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Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution : an observational study

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Abstract
Background In particular surgical conditions, a balanced anesthesia with a high-antinociceptive contribution is required. This may induce cardiovascular impairment and thus compromise tissue oxygenation. In this prospective observational study, we investigated the hemodynamic stability and tissue oxygen saturation (StO2) in 40 patients with a high-antinociceptive general anesthesia, goal-directed fluid therapy, and norepinephrine. In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management. Methods In high-antinociceptive propofol/remifentanil anesthesia with bispectral index (BIS) between 40 and 60, norepinephrine was administered to maintain mean arterial pressure (MAP) above 80% of individual baseline. Fluid was administered if the ∆ plethysmographic waveform amplitude exceeded 10%. Surgical and recovery conditions, hemodynamic responses, and tissue oxygenation were investigated. Results Mean (SD) StO2 at the left thenar eminence increased from 83 (6)% before to 86 (4)% 20 min after induction of anesthesia (p <0.05). Cardiac index dropped from 3.0 (0.7) to 2.1 (0.4) L min-1 (p <0.05), MAP from 109 (16) to 83 (14) mm Hg, and heart rate from 73 (12) to 54 (8) bpm (p <0.05). Thirteen out of 40 patients received a fluid bolus. The median (range) norepinephrine administration rate was 0.05 (0.0–0.10) μg kg-1 min-1. After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253–386) s was observed. Conclusions This high-antinociceptive balanced anesthesia with goal-directed fluid and vasopressor therapy adequately preserved StO2 and hemodynamic homeostasis.

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MLA
Vos, Jaap Jan, et al. “Hemodynamics and Tissue Oxygenation during Balanced Anesthesia with a High Antinociceptive Contribution : An Observational Study.” PERIOPERATIVE MEDICINE, vol. 3, 2014, doi:10.1186/2047-0525-3-9.
APA
Vos, J. J., Poterman, M., Hannivoort, L. N., Renardel De Lavalette, V. W., Struys, M., Scheeren, T. W., & Kalmar, A. (2014). Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution : an observational study. PERIOPERATIVE MEDICINE, 3. https://doi.org/10.1186/2047-0525-3-9
Chicago author-date
Vos, Jaap Jan, Marieke Poterman, Laura N Hannivoort, Victor W Renardel De Lavalette, Michel Struys, Thomas WL Scheeren, and Alain Kalmar. 2014. “Hemodynamics and Tissue Oxygenation during Balanced Anesthesia with a High Antinociceptive Contribution : An Observational Study.” PERIOPERATIVE MEDICINE 3. https://doi.org/10.1186/2047-0525-3-9.
Chicago author-date (all authors)
Vos, Jaap Jan, Marieke Poterman, Laura N Hannivoort, Victor W Renardel De Lavalette, Michel Struys, Thomas WL Scheeren, and Alain Kalmar. 2014. “Hemodynamics and Tissue Oxygenation during Balanced Anesthesia with a High Antinociceptive Contribution : An Observational Study.” PERIOPERATIVE MEDICINE 3. doi:10.1186/2047-0525-3-9.
Vancouver
1.
Vos JJ, Poterman M, Hannivoort LN, Renardel De Lavalette VW, Struys M, Scheeren TW, et al. Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution : an observational study. PERIOPERATIVE MEDICINE. 2014;3.
IEEE
[1]
J. J. Vos et al., “Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution : an observational study,” PERIOPERATIVE MEDICINE, vol. 3, 2014.
@article{8642112,
  abstract     = {Background
In particular surgical conditions, a balanced anesthesia with a high-antinociceptive contribution is required. This may induce cardiovascular impairment and thus compromise tissue oxygenation. In this prospective observational study, we investigated the hemodynamic stability and tissue oxygen saturation (StO2) in 40 patients with a high-antinociceptive general anesthesia, goal-directed fluid therapy, and norepinephrine. In addition, optimal surgical conditions and safe and fast emergence are pivotal parts of anesthetic management.

Methods
In high-antinociceptive propofol/remifentanil anesthesia with bispectral index (BIS) between 40 and 60, norepinephrine was administered to maintain mean arterial pressure (MAP) above 80% of individual baseline. Fluid was administered if the ∆ plethysmographic waveform amplitude exceeded 10%. Surgical and recovery conditions, hemodynamic responses, and tissue oxygenation were investigated.

Results
Mean (SD) StO2 at the left thenar eminence increased from 83 (6)% before to 86 (4)% 20 min after induction of anesthesia (p <0.05). Cardiac index dropped from 3.0 (0.7) to 2.1 (0.4) L min-1 (p <0.05), MAP from 109 (16) to 83 (14) mm Hg, and heart rate from 73 (12) to 54 (8) bpm (p <0.05). Thirteen out of 40 patients received a fluid bolus. The median (range) norepinephrine administration rate was 0.05 (0.0–0.10) μg kg-1 min-1. After complete akinesia in all patients during surgery, a median (IQR) extubation time of 311 (253–386) s was observed.

Conclusions
This high-antinociceptive balanced anesthesia with goal-directed fluid and vasopressor therapy adequately preserved StO2 and hemodynamic homeostasis.},
  articleno    = {9},
  author       = {Vos, Jaap Jan and Poterman, Marieke and Hannivoort, Laura N and Renardel De Lavalette, Victor W and Struys, Michel and Scheeren, Thomas WL and Kalmar, Alain},
  issn         = {2047-0525},
  journal      = {PERIOPERATIVE MEDICINE},
  language     = {eng},
  pages        = {8},
  title        = {Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution : an observational study},
  url          = {http://dx.doi.org/10.1186/2047-0525-3-9},
  volume       = {3},
  year         = {2014},
}

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