Central blood volume: maintenance of cardiac output and blood - - PowerPoint PPT Presentation

▶
central blood volume maintenance of cardiac output and
SMART_READER_LITE
LIVE PREVIEW

Central blood volume: maintenance of cardiac output and blood - - PowerPoint PPT Presentation

Jan 13, 2023 160 likes •714 views

Central blood volume: maintenance of cardiac output and blood pressure during surgery Niels H. Secher Department of Anaesthesia Rigshospitalet The Copenhagen Muscle research center University of Copenhagen Department of Anesthesia,

slide-1
SLIDE 1
  • Department
  • f

Anesthesia, Rigshospital

Central blood volume: maintenance of cardiac output and blood pressure during surgery

Niels H. Secher

Department of Anaesthesia Rigshospitalet The Copenhagen Muscle research center University of Copenhagen

slide-2
SLIDE 2

The ether dome (Anesthesi 1846)

slide-3
SLIDE 3

Operation Theatre

slide-4
SLIDE 4

Anesthesia spread rapidly

  • First anesthesia in Denmark 1847
  • But the death rate was approximately 5% until

1950

  • At our part of the RH we conduct app. 6000

procedures meaning that we should experience an anesthesia-rated death almost every day

  • Anesthesiologists are not hired to provide

anesthesia, but to maintain ventilation

  • Death is now related to circular problems rather

than to handling of the ventilation

slide-5
SLIDE 5

Department of Anesthesia, Rigshospitalet

(Ruptured aortic aneurysm) What is the volume deficit?

slide-6
SLIDE 6

(Cholera victim)

slide-7
SLIDE 7

Department of Anesthesia, Rigshospitalet

slide-8
SLIDE 8

Department of Rheumatology, Rigshospitalet

slide-9
SLIDE 9

Department of Anesthesia, Rigshospitalet

Wiggers 1950

Irreversible chock

slide-10
SLIDE 10

19 year old dead in the dentist’s chair

Department of Anesthesia, Rigshospitalet

slide-11
SLIDE 11

Inferior calval vein diameter during HUT and HDT

Department of Rheumatology, Rigshospitalet

HUT: 1.2 cm2 Supine: 1.7 cm2 HDT: 2.2 cm2

slide-12
SLIDE 12

William Harvey discovered that blood is circulating

But we measure typically

  • Heart rate and
  • Blood pressure
slide-13
SLIDE 13

Hjertefrekvens og blodtryk under anæstesi

slide-14
SLIDE 14

Department of Anesthesia, Rigshospitalet

Sander-Jensen et al. 1986.

Cardiaovacular Variables During Hypovolemic shock

slide-15
SLIDE 15
slide-16
SLIDE 16

Hjertemassage

slide-17
SLIDE 17

Department of Anesthesia, Rigshospitalet

Jacobsen & Secher 1992

HR response to hemorrhage

slide-18
SLIDE 18

Department of Anesthesia, Rigshospitalet

Ogoh et al. 2004

The barorecptors do not work during a vasovagal episode

slide-19
SLIDE 19

Department of Rheumatology, Rigshospitalet

Ernest Starling Otto Frank

slide-20
SLIDE 20

Krogh & Lindhard

slide-21
SLIDE 21

Department of Anesthesia, Rigshospitalet

slide-22
SLIDE 22

Department of Anesthesia, Rigshospitalet

R2 = 0,93 R2 = 0,97

  • 60
  • 50
  • 40
  • 30
  • 20
  • 10

10 20

  • 90
  • 60
  • 30

30 60 90 HUT / HDT [degrees] dSV <30 y.o. dSV >30 y.o.

Bundgaard-Nielsen et al. 2009

Cardiac stroke volume decreases with filling of the heart

slide-23
SLIDE 23

J.J. Van Lieshout University of Amsterdam

slide-24
SLIDE 24

Department of Rheumatology, Rigshospitalet

Jans: Acta Anaesthesiol Scand.52:536-40 (2008)

How much fluid? Define normovolæmia !

slide-25
SLIDE 25

Department of Anesthesia, Rigshospitalet

Harms et al 2003

slide-26
SLIDE 26

Registrering af hjernens oxygenering med nær infrarød spektroskopi (NIRS)

slide-27
SLIDE 27

Tollund et al. 2009

Department of Anesthesia, Rigshospitalet

The heart is filled when SvO2 reaches a maximal value

slide-28
SLIDE 28

TI2.5 (Ohm)

