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Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients

Published online by Cambridge University Press:  01 September 2007

C. S. Meyhoff ,
L. Hesselbjerg ,
Z. Koscielniak-Nielsen  and
L. S. Rasmussen
C. S. Meyhoff*
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
L. Hesselbjerg
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
Z. Koscielniak-Nielsen
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
L. S. Rasmussen
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
*
Correspondence to: Christian Sylvest Meyhoff, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital,Rigshospitalet, Copenhagen, DK-2100, Denmark. E-mail: meyhoff@rh.dk; Tel: +4535450958; Fax: +4535452950
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Summary

Background and objective

In most studies of cardiac output changes after spinal anaesthesia, the time-resolution is limited. The aim of this study was to demonstrate cardiac output changes with high time-resolution during onset of spinal anaesthesia in elderly patients.

Methods

We investigated 32 patients aged ⩾60 yr scheduled for elective lower limb surgery. Fourteen received concurrent cardiovascular medication. Cardiac output was measured every 10 s using a pulse wave algorithm derived from the radial artery pressure curve, after calibration with lithium chloride (LiDCO™plus). Data collection ended when the patients were ready for surgery, or if ephedrine was given to raise the mean arterial pressure.

Results

Cardiac output increased initially reaching a maximum after a mean of 7 min. The average increase was 1.1 L min−1 (P < 0.0001). This occurred when mean arterial pressure was reduced 14 mmHg on average. At the end of data collection, cardiac output decreased 0.5 L min−1 from baseline (P = 0.02). Mean arterial pressure decreased progressively in all patients, and only minimal changes in heart rate were found.

Conclusions

Using this high time-resolution method, we detected biphasic changes in cardiac output during onset of spinal anaesthesia. Initially, cardiac output increased. Subsequently, it was significantly reduced from baseline, although this decrease was of minor clinical importance.

Keywords

CARDIAC OUTPUTHYPOTENSIONINDICATOR DILUTION TECHNIQUESLITHIUM CHLORIDESPINAL ANAESTHESIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 770 - 775
Copyright
Copyright © European Society of Anaesthesiology 2007

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