cardiac output response to a colloid preload for spinal … may 1152... · cardiac output response...
TRANSCRIPT
Cardiac output response to a colloid
preload for spinal anaesthesia for
caesarean section in patients with severe
preeclampsia
A Vorster, MJ Arcache, S Schulein, A Emmanuel, D van Dyk, O Okaisabor, AR Reed, MF James, RA Dyer
Introduction
• Fluid management in preeclampsia controversial
– Risk of pulmonary oedema
– Risk of renal injury
• Current restrictive practice appropriate for the patient not invasively monitored
• Individualised fluid therapy is possible when haemodynamic monitoring is available
Aim of study
Measurement of stroke volume
responsiveness in women with severe
early onset preeclampsia undergoing
spinal anaesthesia for caesarean section
Patients and methods
• 42 patients
• Severe treated early onset preeclampsia
• No other cardiovascular disease
• Maternal indication for Caesarean section
• Eligible for spinal anaesthesia
• LiDCOrapid haemodynamic monitor
Prior treatment
• MgSO4
• Antihypertensives
– Dihydrallazine
– Alphamethyldopa
– Nifedipine
• Fluids
– 50-100 mL/ hour IV
– NPO for theatre
In theatre
• 16 G IV line
• 20 G arterial line
• Left lateral position
• LiDCOrapid haemodynamic monitor
• Baseline haemodynamic data
• 300 ml HES 130/0.4 via rapid infusion
• Post infusion haemodynamic data
• Data averaged over 1 minute
Change in Cardiac Output
02
9
31
0
5
10
15
20
25
30
35
< 0% 0 - 5% 5.1 - 10% > 10%
Nu
mb
er
of
pa
tie
nts
Percentage Change
dCO
Change in Stroke Volume
4
15
10
13
0
2
4
6
8
10
12
14
16
< 0% 0 - 5% 5.1 - 10% > 10%
Nu
mb
er
of
pa
tie
nts
Percentage Change
dSV
Change in Heart Rate
6
9
17
10
0
2
4
6
8
10
12
14
16
18
< 0% 0 - 5% 5.1 - 10% > 10%
Nu
mb
er
of
pa
tie
nts
Percentage Change
dHR
Change in Mean Arterial Pressure
5
20
15
2
0
5
10
15
20
25
< 0% 0 - 5% 5.1 - 10% > 10%
Nu
mb
er
of
pa
tie
nts
Percentage Change
dMAP
14.8
7.8 6.94.3
0
5
10
15
20
25
30
dCO dSV dHR dMAP
Pe
rce
nta
ge
Percentage Changes from Baseline
Relation between SV and HR
Conclusions
• Significant cardiac output increase with limited colloid preload:– Mediated by increase in both HR and SV
• A larger study may provide:– Information on correlation between stroke volume
responsiveness and vasopressor requirement
– Clearer guidelines for fluid administration
• Caution in administering further fluid to those who respond with a significant increase in heart rate
Thank you