Preoperative hemodynamic assessment in geriatric patients for elective surgery.

The aging process results in a significant attenuation of the reserve in organ function in normal man. For example, it is well established that cardiac output decreases with aging. Also the heart has decreased capacities to compensate for stress situations such as anesthesia and important surgery. In our study, we have evaluated the hemodynamic response after a blood volume expansion and dopamine administration in eighteen patients over 60 years of age. It should be of value in the assessment of cardiac performance in elderly patients, especially those with ASA physical classification III and before an anesthesia and surgery. Fluid administration resulted in an improvement of cardiac performance in fourteen patients (78%). Four patients (22%) had an increase of pulmonary capillary wedge pressure greater than 12 mmHg without amelioration of cardiac performance. Dopamine increased significantly cardiac index but only at a dose of 6 micrograms/kg/min and by increase of heart rate.

Reversible cardiac tamponade during prolonged parenteral feeding.

Cardiac tamponade caused by a central catheter is a potentially lethal and infrequent complication. Prompt diagnosis is necessary to decrease the high mortality rate. Cardiac catheterization with a Swan-Ganz catheter and echocardiography can rapidly establish the diagnosis.

Intracranial pressure changes in patients with head trauma during haemodialysis.

Intracranial hypertension and acute renal failure are frequent complications in polytraumatized patients with head trauma. This paper deals with the evolution of intracranial pressure during haemodialysis in two cases of traumatic coma. Significant changes in intracranial pressure were noted. Increase of intracranial pressure during haemodialysis was 7.6 mmHg for the first patient and 4.6 mmHg for the second patient. Prophylactic measures are discussed.