British Journal of Anaesthesia, Vol 82, Issue 1 97-103, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
N. Dalibon, S. Schlumberger, M. Saada, M. Fischler and B. Riou
We have compared the value of different variables used in the assessment of
blood loss during progressive hypovolaemia and resuscitation under general
anaesthesia in anaesthetized pigs. We measured mean arterial pressure
(MAP), pulmonary capillary wedge pressure (PCWP), the negative component of
the systolic arterial pressure variation (delta Down) and left ventricular
end-diastolic area (LVEDa) using echocardiography. Blood was progressively
withdrawn (up to 35 ml kg-1 in seven steps) and then reinfused after the
same pattern. Regression coefficient (r) and normalized slope (nS) of the
regression relationship between each variable and amount of blood loss were
determined. The difference between the withdrawal and reinfusion curves was
assessed by the area between the curves. We also estimated the minimal loss
of blood volume which induced significant changes in each variable compared
with that under control conditions during withdrawal of blood (minWBV) and
maximal loss in blood volume which induced no significant changes in a
variable compared with control conditions during retransfusion (maxRBV).
During haemorrhage, MAP decreased (from mean 74 (SD 9) to 31 (5) mm Hg; P
< 0.001), delta Down increased (from 1.2 (1.4) to 11.4 (4.2) mm Hg; P
< 0.001), PCWP decreased (from 6.2 (2.1) to 0.3 (1.0) mm Hg; P <
0.001) and LVEDa decreased (from 13.8 (2.0) to 5.1 (2.0) cm2; P < 0.01).
The highest r values were obtained with MAP and LVEDa, and the highest nS
value with delta Down. The least difference between withdrawal and
reinfusion was with LVEDa, the lowest values of minWBV were with PCWP and
LVEDa, and the highest value of maxRBV was obtained with PCWP. During
progressive haemorrhage under general anaesthesia, LVEDa was an accurate
variable for assessment of blood volume loss, delta Down contributed no
further information compared with MAP, and PCWP was the most reliable
variable for assessing return to baseline blood volume.
LABORATORY INVESTIGATIONS
Haemodynamic assessment of hypovolaemia under general anaesthesia in pigs submitted to graded haemorrhage and retransfusion
Departement d'Anesthesie-Reanimation, Centre Medico-Chirurgical Foch, Suresnes, France; Departement d'Anesthesie-Reanimation, Groupe Hospitalier Pitie-Salpetriere, Universite Paris VI, Paris, France
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