Physiologic and hemodynamic changes in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Objective We aimed to determine the physiological and hemodynamic changes in patients who were undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) cytoreductive surgeries. Methods This prospective, observational study enrolled 21 patients who were undergoing elective cytoreductive surgery with HIPEC at our hospital over 2 years. We collected vital signs, hemodynamic parameters including global end-diastolic volume index (GEVI) and extravascular lung water index (ELWI) using the VolumeView™ system, and arterial blood gas analysis from all patients. Data were recorded before skin incision (T1); 30 minutes before HIPEC initiation (T2); 30 (T3), 60 (T4), and 90 (T5) minutes after HIPEC initiation; 30 minutes after HIPEC completion (T6); and 10 minutes before surgery completion (T7). Results Patients showed an increase in body temperature and cardiac index and a decrease in the systemic vascular resistance index. GEDI was 715.4 (T1) to 809.7 (T6), and ELWI was 6.9 (T1) to 7.3 (T5). Conclusions HIPEC increased patients’ body temperature and cardiac output and decreased systemic vascular resistance. Although parameters that were extracted from the VolumeView™ system were within their normal ranges, transpulmonary thermodilution approach is helpful in intraoperative hemodynamic management during open abdominal cytoreductive surgery with HIPEC. Trial registry name: ClinicalTrials.gov Trial registration number: NCT02325648 URL: https://clinicaltrials.gov/ct2/results?cond=NCT02325648&term

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New transpulmonary thermodilution approach to assess hemodynamic changes in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

10.21203/rs.2.16471/v1 ◽

2019 ◽

Author(s):

Myoung Hwa Kim ◽

Young Chul Yoo ◽

Sun Joon Bai ◽

Kang-Young Lee ◽

Nayeon Kim ◽

...

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Extravascular Lung Water ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Anesthetic Management ◽

Resistance Index ◽

Volume Index ◽

Physiological Changes ◽

Lung Water ◽

Peritoneal Cancer

Abstract Purpose The current treatment of peritoneal cancer combines cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The present study aimed to use the VolumeView TM system to investigate the intraoperative physiological changes, including extravascular lung water, in patients undergoing cytoreductive surgery with HIPEC. Methods This prospective, observational study enrolled 21 patients undergoing elective cytoreductive surgery with HIPEC at our hospital between December 2014 and April 2016. In all patients, we applied the VolumeView TM system (Edwards Lifesciences, Irvine, CA). Internal jugular vein and femoral artery accesses were required to monitor hemodynamic parameters. Data were recorded and analyzed before skin incision; 30 min before HIPEC initiation; 30, 60, and 90 min after HIPEC initiation; 30 min after HIPEC completion; and 10 min before surgery completion. Results During HIPEC, patients showed a rise in body temperature, decrease in the systemic vascular resistance index, and increase in cardiac output. The global end-diastolic volume index was 715.4–809.7, and the extravascular lung water index was 6.9–7.3. Rapid insulin (mean, 6.8 units) was administered because of increased glucose levels, and lactate levels steadily increased during HIPEC. Only 1 patient had acute kidney injury postoperatively, and the mean length of hospital stay was 17 days. Conclusion Our study demonstrated the intraoperative physiological changes in patients undergoing open cytoreductive abdominal surgery with HIPEC. Advanced hemodynamic monitoring should be considered for better anesthetic management in these patients.

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Empagliflozin does not change cardiac index nor systemic vascular resistance but rapidly improves left ventricular filling pressure in patients with type 2 diabetes: a randomized controlled study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01175-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Matthias Rau ◽

Kirsten Thiele ◽

Niels-Ulrik Korbinian Hartmann ◽

Alexander Schuh ◽

Ertunc Altiok ◽

...

Keyword(s):

Cardiac Index ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Resistance Index ◽

