title: Continuous haemodynamic monitoring using transoesophageal Doppler during acute normovolaemic haemodilution in patients with coronary artery disease.
abstract: Transoesophageal Doppler monitoring allows non-invasive assessment of stroke volume. We studied haemodynamic changes during acute normovolemic haemodilution (ANH) in anaesthetised patients with coronary artery disease. Twenty patients were randomly assigned to either ANH or a control group. During ANH, a mean (SD) blood volume of 15.3 (3.4) ml.kg(-1) was withdrawn decreasing systemic oxygen delivery from 12.7 (3.3) to 9.3 (1.8) ml.kg(-1).min(-1) (p < 0.001). In the control group, haemodynamic data remained unchanged, whereas in the ANH group, stroke volume and central venous pressure increased significantly (mean = +21 ml [95% CI: 18-25 ml.min(-1)]; mean = +2.5 mmHg [95% CI: 2.2-2.8 mmHg], respectively) and heart rate decreased (mean = -6 beat.min(-1)[95% CI: 6-8 beat.min(-1)], p < 0.05). According to the Frank-Starling relationship, individual changes in stroke volume compared with central venous pressure fitted a quadratic regression model (R2 > 0.91). A reduced viscosity associated with ANH resulted in improved venous return, higher cardiac preload and increased cardiac output. In summary, this study demonstrated that ANH to a haemoglobin value of 8.6 g.dl(-1) was well tolerated in patients with coronary artery disease.
authors.affiliation: Department of Anaesthesiology Department of Cardiovascular Surgery, University Hospital, Rue Micheli-du-Crest, CH-1211 Geneva, Switzerland. marc-joseph.licker@hcuge.ch
authors.forename: M
authors.initials: M
authors.lastname: Licker
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.forename: D
authors.initials: D
authors.lastname: Tassaux
authors.forename: J
authors.initials: J
authors.lastname: Diaper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D005260:Female; D006438:Hemodilution; D006439:Hemodynamics; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*
chemical_list: D006454:Hemoglobins