Haemodynamic changes during anaesthesia in knee-elbow position.
BACKGROUND
To evaluate hemodynamic alterations during surgical procedures performed in the knee-elbow position.


METHODS



METHODS
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.


METHODS
Operating theatre of a neurosurgical department. Beside TED, the standard monitoring included continuous ECG surveillance, capnometry, noninvasive measurement of blood pressure and pulsoxymetry.


METHODS
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 micrograms/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.
Galimberti
G
G
Istituto Polidisciplinare di Anestesia, Rianimazione e Terapia Antalgica Ospedale di Cattinara, Trieste Italia. g.galimberti@apice.univ.trieste.it
Berlot
G
G
Muchada
R
R
Gullo
A
A
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000768:Anesthesia, General; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D004550:Elbow; D006439:Hemodynamics; D006801:Humans; D007717:Knee; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011187:Posture; D011446:Prospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D004280:Dobutamine