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Continuous oesophageal aortic blood flow echo-Doppler measurement during general anaesthesia in infants

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Abstract

Purpose

Invasive haemodynamic monitoring during general anaesthesia in infants is usually limited to very high risk operations, such as cardiac surgery Nevertheless, different surgical procedures and/or anaesthetic techniques justify additional monitoring for children, as for adults. The aim of this preliminary study was to evaluate the feasibility of using a new echo-Doppler device (Dynemo 3000®) capable of measuring continuous aortic blood flow during general anaesthesia in infants.

Methods

Aortic blood flow (ABF) was measured with a small oesophageal probe designed for newborns and infants. The aortic flowmeter was connected with satellite devices to visualise the haemodynamic profile which included ABE pre-ejection period (PEPi), left ventricular ejection time (LVETi), mean artenal pressure, heart rate, stroke volume and systemic vascular resistance. Twelve infants, aged 8–26 mo, undergoing surgery under general anaesthesia were successively included in the evaluation of this device. Isoflurane (1 % end-expired concentration) was introduced to maintain anaesthesia after induction with halothane, midazolam, fentanyl and atracurium.

Results

Correct positioning of the probe was easily obtained in all cases and the recording quality was excellent, whatever the operative position. Recordings of haemodynamic data showed some myocardial depression from isoflurane: decreased ABF (indexed to body surface area) and lengthened PEP/LVET (2.24 ± 0.53 L · min−1 · m−2 and 0.32 ± 0.05 respectively, before introduction of isoflurane and 1.71 ± 0.53 L · min−1 · m−2 (P = 0.027) and 0.39 ± 0.06 (P ± 0.007) with isoflurane).

Conclusion

These preliminary results suggest that this continuous ABF echo Doppler device may be valuable for pen anaesthetic monitonng in infants.

Résumé

Objectif

La surveillance per-anesthésique de la fonction cardiovasculaire par méthode invasive est exceptionnelle chez les nourrissons, et se limite généralement à des indications chirurgicales à très haut nsque, telle que la chirurgie cardiaque. Pourtant, différentes situations per-opératoires et/ou anesthésiques justifieraient parfois une surveillance renforcée chez le nournsson, comme chez l’adulte. Le but de cette étude préliminaire est d’évaluer la faisabilité d’une nouvelle méthode de mesure continue du débit aortique (DA) au couis de l’anesthésie générale des nourrissons.

Méthodes

Un débitmètre aortique (Dynémo 3000®) perinet grâce à une sonde oesophagienne pédiatrique écho-Doppler de petit calibre, de déterminer en continu le DA, le volume d’éjection systolique, les résistances vasculaires systémiques et les périodes de pré-éjection (PEPi) et d’éjection du ventricule gauche (LVETi). Douze enfants. de 8 à 26 mois, subissant une intervention chirurgicale sous anesthésie générale ont été successivement inclus. L’induction anesthésique a été réalisée par halothane, midazolam, fentanyl et atracunum et l’entretien par isoflurane (fraction téléexpiratoire = 1%).

Résultats

La mise en place de la sonde oesophagienne écho-Doppler a été aisée dans tous les cas. Les enregistrements simultanés du diamètre et du flux aortiques ont été d’excellente qualité, quelle que sort la position opératoire. Lenregistrement des données hémodynamiques montre un effet dépresseur myocardique de l’isoflurane: baisse significative du DA (indexé à la surface corporelle) et allongement du rapport PEP/LVET (2.24 ± 0.53 L · min−1 · m−2 et 0, 32 ± 0,05, respectivement avant l’introduction de l’ isoflurane et 1, 71 ± 0, 53 L · min−1 · m−2 (P =0, 027) et 0, 39 ± 0, 06 (P = 0, 007) sous isoflurane).

Conclusion

Ces résultats préliminaires suggèrent que l’enregistrement continu du DA par voie oesophagienne peut être précieux pour renforcer la surveillance per-anesthésique des nourrissons.

References

  1. 1

    Damen J, Wever JEAT. The use of balloon-tipped pulmonary artery catheters in children undergoing cardiac surgery. Intensive Care Med 1987; 13: 266–72.

  2. 2

    Alverson DC, Eldridge M, Dillon T, Yabek SM, Berman W Jr. Noninvasive pulsed Doppler determination of cardiac output in neonates and children. J Pediatr 1982; 101: 46–50.