Stroke Volume Index ◽

Left Ventricular ◽

Volume Index ◽

Hemodynamic Parameters ◽

Mitral Inflow ◽

Ventricular Filling Pressure

Abstract Background In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients with type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of the HHF event curves within the first 3 months of the trial suggest that immediate hemodynamic effects may play a role. However, hitherto no data exist on early effects of SGLT2 inhibitors on hemodynamic parameters and cardiac function. Thus, this study examined early and delayed effects of empagliflozin treatment on hemodynamic parameters including systemic vascular resistance index, cardiac index, and stroke volume index, as well as echocardiographic measures of cardiac function. Methods In this placebo-controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Hemodynamic and echocardiographic parameters were assessed after 1 day, 3 days and 3 months of treatment. Results Baseline characteristics were not different in the empagliflozin (n = 22) and placebo (n = 20) group. Empagliflozin led to a significant increase in urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 h; day 1: 48.4 ± 34.7 g/24 h; p < 0.001) as well as urinary volume (1740 ± 601 mL/24 h to 2112 ± 837 mL/24 h; p = 0.011) already after one day compared to placebo. Treatment with empagliflozin had no effect on the primary endpoint of systemic vascular resistance index, nor on cardiac index, stroke volume index or pulse rate at any time point. In addition, echocardiography showed no difference in left ventricular systolic function as assessed by left ventricular ejections fraction and strain analysis. However, empagliflozin significantly improved left ventricular filling pressure as assessed by a reduction of early mitral inflow velocity relative to early diastolic left ventricular relaxation (E/eʹ) which became significant at day 1 of treatment (baseline: 9.2 ± 2.6; day 1: 8.5 ± 2.2; p = 0.005) and remained apparent throughout the study. This was primarily attributable to reduced early mitral inflow velocity E (baseline: 0.8 ± 0.2 m/s; day 1: 0.73 ± 0.2 m/sec; p = 0.003). Conclusions Empagliflozin treatment of patients with T2D has no significant effect on hemodynamic parameters after 1 or 3 days, nor after 3 months, but leads to rapid and sustained significant improvement of diastolic function. Trial registration EudraCT Number: 2016-000172-19; date of registration: 2017-02-20 (clinicaltrialregister.eu)

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Empagliflozin does not change cardiac index nor systemic vascular resistance but rapidly improves left ventricular filling pressure in patients with type 2 diabetes: a randomized controlled study

10.21203/rs.3.rs-45927/v2 ◽

2020 ◽

Author(s):

Matthias Rau ◽

Kirsten Thiele ◽

Niels-Ulrik Korbinian Hartmann ◽

Alexander Schuh ◽

Ertunc Altiok ◽

...

Keyword(s):

Cardiac Index ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Resistance Index ◽

Stroke Volume Index ◽

Left Ventricular ◽

Volume Index ◽

Hemodynamic Parameters ◽

Mitral Inflow ◽

Ventricular Filling Pressure

Abstract Background: In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients with type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of the HHF event curves within the first 3 months of the trial suggest that immediate hemodynamic effects may play a role. However, hitherto no data exist on early effects of SGLT2 inhibitors on hemodynamic parameters and cardiac function. Thus, this study examined early and delayed effects of empagliflozin treatment on hemodynamic parameters including systemic vascular resistance index, cardiac index, and stroke volume index, as well as echocardiographic measures of cardiac function.Methods: In this placebo-controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Hemodynamic and echocardiographic parameters were assessed after 1 day, 3 days and 3 months of treatment. Results: Baseline characteristics were not different in the empagliflozin (n=22) and placebo (n=20) group. Empagliflozin led to a significant increase in urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 hrs; day 1: 48.4 ± 34.7 g/24 hrs; p<0.001) as well as urinary volume (1740 ± 601 mL/24 hrs to 2112 ± 837 mL/24 hrs; p=0.011) already after one day compared to placebo. Treatment with empagliflozin had no effect on the primary endpoint of systemic vascular resistance index, nor on cardiac index, stroke volume index or pulse rate at any time point. In addition, echocardiography showed no difference in left ventricular systolic function as assessed by left ventricular ejections fraction and strain analysis. However, empagliflozin significantly improved left ventricular filling pressure as assessed by a reduction of early mitral inflow velocity relative to early diastolic left ventricular relaxation (E/e’) which became significant at day 1 of treatment (baseline: 9.2 ± 2.6; day 1: 8.5 ± 2.2; p=0.005) and remained apparent throughout the study. This was primarily attributable to reduced early mitral inflow velocity E (baseline: 0.8 ± 0.2 m/sec; day 1: 0.73 ± 0.2 m/sec; p=0.003). Conclusions: Empagliflozin treatment of patients with T2D has no significant effect on hemodynamic parameters after 1 or 3 days, nor after 3 months, but leads to rapid and sustained significant improvement of diastolic function.

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Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-021-00653-9 ◽

2021 ◽

Author(s):

Bernd Saugel ◽

Elisa-Johanna Bebert ◽

Luisa Briesenick ◽

Phillip Hoppe ◽

Gillis Greiwe ◽

...

