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Trendelenburg Position Is Helpful To Maintain Hemodynamic Stability in Abdominal Aortic Aneurysmectomy



Trendelenburg Position Is Helpful To Maintain Hemodynamic Stability in Abdominal Aortic Aneurysmectomy



Anesthesiology Abstracts of Scientific Papers Annual Meeting (2001): Abstract No A-231



(Introduction) One of the major concerns about the intraoperative management of abdominal aortic aneurysmectomy is to stabilize the hemodynamics following aortic unclamping. Sufficient fluid loading before unclamping is recommended to prevent hemodynamic alteration. However, positive fluid loading, in turn, may cause congestive heart failure after unclamping. Trendelenburg position is well known to facilitate venous return to the heart, however, no report about the application of this position is available. The aim of this study is to examine the idea that Trendelenburg position would be effective for stabilizing hemodynamics after unclamping. (Method) With institutional approval and informed consents, 18 patients (14 male and 4 female, aged 61-84 yr) undergoing infrarenal abdominal aneurysmectomy were randomly assigned into two groups; supine (control) and Trendelenburg position (TRE) groups. Anesthesia was induced with propofol and maintained with sevoflurane (1-3 %) plus 50 % nitrous oxide in oxygen. Radial artery and pulmonary artery were catheterized. Crystalloid solution was given at a rate of 10 ml/kg/h throughout the operation. The protocol comprised the additional colloid fluid loading (6 % hydroxyethyl starch solution) to maintain pulmonary artery occlusion pressure (PAOP) at approximately 11 mmHg during the period from aortic clamping to the suturing of distal aorta, and then at approximately 14 mmHg until unclamping. After unclamping PAOP was kept at approximately 11 mmHg until the end of operation. Trendelenburg position was taken after the start of the suturing distal aorta to 10 min after unclamping in TRE. Statistical comparisons of colloid fluid volume and hemodynamic parameters were analyzed by ANOVA with Bonferoni adjustment. (Result) There were no significant differences between the two groups of patients in characteristics, aortic cross clamping time, and administration of cell saver blood. In all procedure, colloid fluid administration was significant lower in head down group. At the end of operation, there were not significant differences between two groups in all hemodynamic parameters. (Conclusion) Combined use of conventional volume loading and Trendelenburg positioning provides simple and safety means to obtain stable hemodynamics after unclamping in abdominal aortic aneurysmectomy.

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