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BJA Advance Access originally published online on December 10, 2004
British Journal of Anaesthesia 2005 94(3):292-295; doi:10.1093/bja/aei049
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004. All rights reserved. For Permissions, please e-mail: journal.permissions{at}oupjournals.org

Perioperative lower limb venous haemodynamics in patients under general anaesthesia{dagger}

A. L. Knaggs1,*, K. T. Delis3,4, P. Mason2 and K. Macleod1

Departments of 1 Anaesthesia and 2 Gynaecology, St Mary's Hospital, London, UK. 3 Mayo Clinic, Rochester, Minnesota, USA. 4 Faculty of Medicine, Imperial College, London, UK

* Corresponding author: Department of Anaesthesia, 4th Floor QEQM Wing, St Mary's Hospital, Paddington, Praed Street, London W2 1NY, UK. E-mail: akotow{at}aol.com

Background. This study prospectively determined the haemodynamic changes in the lower limb venous circulation during and shortly after elective abdominal surgery, performed under general anaesthesia.

Methods. Ten females, aged 36–65 yr, ASA I or II, undergoing total abdominal hysterectomy had their peak, mean and minimum velocities, diameter, volume flow and venous pulsatility (peak–minimum/mean velocity) measured in the left popliteal vein on recumbency with duplex at: (i) baseline, (ii) 15 min after induction, (iii) during surgery, and (iv) in recovery 30 min after extubation. Anaesthesia was induced with fentanyl and propofol, paralysis with vecuronium, maintenance with isoflurane in nitrous oxide 66%, and analgesia with morphine. Results are presented as percentage difference from baseline mean value. The Friedman and Wilcoxon[corrected*] tests were applied.

Results. Mean velocity decreased by 23.6% during surgery and by 34.6% in recovery (P<0.05*). Minimum velocity was decreased by 56% during surgery and by 78% in recovery (P<0.05). The volume flow decreased by 26% during surgery, and by 54.4% in recovery (P<0.001). Diameter and peak velocity changed little at surgery and recovery (P>0.2). In contrast, the pulsatility increased by 30% on induction, 83% on surgery and 109% in recovery (P<0.05). Compared with baseline, haemodynamic changes on induction were small (P>0.1*).

Conclusions. A significant decrease in the volume flow, mean and minimum velocities was noted during and immediately after elective total abdominal hysterectomy under general anaesthesia in ASA I and II patients. Flow changes in early recovery mirrored or enhanced those noted intraoperatively. Despite venous flow attenuation, haemodynamic readjustments produced a significant and progressive enhancement of venous flow pulsatility during the course of the procedure.

{dagger} This study was presented at the Anaesthetic Research Society, Middlesborough, July 2003.


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