Changes in mean systemic filling pressure as an estimate of hemodynamic response to anesthesia induction using propofol.
Cardiac output
General anesthesia
Mean systemic filling pressure
Propofol
Venous resistance
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
22 07 2022
22 07 2022
Historique:
received:
25
01
2022
accepted:
12
07
2022
entrez:
22
7
2022
pubmed:
23
7
2022
medline:
27
7
2022
Statut:
epublish
Résumé
Even a small change in the pressure gradient between the venous system and the right atrium can have significant hemodynamic effects. Mean systemic filling pressure (MSFP) is the driving force of the venous system. As a result, MSFP has a significant effect on cardiac output. We aimed to test the hypothesis that the hemodynamic instability during induction of general anesthesia by intravenous propofol administration is caused by changes in MSFP. We prospectively collected data from 15 patients undergoing major surgery requiring invasive hemodynamic monitoring. Hemodynamic parameters, including MSFP, were measured before and after propofol administration and following intubation, using venous return curves at a no-flow state induced by a pneumatic tourniquet. A significant decrease in MSFP was observed in all study patients after propofol administration (median (IQR) pressure 17 (9) mmHg compared with 25 (7) before propofol administration, p = 0.001). The pressure gradient for venous return (MSFP - central venous pressure; CVP) also decreased following propofol administration from 19 (8) to 12 (6) mmHg, p = 0.001. Central venous pressure did not change. These results support the hypothesis that induction of anesthesia with propofol causes a marked reduction in MSFP. A possible mechanism of propofol-induced hypotension is reduction in preload due to a decrease in the venous vasomotor tone.
Sections du résumé
BACKGROUND
Even a small change in the pressure gradient between the venous system and the right atrium can have significant hemodynamic effects. Mean systemic filling pressure (MSFP) is the driving force of the venous system. As a result, MSFP has a significant effect on cardiac output. We aimed to test the hypothesis that the hemodynamic instability during induction of general anesthesia by intravenous propofol administration is caused by changes in MSFP.
METHODS
We prospectively collected data from 15 patients undergoing major surgery requiring invasive hemodynamic monitoring. Hemodynamic parameters, including MSFP, were measured before and after propofol administration and following intubation, using venous return curves at a no-flow state induced by a pneumatic tourniquet.
RESULTS
A significant decrease in MSFP was observed in all study patients after propofol administration (median (IQR) pressure 17 (9) mmHg compared with 25 (7) before propofol administration, p = 0.001). The pressure gradient for venous return (MSFP - central venous pressure; CVP) also decreased following propofol administration from 19 (8) to 12 (6) mmHg, p = 0.001. Central venous pressure did not change.
CONCLUSIONS
These results support the hypothesis that induction of anesthesia with propofol causes a marked reduction in MSFP. A possible mechanism of propofol-induced hypotension is reduction in preload due to a decrease in the venous vasomotor tone.
Identifiants
pubmed: 35869445
doi: 10.1186/s12871-022-01773-8
pii: 10.1186/s12871-022-01773-8
pmc: PMC9306094
doi:
Substances chimiques
Anesthetics, Intravenous
0
Propofol
YI7VU623SF
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
234Informations de copyright
© 2022. The Author(s).
Références
Anesth Analg. 2005 Sep;101(3):622-628
pubmed: 16115962
Am J Physiol. 1954 Nov;179(2):261-7
pubmed: 13218155
Br J Anaesth. 2013 Mar;110(3):388-96
pubmed: 23166149
Br J Anaesth. 2015 Jan;114(1):163-4
pubmed: 25500400
J Clin Monit Comput. 2008 Dec;22(6):391-400
pubmed: 19002596
Anesth Analg. 1992 Mar;74(3):395-405
pubmed: 1539821
Br J Anaesth. 2016 Jun;116(6):784-9
pubmed: 27199311
J Appl Physiol (1985). 2017 Jun 1;122(6):1373-1378
pubmed: 28360123
J Intensive Care Med. 2003 Mar-Apr;18(2):92-9
pubmed: 15189655
Ann Intensive Care. 2018 Jun 20;8(1):73
pubmed: 29926230
Crit Care. 2015 Nov 23;19:411
pubmed: 26597901
Physiol Rev. 1955 Jan;35(1):123-9
pubmed: 14356924
Crit Care. 2016 Sep 10;20:271
pubmed: 27613307
Am Rev Respir Dis. 1992 Sep;146(3):688-93
pubmed: 1519849
Anesth Analg. 1993 Oct;77(4 Suppl):S21-9
pubmed: 8214693
Can J Physiol Pharmacol. 1987 Aug;65(8):1658-65
pubmed: 2825941
Anesth Analg. 1992 Jun;74(6):877-83
pubmed: 1595920
J Clin Anesth. 2005 Feb;17(1):36-43
pubmed: 15721728
Br J Anaesth. 2016 Jun;116(6):736-8
pubmed: 27199304
Anaesthesia. 2001 Mar;56(3):266-71
pubmed: 11251436
Anesthesiology. 2008 Apr;108(4):735-48
pubmed: 18362606