Transoesophageal echocardiography during cardiopulmonary resuscitation in patients after cardiothoracic surgery

RIGHT VENTRICULAR FUNCTION ANALYSIS USING PRESSUREVOLUME DIAGRAMS DURING THE INDUCTION OF ANAESTHESIA WITH ELTANOLONE P. Tassani, U. Jbicke, H. Kunig* Institute of Anaesthesiology, $Jniversity of Munich, Klinikum Grosshadern, 81366 Munich, Germany P.O.Box 192, Saltsburg, PA 15681, USA

Introduction The aim of the study was to evaluate if pressurevolume diagrams and cardiac efficiency (CEF) are suitable parameters to determine the right ventricular function. The induction of anaesthesia using eltanolone was used as an example. Eltanolone is a new steroid, which has recently been formulated as an emulsion. It produces and decreases arterial pressure vasodilation comparable to thiopentone (I). Considering the heart as a physical pump cardiac CEF may be calculated from the ratio of cardiac work performed to the maximum energy (EDV*SBP) expended. EDV = end-diastolic ventricular volume and SBP=systolic ventricular pressure. CEF may be a useful parameter to estimate ventricular functions (2). Patients and Methods Nine patients scheduled for coronary artery bypass grafting were investigated. The exclusion criteria were: Age of the patients > 70 and < 4.5 years, weight > or < 30% of ideal body weight, ejection fraction C 50%) systemic arterial pressure > 150/95 mm Hg and cardiac index < 2.5 l/min/m2. A femoral arterial and a RV ejection fraction pulmonary artery catheter were then placed. Anaesthesia was induced with eltanolone O.Smg/kg together with fentanyl 3pg/kg and vecuronium 0. lmg/kg. The haemodynamic measurements were made in the awake state (baseline), 2 min after induction of anaesthesia and 1 and 5 min after intubation. The measurement of cardiac output (CO), RV ejection fraction (EF), and pulmonary artery pressure permitted calculation of the ventricular volumes and the construction of pressure-volume diagrams from which CEF was determined. The measurements were subjected to analysis of variance. Results CEF was significantly (p
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Pressure-volume diagrams, thus, suggest the possibility of fast and reliable diagnosis of impaired RV tinctions (fig). Discussion The fact that CEF was the only parameter displaying a significant change during induction with eltanolone/fentanyl permits 2 conclusions: 1. CEF determined from pressures and volumes seems to be a more sensitive parameter for the detection of an impaired RV function than CO and EF. with anaesthesia induction of The 2. eltanolone/fentanyl leads to significant impairment efficiency. of the right ventricular cardiac References 1. Tassani P et al: Eltanolone, a new induction in patients with effects agent-hemodynamic coronary artery disease compared to thiopentone. Anesthesiology 79:A328, 1993 2. Kunig H: Pressure-volume curve diagnosis. A.P.I.C.E. conference, Trieste, Italy 1993

pressure

[nm~ Hgl

after

intubation

201

CEF=

I,

I ‘51 I

10%

1

baseline

20

40

I I

60

80

100

120

140

volume

Fig.:

Right

ventricular

diagrams

Cardiothoram

and

Vascular

EACTA 94 Abstracts:

I

1

I

I I

126%

51 I 01 0

I

;

I

101 CEF=

I

I I

pressure-volume

of one patient

Anesthesia, Cardiovascular

160 [ml/m21

as an example

Vol 8, No 5,

Suppl 3 (October),

Pharmacology

1994