmonary artery rupture caused by monitorization with a pulmonary artery catheter, reviewing the clinical approach and discussing hemodynamic monitoring with the pulmonary artery catheter during liver transplantation. A 56 year old female patient, with cirrhosis caused by hepatitis C virus (MELD score 26) presented with acute hepatic encephalopathy. She was medicated and received a liver transplantation with invasive monitoring with a pulmonary artery catheter. In the first 24 hours after surgery, the patient presented with hemodynamic instability, low hematocrit, and cardiorespiratory arrest. After cardiopulmonary resuscitation, hemopericardium was diagnosed by transthoracic echocardiography and even after pericardiocentesis the patient developed recurrent hemopericardium. Pulmonary angiography did not disclose large vessellesions. The pulmonary artery rupture diagnosis was only made after sternotomy and direct lesion observation. Complications from use of pulmonary artery catheter are infrequent, however, due to their clinical severity, can cause high morbidity and mortality. A decreased use of pulmonary artery catheter reduced the number of complications observed. New clinical studies comparing pulmonary artery catheter with non-invasive methods for pulmonary capillary wedge pressure measurement must be conducted in liver transplantation.

Surgical Removal of Knotted Pulmonary Artery Catheter: A Case Report / 대한흉부외과학회지

The complications associated with the use of pulmonary artery catheter include dysrhythmias, heart block, pulmonary artery rupture, pulmonary infarction, endocardial damage, balloon rupture, arterial puncture, thromboembolism, air embolism, infection, pneumothorax, and knotting of the catheter. Knotting of the catheter is a rare complication and it should be anticipated if there is an excessive advancement of the pulmonary artery catheter beyond the normally expected distance. We report a successful surgical removal of knotted pulmonary artery catheter by sternotomy and cardiopulmonary bypass.

Continuous cardiac output measurement with transesophageal Doppler echocardiography versus Swan Ganz catheter / 中华麻醉学杂志

ve Cardiac output is traditional measured by thermodilution technique. Recent advance in catheter technique has allowed continuous monitoring of cardiac output, but it is invasive and expensive. The new transesophageal Doppler echocardiography (HemosonicTM 100) can measure aortic blood flow (ABF) and ABF is closely related to cardiac output (CO) (CO= ABF/70%). The purpose of this study was to compare cardiac output continuously measured with transesophageal Doppler echocardiography and modified Swan-Ganz catheter. Methods Forty ASA II - III patients aged 40-65 yr undergoing elective coronary artery bypass (CAB) were included in this study. Premedication consisted of intramuscular diazepam 10 mg, morphine 10 mg and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.08 mg?kg-1, fentanyl 10?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation, continuous infusion of propofol and intermittent boluses of fentanyl, midazolam and pipecuronium. The sensor of transesophageal Doppler echocardiograph (TDEE) was placed in the esophagus at the level of T5-6 vertebra after induction and tracheal intubation. The sensor faced backward toward descending aorta. Swan-Ganz catheter (CCO/Sv()2) was placed via right internal jugular vein. In addition intra-arterial BP, ECG, SpO2, PET CO2 and nasal temperature were monitored.Results Continuous cardiac output measured with TDEE and Swan-Ganz catheter (CCO/SvO2) were highly correlated (R = 0.801, P

Evaluation of right ventricular performance using volumetric pulmonary artery catheter in patients undergoing off-pump coronary artery bypass grafting / 中华麻醉学杂志

Objective To evaluate the right ventricular function using volumetric pulmonary artery catheter (VPAC) in patients undergoing off-pump coronary artery bypass grafting (CABG) .Methods Thirty-two patients (18 males, 14 females) aged 45-63 yrs weighing 58-74 kg undergoing CABG were studied. Their cardiac functions were graded according to NYHA classification as Ⅰ or Ⅱ. Radial artery was cannulated before induction of anesthesia for BP monitoring. Anesthesia was induced with midazolam 0.03-0.05 mg?kg-1, fentanyl 10-15 ?g?kg-1 and pipecuronium 0.1-0.15 mg?kg-1 and maintained with 1.0-1.5% isoflurane. The probe (7 MHz) of the transesophageal echocardiography (TEE, Sonos 2500, HP) was placed in esophagus after tracheal intubation for measurement of both right and left ventricular end-diastolic, end-systolic volume and ejection fraction (LVEDV, LVESV, LVEF, RVEDV, RVESV, RVEF). VPAC (type 774HF75, Edwards Life Science Co) was placed via right internal jugular vein for measurement of RVEDV, RVESV and RVEF. 6% HAES 10 ml?kg-1 was infused over 10 min. The cardiovascular parameters mentioned above were measured before and immediately after 6% HAES infusion using both TEE and VPAC, and compared.Results The RVEDV and RVESV (measured by TEE and VPAC) and LVEDV, LVESV (by TEE) were significantly increased after HAES infusion as compared with the baseline values (P

Significance of hemodynamics monitoring by Swan-Ganz catheter for patients undergone off-pump coronary artery bypass grafting / 解放军医学杂志

0.05), but the trachea cannula duration and residence time in ICU were significantly shorter in study group (10.36?3.14h and 36.47?6.25h, respectively) compared with those in control group (15.72?2.23h and 56.12?7.31h, respectively) (P