  3. 3

    Walther FJ, Siassi B, Ramadan NA, Ananda AK, Wu PYK. Pulsed Doppler determinations of cardiac output in neonates: normal standards for clinical use. Pediatrics 1985; 76: 829–33.

  4. 4

    Payen D, Ecoffey C, Carli P, Dubousset A-M. Pulsed Doppler ascending aorta, carotid, brachial, and femoral artery blood flows during caudal anesthesia in infants. Anesthesiology 1987; 67: 681–5.

  5. 5

    Daigle RE, Miller CW, Histand MB, McLeod FD, Hokanson DE. Nontraumatic aortic blood flow sensing by use of an ultrasonic esophageal probe. J Appl Physiol 1975; 38: 1153–60.

  6. 6

    Cathignol D, Fourcade C. Sonde intracorporelle ultrasonore. Brevet INSERM no 78-14494.

  7. 7

    Lavandier B, Cathignol D, Muchada R, Bui Xuan B, Motin J. Noninvasive aortic blood flow measurement using an intraesophageal probe. Ultrasound Med Biol 1985; 11: 451–60.

  8. 8

    Muchada R, Lavandier B, Cathignol D, et al. Non invasive haemodynamic monitoring in gynaecological laparoscopy. (French) Ann Fr Anesth Reanim 1986; 5: 14–7.

  9. 9

    Muchada R, Cathignol D, Lavandier B, Lamazou J, Haro D. Aortic blood flow measurement. American Journal of Noninvasive Cardiology 1988; 2: 24–31.

  10. 10

    Muchada R, Cathignol D. Esophageal measurment of aortic blood flow by echo-Doppler.In: Vincent JL (Ed.). Update in Intensive Care and Emergency Medicine. Berlin: Springer Verlag, 1987: 356–65.

  11. 11

    Gueugniaud FT, Caritat R, Barreiro G, Muchada R, Bertin-Maghit M, Petit P. Noninvasive haemodynamic monitoring for burnt patients: feasibility and usefulness of aortic blood flow measurement. (French) Réanimation Urgences 1993; 2: 533–8.

  12. 12

    Gueugniaud FT, Muchada R, Bertin-Maghit M, Griffith N, Petit P. Non invasive continuous haemodynamic and PETCO2 monitoring during peroperative cardiac arrest. Can J Anaesth 1995; 42: 910–3.

  13. 13

    Muchada R, Vernier F, Fady J-F, Haro D, Lavandier B, Cathignol D. A new automatic measurement method of systolic time intervals (STI). J Cardiothorac Vasc Anesth 1992; 6 (Suppl 1): 22.

  14. 14

    Weissler AM, Harris WS Schoenfeld CD. Systolic time intervals in heart failure in man. Circulation 1968; 37: 149–56.

  15. 15

    Wolf WJ, Neal MB, Peterson MD. The hemodynamic and cardiovascular effects of isoflurane and halothane anesthesia in children. Anesthesiology 1986; 64: 328–33.

  16. 16

    Gentles TL, Rosenfeld HM, Sanders SP, Laussen PC, Burke RP, van der VeldeME. Pediatric biplane transesophageal echocardiography: preliminary experience. Am Heart J 1994; 128: 1225–33.

  17. 17

    Lam J, Neirotti RA, Cubbers WJ, et al. Usefulness of biplane transoesophageal echocardiography in neonates, infants and children with congenital heart disease. Am J Cardiol 1993; 72: 699–706.

  18. 18

    Mark JB, Steinbrook RA, Gugino LD, et al. Continuous noninvasive monitoring of cardiac output with esophageal Doppler ultrasound during cardiac surgery. Anesth Analg 1986; 65: 1013–20.

  19. 19

    Espersen K, Jensen EW, Rosenborg D, et al. Comparison of cardiac output measurement techniques: thermodilution, Doppler, CO2-rebreathing and the direct Fick method. Acta Anaesthesiol Scand 1995; 39: 245–51.

  20. 20

    Lavandier B, Muchada R, Chignier E, Fady JF, Birer A, Cathignol D. Assessment of a potentially noninvasive method for monitoring aortic blood flow in children. Ultrasound Med Biol 1991; 17: 107–16.

  21. 21

    Muchada R, Rinaldi A, Cathignol D. Non invasive cardiovascular monitoring during general anaesthesia. (Italian) Minerva Anestesiol 1990; 56: 199–205.