Keyword(s):

Heart Rate ◽

Arterial Pressure ◽

Stroke Volume ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Resistance Index ◽

Stroke Volume Index ◽

Volume Index ◽

Systemic Vascular Resistance Index ◽

Anesthetic Induction

AbstractIt remains unclear whether reduced myocardial contractility, venous dilation with decreased venous return, or arterial dilation with reduced systemic vascular resistance contribute most to hypotension after induction of general anesthesia. We sought to assess the relative contribution of various hemodynamic mechanisms to hypotension after induction of general anesthesia with sufentanil, propofol, and rocuronium. In this prospective observational study, we continuously recorded hemodynamic variables during anesthetic induction using a finger-cuff method in 92 non-cardiac surgery patients. After sufentanil administration, there was no clinically important change in arterial pressure, but heart rate increased from baseline by 11 (99.89% confidence interval: 7 to 16) bpm (P < 0.001). After administration of propofol, mean arterial pressure decreased by 23 (17 to 28) mmHg and systemic vascular resistance index decreased by 565 (419 to 712) dyn*s*cm−5*m2 (P values < 0.001). Mean arterial pressure was < 65 mmHg in 27 patients (29%). After propofol administration, heart rate returned to baseline, and stroke volume index and cardiac index remained stable. After tracheal intubation, there were no clinically important differences compared to baseline in heart rate, stroke volume index, and cardiac index, but arterial pressure and systemic vascular resistance index remained markedly decreased. Anesthetic induction with sufentanil, propofol, and rocuronium reduced arterial pressure and systemic vascular resistance index. Heart rate, stroke volume index, and cardiac index remained stable. Post-induction hypotension therefore appears to result from arterial dilation with reduced systemic vascular resistance rather than venous dilation or reduced myocardial contractility.

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Anaesthetic Management of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC): A True Challenge To an Anaesthetist

Journal of Current Medical Research and Opinion ◽

10.15520/jcmro.v3i07.307 ◽

2020 ◽

Vol 3 (07) ◽

pp. 503-507

Author(s):

Dr. Roly Mishra ◽

Dr.Kritika Sharma ◽

Dr Jueeli Barpande ◽

Dr Nitu Kumari ◽

Dr. Hemant Mehta

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Perioperative Management ◽

Renal Toxicity ◽

Fluid Management ◽

Anaesthetic Management ◽

Major Surgery ◽

Poor Survival ◽

Arterial Blood

Patients diseased with gynecological malignancies were believed untreatable with poor survival chances till hyperthermic intraperitoneal chemotherapy after capital cytoreductive surgery came into existence. Perioperative management of this patient, for a major surgery like CRS/HIPEC is complex and challenging. Major perioperative concerns in these patients include anesthetic challenges intraoperative fluid management, maintaining mean arterial blood pressure, thermoregulation electrolyte imbalances, significant blood loss and fluid shifts and renal toxicity after chemotherapeutic drugs administration. We report a case of 66 year old female diagnosed with carcinoma ovary with moderate ascites posted for cytoreductive surgery and HIPEC.

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Reversal of hyperdynamic response to continuous endotoxin administration by inhibition of NO synthesis

Journal of Applied Physiology ◽

10.1152/jappl.1992.73.1.324 ◽

1992 ◽

Vol 73 (1) ◽

pp. 324-328 ◽

Cited By ~ 108

Author(s):

J. Meyer ◽

L. D. Traber ◽

S. Nelson ◽

C. W. Lentz ◽

H. Nakazawa ◽

...

Keyword(s):

Cardiac Output ◽

Mean Arterial Pressure ◽

Methyl Ester ◽

Arterial Pressure ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Resistance Index ◽

Volume Index ◽

Systemic Vascular Resistance Index ◽

Cardiovascular Performance

Septic shock is characterized by an increase in cardiac output and a fall in systemic vascular resistance index and mean arterial pressure. Endotoxin alters the smooth muscle function of blood vessels, probably by means of an increased production of the potent vasodilator nitric oxide (NO). The present study was accomplished to determine how the inhibition of NO synthesis influences cardiovascular performance in an ovine model of hyperdynamic endotoxemia. Endotoxemia was induced in five range ewes (41 +/- 2 kg) by continuous infusion of Escherichia coli endotoxin (LPS, 10 ng.kg-1.min-1) over the entire study period. After 24 h of LPS infusion, cardiac output increased from 5.2 +/- 0.3 to 7.9 +/- 0.6 (SE) 1/min (P less than 0.05) and mean arterial pressure and systemic vascular resistance index fell from 92 +/- 5 to 79 +/- 6 mmHg (P = 0.08) and from 1,473 +/- 173 to 824 +/- 108 dyn.s.cm-5.m2 (P less than 0.05), respectively. The pulmonary shunt fraction increased from 0.23 +/- 0.03 to 0.32 +/- 0.03 (P less than 0.05). The intravenous administration of the NO synthase inhibitor N omega-nitro-L-arginine methyl ester (25 mg/kg) 24 h after the start of the LPS infusion changed these values to approximately baseline levels over the subsequent 4 h. Although N omega-nitro-L-arginine methyl ester increased pulmonary arterial pressure and pulmonary vascular resistance (P less than 0.05), right and left ventricular stroke volume index showed no significant changes. It is concluded that NO has a major function in cardiovascular performance in endotoxemia.(ABSTRACT TRUNCATED AT 250 WORDS)

