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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 September;65(9):617-23

language: English

Haemodynamic chang­es dur­ing anaesth­e­sia in ­knee-­elbow posi­tion

Galimberti G. 1, Berlot G. 1, Muchada R. 2, Gullo A. 1

1 Istituto Polidisciplinare di Anestesia, Rianimazione e Terapia Antalgica, Ospedale di Cattinara - Trieste (Italia);
2 Department d’Anesthesie et Reanimation, Clinique Mutualiste E. André - Lyon (France)


Background. To eval­u­ate hemo­dy­nam­ic alter­a­tions dur­ing sur­gi­cal pro­ce­dures per­formed in the ­knee-­elbow posi­tion.
Methods. Design of the ­study: pros­pec­tive eval­u­a­tion of the aor­tic ­blood ­flow (ABF) and oth­er car­di­o­vas­cu­lar var­i­ables meas­ured ­with a tran­se­soph­a­geal Doppler (TED) in 2 ­groups of ­patients ­free of pre­vi­ous car­di­o­vas­cu­lar dis­eas­es under­go­ing lum­bar dis­cec­to­my.
Environment. Oper­ating thea­tre of a neu­ro­sur­gi­cal depart­ment. Beside TED, the stan­dard mon­i­tor­ing includ­ed con­tin­u­ous ECG sur­veillance, cap­nom­e­try, non­in­va­sive mea­sure­ment of ­blood pres­sure and pul­soxym­e­try.
Patients. Over­all, 24 ASA 1 ­patients ­have ­been ­enrolled. In 12 ­patients (Group A) the inter­ven­tion was per­formed with­out dobu­ta­mine. In the oth­er 12 ­patients (Group B) dobu­ta­mine (2,5-3 µg/kg/min) was start­ed from the begin­ning of the inter­ven­tion; the two ­groups did not dif­fer in ­terms of age, ­body ­size, dura­tion of sur­gery or anes­thet­ic tech­nique ­used; hemo­dy­nam­ic mea­su­re­ments ­were ­obtained at the begin­ning of the inter­ven­tion (T1), ­with the ­patients ­still ­supine, dur­ing the inter­ven­tion in the ­knee-­elbow posi­tion (T2) and final­ly at the end of the pro­ce­dure (T3) ­being the ­patients ­still anes­the­tized but ­lying ­supine ­again.
Results. In ­both ­groups the ABF ; the sys­tol­ic vol­ume and the ­ETCO2 sig­nif­i­cant­ly ­decreased in the ­knee-­elbow posi­tion; con­com­i­tant­ly, periph­er­al vas­cu­lar resis­tanc­es ­increased. In Group B, the hemo­dy­nam­ic var­i­ables ­were sig­nif­i­cant­ly bet­ter ­than in the oth­er ­group.
Conclusions. In the ­patients ­enrolled, the per­i­op­er­a­tive admin­is­tra­tion of low-­dose dobu­ta­mine was asso­ciat­ed ­with bet­ter car­di­o­vas­cu­lar per­for­mance.

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