Evaluation of Transesophagel Dopppler Effect on the Inotropic Use in Cardiac Surgery
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- Category: Vol. 85, September 2017
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Evaluation of Transesophagel Dopppler Effect on the Inotropic Use in Cardiac Surgery, RANDAH A. ZAIN EL-DIN, MOHAMED A. EL-ASHERY and GHADA A. KAZAMEL
Abstract
Background: Adequacy of Cardiac output (CO), is judged by its adequacy to maintain organ perfusion. Because CO is affected by many factors. Normalizing those factors with or without inotrope will result in optimum CO. While the use of inotrope alone will only increase contractility and blood pressure.
Objective: To evaluate the efficacy of transesophageal Doppler as a monitor on intropic use.
Material and Methods: Between March 2014 and Novem-ber 2015, 80 CABG patients were submitted to the study divided into 2 equal groups group (Group 1) were transesoph-ageal Doppler was used to measure CO, SVR, SV and man-aged to reach an acceptable CO. And patients in Group (2) were only clinical data BP, heart rate, CVP, urine output were used to reach the desired CO. The use of inotrope, type, duration, and dose to go out of bypass were observed in both groups, also the post-operative ventilation period, ICU length of stay.
Results: 27 patients of Group (1) and 25 from Group (2) had mean blood pressure less than 60mmHg. 11 patients from Group (1) restored their mean pressure by volume infusion and nitroglycerine adjustment only. 12 patients needed nore-pinephrine, and only 10 patients needed epinephrine. While 22 patients from Group (2) used epinephrine (p<0.001) and only 5 patients used norepinephrine (p<0.05). Adjusting the SVR and fluid volume restored blood pressure and CO in 89% of hypotensive cases in Group (1). While 94% of cases restored their CO by epinephrine in Group (2).
Conclusion: The use of transesophageal Doppler to mea-sure cardiac output SVR and SV, significantly decreased the use of inotrope and regulated the anesthesiologists choice of inotropes and vasoactive drugs to more specific and precise drugs.