[Preoperative evaluation of hemodynamics using indocyanine green clearance meter in patients with peritonitis from gastrointestinal perforation].
BACKGROUND
Since patients with perforated peritonitis often present hemodynamic instability, preoperative evaluation of hemodynamics is important for anesthesiologists. Indocyanine green (ICG) can be used to measure cardiac output (C.O.), blood volume (B.V.) and hepatic function. Previous studies have reported that the average elimination rate constant of ICG (KICG) might be reduced in critically ill patients. This study was therefore conducted to investigate the relationship between acute physiology and chronic health evaluation (APACHE) II score and KICG value, cardiac output, and blood volume in patients scheduled for emergency surgery.


METHODS
After obtaining informed consent hemodynamics of thirteen patients undergoing emergency surgery for perforated peritonitis were measured by in vivo ICG clearance technique. After induction of anesthesia, ICG elimination rate was measured following intravenous administration of ICG (20 mg) with a DDG analyzer (DDG-2001) using a nose probe for pulse dye densitometry. All measurements were performed prior to surgery. The value of C.O./B.V. was used as an indicator of cardiac function. The severity of each patient's illness was also assessed using the APACHE II scoring system at the start of operation.


RESULTS
There was a negative correlation between APACHE II score and KICG (KICG = 0.34 0.01 x APACHE II score, r = -0.56). In addition, there was a positive correlation between APACHE II score and C.O./B.V. (C.O./B.V. = 1.10 + 0.05 x APACHE II score, r = 0.79).


CONCLUSIONS
Patients with high APACHE II score may show low hepatic blood flow and high cardiac output compared with blood volume. ICG clearance rate might be useful for preoperative evaluation of hemodynamics in patients with perforated peritonitis.
Takazawa
Tomonori
T
Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi.
Nishikawa
Koichi
K
Watanabe
Iwao
I
Goto
Fumio
F
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D002302:Cardiac Output; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications*; D012720:Severity of Illness Index
D007208:Indocyanine Green