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Comparison of the Efficacy of Continuous Cardiac Output Swan-Ganz-Catheter, Pulse Contour Analysis and Transesophageal Echocardiography during OPCAB Surgery



Comparison of the Efficacy of Continuous Cardiac Output Swan-Ganz-Catheter, Pulse Contour Analysis and Transesophageal Echocardiography during OPCAB Surgery



Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-216



Introduction: To this date it remains unclear how the rapid hemodynamic changes that occur during off-pump-coronary-artery-bypass (OPCAB) surgery should best be monitored to optimize cardiac performance (1). It is current clinical practice to monitor OPCAB patients with pulmonary artery catherization (PAC) to assess cardiac output. However, a PAC can induce relevant side effects, such as dysrhythmia. Therefore, we compared the continuous cardiac output (CCO) Swan-Ganz-catheter, pulse contour analysis (PiCCO) and transesophageal echocardiography (TEE) with respect to their usefulness for dynamic evaluation of hemodynamic changes during OPCAB surgery. Methods: Following IRB approval and written informed consent 15 patients (60+-8 yrs) undergoing single-vessel revascularization (LIMA-LAD) were enrolled in this prospective study. Following premedication with midazolam and clonidine, anesthesia was conducted as total intravenous anesthesia using sufentanil, propofol and pancuronium. Apart from standard monitoring all patients were equipped with a CCO-catheter, a PiCCO-catheter and a TEE probe. Hemodynamic parameters including heart rate (HR), mean arterial blood pressure (MAP), systematic vascular resistance, PCWP and cardiac output were recorded at six defined measuring points during the procedure (Table 1). Data are shown as mean and standard deviation; statistical analysis was performed using the Kruskal-Wallis-test, Greenhouse-Geisser-test and Spearman-Rho-correlation (p<0.05). Results: We experienced no problems with maintaining hemodynamic stability in all 15 patients. Correlation for cardiac output was 0.7 between CCO and TEE, 0.75 between CCO and PiCCO and 0.92 between PiCCO and TEE. Data are shown in Table 1.

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