Effects of induction of anaesthesia with sufentanil and positive-pressure ventilation on the intra- to extrathoracic volume distribution.
OBJECTIVE
Induction of general anaesthesia in combination with positive-pressure ventilation is often associated with a significant decrease of arterial pressure. A decreased preload may contribute to this phenomenon. The aim was to investigate whether a change in cardiac filling occurs following the induction of general anaesthesia with sufentanil under typical clinical conditions.


METHODS
Fifteen patients scheduled for elective coronary bypass grafting were studied immediately before surgery. In addition to standard monitors, a transpulmonary double-indicator dilution technique measured in vivo intrathoracic blood volume, global end-diastolic volume and total circulating blood volume. For induction of anaesthesia 2 microg kg(-1) sufentanil was given. Measurements were performed awake and after the induction of anaesthesia, intubation and mechanical ventilation of the lungs.


RESULTS
To maintain arterial pressure during the induction period within -20% of baseline pressure, on average 22 +/- 6mLkg(-1) crystalloids and 8 +/- 6mLkg(-1) colloids were given. Despite these amounts of fluid, cardiac filling was decreased, whereas circulating blood volume increased significantly. Both central venous pressure and pulmonary capillary wedge pressure increased.


CONCLUSIONS
Induction of general anaesthesia with positive-pressure ventilation is regularly associated with a blood volume shift from intra- to extrathoracic compartments. Even in low-dose opioid monoanaesthesia with sufentanil--often regarded as relatively inert in haemodynamic terms--the phenomenon could be demonstrated as the primary cause of the often-observed decrease of arterial pressure. It seems, therefore, rationally justified to restore cardiac filling by generous administration of intravenous fluids, at least in patients with unaffected cardiac pump function. During induction of anaesthesia, central venous pressure and pulmonary capillary wedge pressure do not reliably indicate cardiac filling.
von Spiegel
T
T
University of Bonn, Department of Anaesthesiology and Intensive Care Medicine, Germany. vspiegel@ukb.uni-bonn.de
Giannaris
S
S
Schorn
B
B
Scholz
M
M
Wietasch
G J K
GJ
Hoeft
A
A
D000759:Adjuvants, Anesthesia; D000368:Aged; D018681:Anesthetics, General; D001810:Blood Volume; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume / Q000502:physiology; D017409:Sufentanil
D000759:Adjuvants, Anesthesia; D018681:Anesthetics, General; D017409:Sufentanil