  • 2

2 4 TI90 (Ohm)

  • 2

2 4 HR (beats min-1) 75 100 125 MAP (mm Hg) 40 60 80 Volume deficit (ml kg-1)

  • 25
  • 20
  • 15
  • 10
  • 5

5 CO (l min-1) 2 4

Krantz et al. Acta Anaest Scand 44:598-604 (2000) rho

  • 0,97
  • 0,98
  • 0,59

0,70 0,57

Department of Anesthesia, Rigshospitalet

TI reflects chances in blood volume accurately

slide-29
SLIDE 29

Department of Anesthesia, Rigshospitalet

Cai et al. 2002

slide-30
SLIDE 30
slide-31
SLIDE 31

y = 8,8565x - 8,7409 R² = 0,8813 y = -8,1954x - 22,618 R² = 0,5442 5 10 15 20 25 30

  • 6
  • 4
  • 2

2 4

CO (l/min) CVP (mmHg)

Rowing Running Lineær (Running)

slide-32
SLIDE 32

y = 21,891ln(x) - 86,804 R² = 0,9471 y = 35,542ln(x) - 140,29 R² = 0,9414 5 10 15 20 25 30 60 70 80 90 100 110 120 130 140 150 160

CO (l/min) Plasma ANP (pg/ml)

slide-33
SLIDE 33

Pro-atrial natriuretic peptide ProANP in relation to intraoperative blood loss and fluid balance.

Kirsten C Rasmussen et al. BMJ Open 2016;6:e010323

slide-34
SLIDE 34

Department of Rheumatology, Rigshospitalet

slide-35
SLIDE 35

The RH-test

slide-36
SLIDE 36

Department of Anesthesia, Rigshospitalet

Individual goal directed fluid volume therapy and postoperative outcome (M Bundgaard-Nielsen)

  • Review of 9 (10) randomized studies (877 patients)
  • Abdominal, orthopedic, gynecological, urological, and

cardiac surgery

  • Intra- or early post-operative individualized fluid

”optimization”

  • Hospital stay
  • PONV
  • Complications
  • Ileus
slide-37
SLIDE 37
slide-38
SLIDE 38

Department of Rheumatology, Rigshospitalet

slide-39
SLIDE 39

Department of Rheumatology, Rigshospitalet

slide-40
SLIDE 40
slide-41
SLIDE 41
slide-42
SLIDE 42

Central blood volume

  • How to define CBV
  • How to monitor CBV
slide-43
SLIDE 43

August og Marie Krogh

slide-44
SLIDE 44

Department of Anesthesia, Rigshospitalet

Kety-Schmidt method for “global” CBF: a measure of internal jugular venous flow

slide-45
SLIDE 45

Department of Anesthesia, Rigshospitalet

slide-46
SLIDE 46

Birgitte Hanel finds reduced CBV after exercise by pulmonary diffusion capacity

slide-47
SLIDE 47
  • Department of Anesthesia, Rigshospitalet

Clinical evaluation of cerebral blood flow Dubrovnik 2017

Niels H. Secher

Department of Anaesthesia Rigshospitalet The Copenhagen Muscle research center University of Copenhagen

slide-48
SLIDE 48

Alternative evaluation of CBV

  • Pulmonary diffusion capacity
  • Thoracic electrical impedance
  • Echocardiography
  • Monitoring plasma atrial natiuretic

peptide

slide-49
SLIDE 49

Department of Anesthesia, Rigshospitalet

Cai et al. 2002

TI predicts Hypotension during dialysis

slide-50
SLIDE 50

Department of Anesthesia, Rigshospitalet

N A Lassen

Brain function and blood flow. Lassen NA, Ingvar DH, Skinhøj E.

Regional CBF increases during exercise but not after regional anaesthesia

slide-51
SLIDE 51

Cerebral autoregulation

slide-52
SLIDE 52

Secure filling of the heart before other interventions are considered

slide-53
SLIDE 53
slide-54
SLIDE 54

Arnold Mærsk Mc-Kinney Møller 13 July 1913 Hellerup, Denmark son of a Danish father, Arnold Peter Møller, founder of the A.P. Moller – Maersk Group, and an American mother, Chastine Estelle Roberta (née McKinney) Møller. Died 16 April 2012 (aged 98)