title: Pulmonary artery catheter placement for elective coronary artery bypass grafting: before or after anesthetic induction?
abstract: Pulmonary arterial catheters (PACs) are often used during and after coronary artery bypass grafting. We hypothesized that placement of a PAC would be faster in anesthetized patients. We further hypothesized that the presence or absence of a PAC during the induction of anesthesia would make no difference in hemodynamics, vasoactive drug use, or IV fluid administration during the induction. Patients (n = 200) undergoing elective coronary artery bypass grafting were assigned to PAC insertion either before or after the induction of anesthesia. Total time for PAC insertion, number of finder needle and venous catheter insertion attempts, incidence of carotid artery puncture, arrhythmias or ST segment changes, arterial blood gas analysis, hemodynamic variables, IV fluids, and vasoactive drugs required during and after the anesthetic induction were recorded. Thirty-two different physicians placed the PACs. PAC placement was faster (10 versus 12 min, P = 0.0003) and required fewer punctures with a finder needle (P = 0.0107) in anesthetized patients. There were no significant differences between groups in hemodynamic values or use of vasoactive or anesthetic drugs or IV fluids during the induction. There were also no significant differences between groups in the incidence of myocardial ischemia, arterial hypoxemia, or hypercarbia. Placement of a PAC before the induction of anesthesia consumes more time and fails to improve hemodynamic stability or lessen vasoactive drug use during the induction of anesthesia.
  
  
  CONCLUSIONS
  Insertion of pulmonary artery catheters (PACs) before the induction of anesthesia requires more needle sticks and takes longer than insertion after the induction of anesthesia; moreover, previous PAC insertion has no significant effect on hemodynamics or use of vasoactive drugs or IV fluid associated with the induction of anesthesia.
authors.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA. mhwall@wfubmc.edu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Wall
authors.forename: Drew A
authors.initials: DA
authors.lastname: MacGregor
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kennedy
authors.forename: Robert L
authors.initials: RL
authors.lastname: James
authors.forename: John
authors.initials: J
authors.lastname: Butterworth
authors.forename: Kathryn F
authors.initials: KF
authors.lastname: Mallak
authors.forename: Roger L
authors.initials: RL
authors.lastname: Royster
mesh_terms: D000368:Aged; D000758:Anesthesia; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D011229:Preanesthetic Medication
chemical_list: D010100:Oxygen