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Perioperative Medicine
Published in: Perioperative Medicine 1/2014

Open Access 01-12-2014 | Research

Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational study

Authors: Jaap Jan Vos, Marieke Poterman, Laura N Hannivoort, Victor W Renardel De Lavalette, Michel MRF Struys, Thomas WL Scheeren, Alain F Kalmar

Published in: Perioperative Medicine | Issue 1/2014

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Abstract

Background

In particular surgical conditions, a balanced anesthesia with a high-antinociceptive contribution is required. This may induce cardiovascular impairment and thus compromise tissue oxygenation. In this prospective observational study, we investigated the hemodynamic stability and tissue oxygen saturation (StO2) in 40 patients with a high-antinociceptive general anesthesia, goal-directed fluid therapy, and norepinephrine. In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management.

Methods

In high-antinociceptive propofol/remifentanil anesthesia with bispectral index (BIS) between 40 and 60, norepinephrine was administered to maintain mean arterial pressure (MAP) above 80% of individual baseline. Fluid was administered if the ∆ plethysmographic waveform amplitude exceeded 10%. Surgical and recovery conditions, hemodynamic responses, and tissue oxygenation were investigated.

Results

Mean (SD) StO2 at the left thenar eminence increased from 83 (6)% before to 86 (4)% 20 min after induction of anesthesia (p <0.05). Cardiac index dropped from 3.0 (0.7) to 2.1 (0.4) L min-1 (p <0.05), MAP from 109 (16) to 83 (14) mm Hg, and heart rate from 73 (12) to 54 (8) bpm (p <0.05). Thirteen out of 40 patients received a fluid bolus. The median (range) norepinephrine administration rate was 0.05 (0.0–0.10) μg kg-1 min-1. After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253–386) s was observed.

Conclusions

This high-antinociceptive balanced anesthesia with goal-directed fluid and vasopressor therapy adequately preserved StO2 and hemodynamic homeostasis.

Trial registration

ISRCTN20153044
Appendix
Available only for authorised users
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Metadata
Title
Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational study
Authors
Jaap Jan Vos
Marieke Poterman
Laura N Hannivoort
Victor W Renardel De Lavalette
Michel MRF Struys
Thomas WL Scheeren
Alain F Kalmar
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Perioperative Medicine / Issue 1/2014
Electronic ISSN: 2047-0525
DOI
https://doi.org/10.1186/2047-0525-3-9

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