Does central venous pressure reflect the circulating blood volume for the decrement of compliance just after esophagectomy?
This study investigates whether the pressure parameters obtained from the Swan-Ganz catheter (SGC) accurately reflect the circulating blood volume just after en bloc resection of the thoracic esophagus with regional lymph node dissection. It is well known that this operation induces severe hemodynamic changes and although the pressure parameters obtained from the SGC are an accepted means of monitoring circulating blood volume, we have often experienced a discrepancy between the SGC data and the clinical state. We examined the pressure parameters and diameter of the inferior vena cava (IVC) and left ventricle (LV), and the central venous compliance using SGC and echocardiography in ten patients who underwent esophagectomy for esophageal cancer. The central venous pressure, pulmonary arterial mean pressure, and pulmonary artery wedged pressure were significantly increased just after the operation compared with the preoperative levels, while the diameters of the IVC and LV decreased just after the operation. The compliances of the IVC decreased significantly just after the operation. The hemodynamic shift to the third space after esophagectomy induces decrement of the compliances of IVC. As the CVP does not always reflect the circulating blood volume, measuring the diameter of the IVC using echocardiography is extremely useful for monitoring circulating blood volume just after esophagectomy.
Motoyama
S
S
Second Department of Surgery, Akita University School of Medicine, Japan.
Kitamura
M
M
Kibira
S
S
Suzuki
H
H
Kamata
S
S
Saito
R
R
Kimura
K
K
Sasaki
S
S
Taguchi
K
K
Okuyama
M
M
Miura
M
M
Ogawa
J
J
D001810:Blood Volume / Q000502:physiology*; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure / Q000502:physiology*; D004452:Echocardiography; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014655:Vascular Resistance / Q000502:physiology; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology