RESUMEN
OBJECTIVE: To validate a new system of continuous cardiac output monitoring. DESIGN: Multicenter, prospective, nonrandomized clinical study. SETTING: Four university hospitals. PATIENTS: Forty-seven adult intensive care unit patients. INTERVENTIONS: Pulmonary artery catheterization. MEASUREMENTS AND MAIN RESULTS: Continuous and bolus cardiac output measurements were obtained over 72 hrs. The 327 continuous cardiac output measurements compared favorably with bolus cardiac output measurements (bias = 0.12 L/min, precision = +/-0.84). The continuous cardiac measurement was not adversely affected by temperatures of <37 degrees C or >38 degrees C, high (>7.5 L/min) or low (<4.5 L/min) cardiac output values, or duration (72 hrs) of the study. CONCLUSIONS: This continuous cardiac output system provides a reliable estimate of cardiac output for clinical use if applied in conditions similar to this study. The combination of a continuous measure of cardiac output with other continuous physiologic monitoring (arterial and mixed venous oxygen saturation, oxygen consumption, etc.) may provide important information that no single parameter could achieve.
Asunto(s)
Gasto Cardíaco , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia/normas , Monitoreo Fisiológico/métodos , Arteria Pulmonar , Adolescente , Adulto , Velocidad del Flujo Sanguíneo , Temperatura Corporal , Enfermedades Cardiovasculares/fisiopatología , Enfermedad Crítica , Estudios de Evaluación como Asunto , Humanos , Unidades de Cuidados Intensivos , Monitoreo Fisiológico/instrumentación , Estudios Prospectivos , TermodiluciónAsunto(s)
Anestesia General/efectos adversos , Encéfalo/metabolismo , Oxígeno/metabolismo , Anestésicos/toxicidad , Animales , Presión Sanguínea/efectos de los fármacos , Encéfalo/efectos de los fármacos , Fenómenos Fisiológicos Cardiovasculares , Sistema Cardiovascular/efectos de los fármacos , Espectroscopía de Resonancia por Spin del Electrón/métodos , Halotano/toxicidad , Frecuencia Cardíaca/efectos de los fármacos , Indoles , Isoflurano/toxicidad , Ketamina/toxicidad , Masculino , Compuestos Organometálicos , Oximetría/métodos , Oxígeno/sangre , Pentobarbital/toxicidad , Ratas , Ratas Wistar , Fenómenos Fisiológicos Respiratorios , Sistema Respiratorio/efectos de los fármacos , Marcadores de Spin , Xilazina/toxicidadAsunto(s)
Anestesia Local , Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Ventilación del Oído Medio/métodos , Prilocaína/administración & dosificación , Niño , Preescolar , Combinación de Medicamentos , Honduras , Humanos , Lactante , Combinación Lidocaína y Prilocaína , Pomadas , Otitis Media con Derrame/cirugía , PuncionesRESUMEN
BACKGROUND. Compartment syndrome involving the lower extremity is a rare complication of surgical procedures that incorporate the lithotomy position. In patients who are at risk for this complication, the safety of using postoperative epidural anesthesia with local anesthetics has been questioned because of the difficulty in recognizing compartment syndrome with ongoing epidural blockade. RESULTS. The authors describe a case of lower extremity compartment syndrome that developed after a radical cystectomy with the patient in the lithotomy position. Prompt recognition occurred despite the use of epidural anesthesia with bupivacaine and fentanyl.
