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[Value of vasodilators in decreasing the afterload during infrarenal abdominal aorta cross-clamping]
Insights
Aortic cross-clamping (A. C. C.) can impair cardiac function. Pre-procedure vascular filling and nitroprusside (N. P.) infusion improved hemodynamics, a benefit maintained during A. C. C.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Aortic cross-clamping (A. C. C.) is associated with adverse hemodynamic effects.
- A. C. C. can lead to increased afterload, altered left ventricular function, and reduced cardiac index (C. I.).
Purpose of the Study:
- To evaluate the hemodynamic effects of nitroprusside (N. P.) infusion and vascular filling prior to A. C. C.
- To determine if these improvements can be maintained during A. C. C. below the renal arteries.
Main Methods:
- Prospective study of 15 patients undergoing surgery with A. C. C. below renal arteries.
- Hemodynamic monitoring using Swan-Ganz catheter, including pressures and cardiac output determinations.
- Administration of vascular filling and N. P. infusion before and during A. C. C.
Main Results:
- Vascular filling and N. P. infusion significantly improved C. I. (from 1.8 to 2.8 l/min/m2) and decreased peripheral vascular resistance (2,346 to 1,425 dyne/s/cm-5).
- Pulmonary capillary pressure, heart rate, and mean arterial pressure remained stable.
- Hemodynamic improvements were sustained throughout the A. C. C. period with adjusted N. P. infusion.
Conclusions:
- Pre-procedural optimization of hemodynamics with vascular filling and N. P. is effective in mitigating adverse effects of A. C. C.
- This strategy helps maintain improved cardiac function and stability during aortic cross-clamping.
Abstract:
Adverse effects of aortic crossclamping (A. C. C.) have been shown by a retrospective study and a literature review. A. C. C. results in increased afterload with ensuing left ventricular function alteration and low cardiac index (C. I.). 15 P. T. S. sustaining an operation with A. C. C. below the renal arteries were studied. A Swan-Ganz catheter was positioned with recording of pressures, including radial artery pressure and repeated cardiac output determinations. Prior to A. C. C., vascular filling and nitroprusside (N. P.) infusion improved hemodynamic conditions. Increase of C. I. (1.8 to 2.8 l/mm-1/m2) was observed with important decrease in peripheral vascular resistance (from 2,346 to 1,425 dyne/s-1/cm-5), pulmonary capillary pressure was lowered slightly and heart rate as well as mean arterial pressure remained stable. During A. C. C., rate of N. P. infusion was increased to maintain stable arterial pressure. Hemodynamic improvement observed prior to A. C. C. was maintained.