Perioperative hemodynamic study of patients undergoing abdominal surgery using pulse dye densitometry.
OBJECTIVE
Pulse dye densitometry (PDD) using indocyanine-green (ICG) is a newly developed technique for monitoring cardiac output (CO), cardiac index (CI), circulating blood volume (BV) and ICG elimination rate (K-ICG). We measured hemodynamic changes during the perioperative period in patients undergoing digestive surgery to analyze relationships between hemodynamic changes and surgical procedures, blood loss, water balance and SIRS.


METHODS
Eighty-seven patients who underwent gastrectomy (n=46) and colectomy (n=41) without postoperative complications were enrolled in this study. The corresponding data from 15 patients who underwent laparoscopic cholecystectomy were used as controls. CO, CI, BV and K-ICG were measured by PDD before operation, on the first postoperative day (POD 1), POD 3, POD 7 and POD 14.


RESULTS
In all patients, CO and CI increased significantly until POD 3 compared with preoperative levels. BV on POD 1 decreased significantly compared to the preoperative level. K-ICG increased significantly until POD 14. Laparoscopic cholecystectomy resulted in less surgical stress than gastrectomy or colectomy as measured by hemodynamic changes. There were minimal differences in hemodynamics between the gastrectomy and colectomy groups. There were significant negative correlations between intraoperative blood loss and the [POD 1: preoperative values] ratios for CO, CI, BV or K-ICG. There was no correlation between changes in water balance from operation to POD 1 and [POD 1: preoperative value] BV ratio.


CONCLUSIONS
An increase in CO and decrease in BV were observed at the early operative stage, especially in patients with systemic inflammatory response syndrome (SIRS). Interestingly, hepatic artery flow volume (K-ICG) remained high until POD 14. It is important to minimize intraoperative blood loss, since it markedly affects postoperative hemodynamics.
Nishioka
Masanori
M
Department of Digestive Surgery, University of Tokushima, School of Medicine, National Kochi Hospital, Japan. khotchi@clin.med.tokushima-u.ac.jp
Ishikawa
Masashi
M
Hanaki
Norikazu
N
Kashiwagi
Yutaka
Y
Miki
Hisashi
H
Miyake
Hidenori
H
Tashiro
Seiki
S
D000005:Abdomen / Q000601:surgery; D000368:Aged; D016063:Blood Loss, Surgical; D002302:Cardiac Output / Q000502:physiology*; D003082:Colectomy; D004396:Coloring Agents; D003720:Densitometry / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period
D004396:Coloring Agents; D007208:Indocyanine Green