J Dent Anesth Pain Med.  2019 Dec;19(6):353-360. 10.17245/jdapm.2019.19.6.353.

Efficacy of minimal invasive cardiac output and ScVOâ‚‚ monitoring during controlled hypotension for double-jaw surgery

• Kim S
• Song J
• Ji S
• Kwon MA
• Nam D

• KMID: 2466650
• DOI: http://doi.org/10.17245/jdapm.2019.19.6.353

Abstract

BACKGROUND
Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH.
METHODS
We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared.
RESULTS
Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits.
CONCLUSION
The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.

Keyword

Cardiac Output; Controlled Hypotension; Osteotomy, Le Fort; Remifentanil

MeSH Terms

Anemia
Anesthesia, General
Arterial Pressure
Blood Pressure
Cardiac Output*
Catheters
Erythrocyte Transfusion
Humans
Hypotension, Controlled*
Medical Records
Operative Time
Orthognathic Surgery
Osteotomy, Le Fort
Oxygen
Retrospective Studies
Vascular Access Devices
Oxygen

Figure

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  Fig. 1 Flow chart of the included cases. CH: controlled hypotension, N: number of patients, MBP: mean arterial blood pressure

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  Fig. 2 Scatter plot with regression line between preoperative hemoglobin and packed red blood cells transfusion.

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