  22. 22

    Muchada R, Cathignol D. Fontaine B, Lavandier B. Will morphometric data permit the determination of thoracic aorta caliber for precise measurement of blood flow in adults? (French) JEMU 1990; 11: 76–80.

  23. 23

    Muchada R, Rinaldi A, Lavandier B, Cathignol D. Transesophageal Doppler ultrasound in children: importance of aortic diameter evaluation audits changes for the evaluation of aortic output. (Italian) Minerva Anestesiol 1992; 58: 347–53.

  24. 24

    Boudoulas H. Systolic time intervals. Eur Heart J 1990; 11(Suppl 1): 93–104.

  25. 25

    Brunel D, Muchada R. Evaluation of tissue perfusion by simultaneous monitoring of aortic flow rate and capnography. (French) Presse Med 1991; 20: 1665–6.

  26. 26

    Gueugniaud PY, Tournadre JP, Muchada R, Bertin-Maghit M, Petit P. Intérêt de la perfusion de dobutamine pour traiter la dépression myocardique sous anesthésie générale diagnostiquée par la surveillance hémodynamique non invasive. Ann Fr Anesth Réanim 1995; 14: R32.

  27. 27

    Tournadre JP, Moulaire V, Barreiro G, Brunei D, Van StrafenV, Muchada R. Simultaneous monitoring of noninvasive hemodynamic profile and capnography for tissue perfusion evaluation. J Anesth 1994; 8: 400–5.

  28. 28

    Muchada R, Rinaldi A. Haemodynamic and PETCO2 variations during laparoscopic cholecystectomy.In: Gullo A (Ed.). Anaesthesia, Pain, Intensive Care and Emergency medicine (APICE). Trieste: Fogliazza, 1994: 539–54.

  29. 29

    Gueugniaud PY, Bertin-Maghit M, Petit P, Muchada R. Diagnosis of circulatory arrest from carbon dioxide embolism with aortic blood flow and capnogram monitoring during laparoscopic cholecystectomy. (French) Ann Fr Anesth Réanim 1995; 14: 417–20.

  30. 30

    Abrams JH, Weber RE, Holmen KD. Continuous cardiac output determination using transtracheal Doppler: initial results in humans. Anesthesiology 1989; 71: 11–5.

  31. 31

    Peterson RJ, Kissoon N, Bayne EJ, Marvin WJ Jr, Murphy SP, Ceithaml EL. Transtracheal Doppler in infants and small children following surgery for congenital heart disease: rational use of an improved technology. Crit Care Med 1994; 22: 1294–300.

  32. 32

    Trang TTH, Tibballs J, Mercier J-C, Beaufils F. Optimization of oxygen transport in mechanically ventilated newborns using oximetry and pulsed Dopplerderived cardiac output. Crit Care Med 1988; 16: 1094–7.

  33. 33

    Seear MD, D’Orsogna L, Sandor GGS, De SouzaE, Popov R. Doppler-derived mean aortic flow velocity in children: an alternative to cardiac index. Pediatr Cardiol 1991; 12: 197–200.

  34. 34

    Seear M, Webber S, Leblanc J. Descending aortic blood flow velocity as a noninvasive measure of cardiac output in children. Pediatr Cardiol 1994; 15: 178–83.

  35. 35

    Weissler AM. Current concepts in cardiology. Systolictime intervals. N Engl J Med 1977; 296: 321–4.

  36. 36

    Piriou V, Muchada R, Tournadre JP. End tidal CO2 et débit aortique. Ann Fr Anesth Réanim 1995; 14: R31.

  37. 37

    Gueugniaud PY, Muchada R, Moussa M, Petit P. Noninvasive hemodynamic monitoring during general anesthesia in infants: interest of a continuous aortic blood flow echo-Doppler measurement. Anesthesiology 1995;83: A1160.

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Correspondence to Pierre-Yves Gueugniaud.

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Gueugniaud, P., Muchada, R., Moussa, M. et al. Continuous oesophageal aortic blood flow echo-Doppler measurement during general anaesthesia in infants. Can J Anaesth 44, 745–750 (1997). https://doi.org/10.1007/BF03013390

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Keywords

  • Isoflurane
  • Mean Arterial Pressure
  • Systemic Vascular Resistance
  • Atracurium
  • Systolic Time Interval