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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 2001 June;67(6):447-56

language: Italian

Haemodynamic study by PiCCO system with brachial artery access during anesthesia for abdominal aortic aneurysm repair

Antonini M., Meloncelli S., Dantimi C., Tosti S., Ciotti L., Gasparetto A.

Università degli Studi «La Sapienza» - Roma Istituto di Anestesiologia e Rianimazione


Back­ground. The hae­mod­y­nam­ic mon­i­tor PiC­CO ­System, ­based on trans­pul­mo­nary arte­ri­al ther­mo­di­lu­tion, has ­been ­used ­with a bra­chi­al-axil­lary ­access ­instead of the femo­ral arte­ri­al ­access dur­ing abdom­i­nal aor­tic aneu­rysm sur­gi­cal ­repair. Accu­ra­cy and lim­i­ta­tions of ­pulse con­tour con­tin­u­ous car­diac out­put (­PCCO) ­were eval­u­at­ed on the ­basis of arte­ri­al ther­mo­di­lu­tion car­diac out­put. The pat­terns of car­diac ­index, pre­load, after­load and car­diac func­tion param­e­ters ­were ­also stud­ied in the dif­fer­ent phas­es of the sur­gi­cal pro­ce­dure.
Meth­ods. Twen­ty con­sec­u­tive ­patients ­were stud­ied. ­Mean dif­fer­enc­es (­bias) ­between ­PCCO and arte­ri­al ther­mo­di­lu­tion car­diac out­put ­were cal­cu­lat­ed by the ­Bland-Alt­man ­test. Anal­y­sis of var­i­ance ­with mul­ti­ple com­par­i­son ­test of hae­mod­y­nam­ic var­i­ables in the dif­fer­ent phas­es ­were per­formed. The cor­re­la­tion coef­fi­cients ­between car­diac ­index and the vol­u­met­ric pre­load var­i­ables ­were ­also ­obtained.
­Results. Bra­chi­al ­artery cath­et­er­iza­tion was ­achieved with­out any ­major com­pli­ca­tion. ­Pulse con­tour con­tin­u­ous car­diac ­index (CI) and arte­ri­al ther­mo­di­lu­tion CI val­ues ­showed over­all ­mean dif­fer­enc­es (­bias) of –0.04 L·min-1. m-2 (SD 0.8) but ­after aor­tic ­cross-clamp­ing and aor­tic unclamp­ing ­they ­were 0.64 L·min-1. m-2 (SD 0.57) e –0.57 L·min-1. m-2 (SD 0.85), respec­tive­ly (p<0.05). CI, glo­bal end-dia­stol­ic vol­ume (­GEDV) and intra­tho­rac­ic ­blood vol­ume (ITB­VI) ­were sig­nif­i­cant­ly low­er dur­ing aor­tic ­cross-clamp­ing. CI was not cor­re­lat­ed to cen­tral ­venous pres­sure (r=0.18) but ­instead, to ­GEDV (r=0.57) and ITB­VI (r=0.65).
Con­clu­sions. PiC­CO ­System ­with bra­chi­al-axil­lary arte­ri­al ­access was suit­able for hae­mod­y­nam­ic mon­i­tor­ing of the abdom­i­nal aor­tic aneu­rysm sur­gi­cal ­repair pro­ce­dures. ­PCCO ­must be recal­i­brat­ed ­with arte­ri­al ther­mo­di­lu­tion ­after aor­tic ­cross-clamp­ing and unclamp­ing to ­avoid an ­over-esti­ma­tion and an ­under-esti­ma­tion respec­tive­ly. Dur­ing aor­tic ­cross-clamp­ing ­GEDV and ITB­VI indi­cat­ed a ­decreased pre­load. Oth­er hae­mod­y­nam­ic var­i­ables ­were ­less val­u­able but EVL­WI ­showed an inter­est­ing ­steady ­increase dur­ing the ­whole pro­ce­dure.

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