Cardiac Output During and Following Surgical Operations

Heilbrunn, Alfred; Allbritten, Frank F.

doi:10.1097/00000658-196008000-00003

Cited by 27 publications

(4 citation statements)

References 25 publications

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“…However, in our study, the time-related elevation in CO was smaller for older patients. This can be explained by the decrease in the cardiac functional reserve occurring as an effect of aging [42,43]. In our study, CO changes directly influenced propofol and fentanyl disposition and thus also affected the BIS values.…”

Section: The Influence Of Patients' Agementioning

confidence: 64%

The influence of cardiac output on propofol and fentanyl pharmacokinetics and pharmacodynamics in patients undergoing abdominal aortic surgery

Bienert

Sobczyński

Młodawska

et al. 2020

J Pharmacokinet Pharmacodyn

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Cardiac output (CO) is expected to affect elimination and distribution of highly extracted and perfusion rate-limited drugs. This work was undertaken to quantify the effect of CO measured by the pulse pressure method on pharmacokinetics and pharmacodynamics of propofol and fentanyl administrated during total intravenous anesthesia (TIVA). The data were obtained from 22 ASA III patients undergoing abdominal aortic surgery. Propofol was administered via target-controlled infusion system (Diprifusor) and fentanyl was administered at a dose of 2-3 lg/kg each time analgesia appeared to be inadequate. Hemodynamic measurements as well as bispectral index were monitored and recorded throughout the surgery. Data analysis was performed by using a non-linear mixed-effect population modeling (NONMEM 7.4 software). Three compartment models that incorporated blood flows as parameters were used to describe propofol and fentanyl pharmacokinetics. The delay of the anesthetic effect, with respect to plasma concentrations, was described using a biophase (effect) compartment. The bispectral index was linked to the propofol and fentanyl effect site concentrations through a synergistic E max model. An empirical linear model was used to describe CO changes observed during the surgery. Cardiac output was identified as an important predictor of propofol and fentanyl pharmacokinetics. Consequently, it affected the depth of anesthesia and the recovery time after propofol-fentanyl TIVA infusion cessation. The model predicted (not observed) CO values correlated best with measured responses. Patients' age was identified as a covariate affecting the rate of CO changes during the anesthesia leading to age-related difference in individual patient's responses to both drugs.

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Section: The Influence Of Patients' Agementioning

confidence: 64%

The influence of cardiac output on propofol and fentanyl pharmacokinetics and pharmacodynamics in patients undergoing abdominal aortic surgery

Bienert

Sobczyński

Młodawska

et al. 2020

J Pharmacokinet Pharmacodyn

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show abstract

“…The first measurements of cardiac output, using indicator dilution techniques, were complicated and cumbersome (5) but helped us recognize the large variability in cardiac output that can exist in patients. The development of the balloon-tipped pulmonary artery catheter (PAC) by Swan et al (6) in 1970, just before the Society for Critical Care Medicine was founded in 1971, revolutionized our approach to the monitoring of cardiac output enabling the simpler pulmonary artery thermodilution technique (7).…”

Section: Some Key Steps In the History Of Hemodynamic Monitoringmentioning

confidence: 99%

Hemodynamic Monitoring and Support

Vincent

Joosten

Saugel

2021

Critical Care Medicine

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“…Le Manach et al 4 evaluate a new technique to assess changes in cardiac output during fluid administration in the surgical patient. In this context, it is interesting to return to the first measurements of cardiac output during surgery more than 50 yr ago 5 ; the method used, based on dyedilution techniques ( fig. 1), revealed unsuspected changes, including a 20% decrease in cardiac output, during induction of anesthesia.…”

mentioning

confidence: 99%

“…Fifty years after Heilbrunn and Allbritten's publication, 5 the answer must surely be "no." After all, it is difficult to interpret absolute cardiac output values in conditions of low oxygen demand; changes in stroke volume or cardiac output are much more informative, particularly to appreciate the response to fluids, still the major intervention used to optimize stroke volume during surgery.…”

mentioning

confidence: 99%