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The Cardiovascular Effects of Sevoflurane and Isoflurane After Premedication of Healthy Dogs Undergoing Elective Surgery

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5963 ◽

2014 ◽

Vol 50 (1) ◽

pp. 27-35 ◽

Cited By ~ 3

Author(s):

Janan M. Abed ◽

Fred S. Pike ◽

Monica C. Clare ◽

Benjamin M. Brainard

Keyword(s):

Blood Pressure ◽

Cardiac Output ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Surgical Procedure ◽

Resistance Index ◽

Cardiovascular Effects ◽

Arterial Catheter ◽

Arterial Blood ◽

Healthy Dogs

Sevoflurane and isoflurane are commonly used in veterinary anesthesia. The objective of this prospective, randomized, open-label clinical study was to compare the cardiovascular effects of sevoflurane and isoflurane via direct arterial blood pressure measurements and the lithium dilution cardiac output (LDCO) on premedicated healthy dogs undergoing elective tibial plateau leveling osteotomy (TPLO). Nineteen client-owned dogs were included. All dogs were premedicated with hydromorphone (0.05 mg/kg IV and glycopyrrolate 0.01 mg/kg subcutaneously). Ten dogs were anesthetized with sevoflurane and nine dogs were anesthetized with isoflurane. Eighteen dogs were instrumented with a dorsal pedal arterial catheter, and one dog had a femoral arterial catheter. All dogs had continuous, direct systolic (SAP), diastolic (DAP), and mean arterial (MAP) blood pressure readings as well as heart rate (HR), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), stroke volume variation (SVV), and pulse pressure variation (PPV) recorded q 5 min during the surgical procedure. There was no significant statistical difference in all parameters between the sevoflurane and isoflurane treatment groups. Both sevoflurane and isoflurane inhalant anesthetics appear to have similar hemodynamic effects when used as part of a multimodal anesthetic protocol in premedicated healthy dogs undergoing an elective surgical procedure.

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Sodium Nitropusside Induced Hypotension: Haemodynamic Response and dose Requirements during Propofol or Halothane Anaesthesia

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200206 ◽

1994 ◽

Vol 22 (2) ◽

pp. 155-160 ◽

Cited By ~ 6

Author(s):

M. Abdulatif

Keyword(s):

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Resistance Index ◽

Halothane Anaesthesia ◽

Middle Ear Surgery ◽

Induced Hypotension ◽

Arterial Blood ◽

Group I ◽

Reflex Tachycardia ◽

Oxygen Group

This study was designed to investigate the influence of anaesthesia induced and maintained with propofol on the haemodynamic effects and the dose requirements of SNP during the course of induced hypotension. Twenty-four adult ASA physical status I patients undergoing middle ear surgery were randomly assigned to receive anaesthesia with either morphine, thiopentone, d-tubocurarine, halothane 0.6% end-tidal and N2O 70% in oxygen (group I n=12), or morphine, propofol, d-tubocurarine, propofol infusion 108 μg. kg−1. min−1 and N2O in oxygen (group 2 n = 12). Mean arterial blood pressure (MAP) was reduced to 60-65 mmHg in all patients using a continuous infusion of sodium nitroprusside (SNP) 0.01%. Propofol produced a significant (17%) reduction in the MAP before institution of SNP infusion. This was related to a 24% reduction in the systemic vascular resistance index (SVRI). In the halothane group SVRI was significantly reduced during SNP infusion. Halothane anaesthesia was associated with significant reflex tachycardia in response to SNP induced hypotension. Eight patients in the halothane group (66%) required propranolol 0.5-3 mg to control tachycardia. Propofol anaesthesia attenuated significantly the reflex tachycardia in response to SNP induced hypotension. Two patients in the propofol group (16%) required 0.5 mg propranolol to control reflex tachycardia. The mean SNP dose requirements were 7.25 ± 1.6 and 2.1 ± 1.4 μg. kg−1.min−1 in the halothane and propofol groups, respectively (P < 0.0001). None of the patients in the two groups developed rebound hypertension following SNP withdrawal. It is concluded that propofol anaesthesia reduces significantly the dose requirements for SNP through attenuation of the homeostatic reflex increase in the heart rate and systemic vascular resistance.

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