Cardiac Output, Sevoflurane, Vascular Resistance, Venous Return
Conditions
Keywords
sevoflurane, cardiac output, mean systemic filling pressure, vascular resistance
Brief summary
Cardiac output (CO) is measured using Mostcare. Mean systemic filling pressure (MSFP) and vascular resistances are calculated using venous return curves constructed by measuring steady-state arterial and venous pressures and cardiac output (CO) during inspiratory hold manoeuvres at increasing plateau pressures. Measurements are performed at three incremental levels of targeted sevoflurane concentrations.
Detailed description
Tracheal intubation is performed after anesthesia induction with sevoflurane. Radial arterial is cannulated and pressure transducer is connected to MostCare (core technique PRAM). HR, MAP, CVP, CO, SVR, PPV, and dp/dt are recorded at three incremental levels of targeted sevoflurane concentrations. MSFP and vascular resistances are calculated.
Interventions
None listed
Sponsors
Children's Hospital of Fudan University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
3 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* American Association of Anesthesiologists (ASA)physical status score I-III * major elective surgery that dictates the use of invasive hemodynamic monitoring including CVP and continuous arterial blood pressure monitoring.
Exclusion criteria
* symptomatic peripheral vascular disease or pulmonary disease * aberrant cardiovascular anatomy * significant valvular regurgitation * severe arrhythmia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cardiac output | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | Cardiac output is monitored using Mostcare via a radial arterial catheter connected to the pressure transducer. |
| mean systemic filling pressure | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | Mean systemic filling pressure (MSFP) is calculated using venous return curve constructed by measuring steady-state arterial and venous pressures and CO during inspiratory hold manoeuvres at increasing plateau pressures. The CVP and CO data are fitted by linear regression to define the venous return curve. We define MSFP by extrapolation to zero flow. |
| vascular resistance | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | Total systemic vascular resistance (Rsys) is calculated as the ratio of the pressure difference between mean Pa and mean CVP and CO. The resistance downstream to MSFP is taken to reflect the resistance to venous return (Rv) and is calculated as the ratio of the pressure difference between MSFP and CVP and CO. Systemic arterial resistance (Ra) is taken to be the difference between systemic and venous resistance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| mean arterial pressure | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | Systemic arterial blood pressure is monitored via a radial arterial catheter connected to a pressure transducer. |
| dP/dt | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | dP/dt is obtained from Mostcare. |
| central venous pressure | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | CVP is measured with a catheter inserted through the right internal jugular vein. |
| pulse pressure variation | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. | PPV is obtained from Mostcare. |
Countries
China
Outcome results
None listed