Assessment of haemodynamic response to induction of general anaesthesia in healthy adult patients undergoing elective orthopaedic surgery by using a continuous non-invasive cardiovascular monitoring
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Accepted version
Published version
Author(s)
Type
Journal Article
Abstract
Background
Continuous cardiovascular monitoring as part of management of high-risk surgical patients is widely practiced, however continuous monitoring as part of routine management in low-risk surgical patients is unclear. Detailed monitoring of cardiovascular parameters from the pre-induction stage allows clinicians to individualise anaesthetic management in the perioperative period. Our aim was to investigate haemodynamic and Bispectral Index (BIS) changes in healthy patients undergoing surgery following induction of anaesthesia with propofol using a continuous non-invasive blood pressure device (LiDCOrapid™).
Methods
This prospective, observational single-centre study was conducted at a London teaching hospital between June-November 2014. Patients aged between 18-45 years, American Society of Anesthesiologists grade I-II undergoing elective lower-limb arthroscopic procedures were included. Variables including heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR) and BIS were recorded continuously prior to induction and up to 3-minutes after.
Results
The following relative haemodynamic changes were noted between baseline and 1-minute post-induction with propofol: CO +15.2%, HR +10.1%, SVR -22.9% and MAP -10.1%(p<0.001 for each parameter). There was a mean change of: HR -10.1%, CO -14% and MAP -18.0%(p<0.001 for each parameter) between baseline and 3-minutes post-induction. Median change of BIS was -61.7%(p<0.001) between baseline and 3-minutes post-induction. Significant, positive correlations noted between MAP and BIS at 30-seconds(r=0.60, p<0.001) and 1-minute post-induction (r=0.61, p<0.001).
Conclusion
Our study shows that healthy patients undergoing continuous minimally invasive orthopaedic surgery experience significant haemodynamic and BIS changes following induction of anaesthesia. Our findings highlight the importance of baseline cardiovascular and BIS monitoring as part of routine perioperative management.
Continuous cardiovascular monitoring as part of management of high-risk surgical patients is widely practiced, however continuous monitoring as part of routine management in low-risk surgical patients is unclear. Detailed monitoring of cardiovascular parameters from the pre-induction stage allows clinicians to individualise anaesthetic management in the perioperative period. Our aim was to investigate haemodynamic and Bispectral Index (BIS) changes in healthy patients undergoing surgery following induction of anaesthesia with propofol using a continuous non-invasive blood pressure device (LiDCOrapid™).
Methods
This prospective, observational single-centre study was conducted at a London teaching hospital between June-November 2014. Patients aged between 18-45 years, American Society of Anesthesiologists grade I-II undergoing elective lower-limb arthroscopic procedures were included. Variables including heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR) and BIS were recorded continuously prior to induction and up to 3-minutes after.
Results
The following relative haemodynamic changes were noted between baseline and 1-minute post-induction with propofol: CO +15.2%, HR +10.1%, SVR -22.9% and MAP -10.1%(p<0.001 for each parameter). There was a mean change of: HR -10.1%, CO -14% and MAP -18.0%(p<0.001 for each parameter) between baseline and 3-minutes post-induction. Median change of BIS was -61.7%(p<0.001) between baseline and 3-minutes post-induction. Significant, positive correlations noted between MAP and BIS at 30-seconds(r=0.60, p<0.001) and 1-minute post-induction (r=0.61, p<0.001).
Conclusion
Our study shows that healthy patients undergoing continuous minimally invasive orthopaedic surgery experience significant haemodynamic and BIS changes following induction of anaesthesia. Our findings highlight the importance of baseline cardiovascular and BIS monitoring as part of routine perioperative management.
Date Issued
2017-03-16
Date Acceptance
2016-11-10
Citation
Open Anesthesiology Journal, 2017, 11, pp.75-82
ISSN
1874-3218
Publisher
Bentham open
Start Page
75
End Page
82
Journal / Book Title
Open Anesthesiology Journal
Volume
11
Copyright Statement
© 2017 Hua et al.
This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a
copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a
copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.
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Published