Single transpulmonary thermodilution in off‐pump coronary artery bypass grafting: haemodynamic changes and effects of different anaesthetic techniques

Abstract

During OPCAB, STD and pulse-contour analysis displayed changes in preload, myocardial function and afterload that gave valuable guidance for the conduct of anaesthesia, fluid management, and the administration of vasoactive agents. As assessed using STD, isoflurane within the present dose range appears to maintain myocardial performance and vascular tone better than midazolam or propofol.

Comparison of Goal-Directed Hemodynamic Optimization Using Pulmonary Artery Catheter and Transpulmonary Thermodilution in Combined Valve Repair: A Randomized Clinical Trial

“…The increase of SVV that we observed in patients of the TTD group at the end of the first postoperative day may be explained mainly by cessation of respiratory support. These results correspond with other studies of goal-directed therapy in cardiac surgery [12, 19, 23, 24]. …”

“…Recently, so-called “less invasive” techniques for measurement of cardiac output (CO) have been implemented as a useful adjunct or even alternative to the hemodynamic monitoring by means of the pulmonary artery catheter (PAC). Among these various techniques, transpulmonary thermodilution, allowing measurement of volumetric parameters and subsequent continuous, “beat-to-beat” CO-computation based on pulse contour analysis, has proved to be a valuable monitoring tool both in coronary surgery and heart failure [12–15]. However, its potential advantage in heart valve surgery in comparison with pressure-oriented hemodynamic monitoring, which is still widely used, has not been elucidated.…”

Epidural anesthesia and postoperative analgesia with ropivacaine and fentanyl in off-pump coronary artery bypass grafting: a randomized, controlled study

“…After OPCAB, we observed a reduction of systemic vascular tone and a rise in myocardial performance. These changes are consistent with other investigations of CABG and may result from the restoration of coronary blood flow and reversal of myocardial depression by goal-directed hemodynamic optimization [1,19,20]. As shown in several previous studies, volumetric parameters measured by transpulmonary thermodilution, such as GEDVI, which we used for hemodynamic optimization, is a more sensitive indicator of preload compared to CVP and can serve as guidance for colloid administration [19-24].…”

Transient Acute Decompensated Heart Failure Following Propofol and Fentanyl Administration in a Healthy 19‐Year‐Old Patient

“…Agents such as propofol and fentanyl have known vasodilatory effects and LV depression in patients with and without preexisting heart failure. 3,6 The mechanisms by which the propofol ⁄ fentanyl combination produces cardiac depression are multifactorial. In the absence of heart failure, systolic and diastolic arterial pressures were observed to be reduced as much as 30% and 25%, respectively, 1 whereas other studies demonstrated a less significant impact on MAP 2-4 at standard doses of propofol.…”

“…Even without preexisting heart failure, the effects of these agents on ejection fraction in patients with normal LV function have been reported to be mildly reduced. 3,6 The mechanisms by which the propofol ⁄ fentanyl combination produces cardiac depression are multifactorial. Propofol produces vasodilation through induction of nitric oxide, blocking calcium channels, and protein kinase activation.…”