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GENERAL ARTICLES

Intravascular Fluid Administration and Hemodynamic Performance During Open Abdominal Surgery

Christer H. Svensén, MD, PhD, DEAA^*, Joel Olsson, MD, PhD, DEAA^*, and Robert G. Hahn, MD, PhD

From the *Department of Anesthesiology, University of Texas Medical Branch, Galveston; Karolinska Institute, Stockholm, Sweden.

Address correspondence and reprint requests to Christer H. Svensén, MD, PhD, DEAA, Department of Anesthesiology, 301 University Blvd, Galveston, TX 77555-0591. Address e-mail to chsvense{at}utmb.edu.

We studied whether central hemodynamics measured by a pulmonary artery catheter can serve as a pharmacodynamic expression of fluid therapy in 10 patients undergoing open abdominal surgery. We examined how closely hemodynamic variables follow plasma dilution, which is an index of plasma volume expansion, during and after an IV infusion of 25 mL/kg of lactated Ringer’s solution over 45 min. Pulmonary artery wedge pressure and central venous pressure responded to IV fluid with an increase that correlated with accompanying plasma dilution. Six of 10 patients showed a decrease in cardiac output that was probably secondary to an increase in peripheral vascular resistance (nonresponders), whereas the rest increased cardiac output (responders). Volume kinetic analysis suggested that 54% of the infused fluid resided in the central fluid space at the end of the infusion and 25% at the end of the study in the responders compared with 25% and 3%, respectively, in nonresponders. In conclusion, half of the patients undergoing open abdominal surgery responded to crystalloid fluid with a decrease in cardiac output. Pulmonary artery wedge pressure and central venous pressure responded more consistently to different degrees of plasma dilution, which can be simulated for various fluid regimens using volume kinetics.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999