Fakhari Solmaz, Bilehjani Eissa, Farzin Haleh, Pourfathi Hojjat, Chalabianlou Mohsen
Cardiovascular Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Integr Blood Press Control. 2018 Jun 7;11:57-63. doi: 10.2147/IBPC.S126514. eCollection 2018.
Some cardiac patients do not tolerate the intravenous fluid load commonly administered before anesthesia induction. This study investigated preinduction passive leg-raising maneuver (PLRM) as an alternative method to fluid loading before cardiac anesthesia.
During a 6-month period, 120 adult elective heart surgery patients were enrolled in this study and allocated into 2 groups: PLRM group vs control group (n=60). Anesthesia was induced using midazolam, fentanyl, and cisatracurium. Initially, 250 mL of fluid was administrated intravenously in all of patients before anesthesia induction. Then in the PLRM group, PLRM was performed starting 2 minutes before anesthesia induction and continued for 20 minutes after tracheal intubation. In the control group, anesthesia was induced in a simple supine position. Heart rate, invasive mean arterial blood pressure (MAP), and central venous pressure (CVP) were recorded before PLRM, before anesthetic induction, before laryngoscopy, and at 5, 10, and 20 minutes after tracheal intubation. The hypotension episode rate (MAP <70 mmHg) and CVP changes were compared between the 2 groups. The predictive value of the ≥3 mmHg increase in CVP value in response to PLRM for hypotension prevention was defined.
Hypotension rates were lower in the PLRM group (63.3% vs 81.6%; -value 0.04), and MAP was higher among PLRM patients immediately before anesthetic injection, before laryngoscopy, and 20 minutes after intubation, compared to the control group. PLRM increased CVP by 3.57±4.9 mmHg (from 7.50±2.94 to 11.05±3.55 mmHg), which required several minutes to reach peak value, returning to baseline after 15 minutes. This change did not correlate to subsequent MAP changes; an increase in the CVP value ≥3 mmHg decreased the postinduction hypotension rate by 62.50%.
Preinduction PLRM can provide a more stable hemodynamic status in adult cardiac surgery patients and decreases anesthesia-induced hypotension rates by 62.50%. Rate of the changes in the CVP value caused by PLRM is not predictive of subsequent MAP changes.
一些心脏疾病患者无法耐受麻醉诱导前常规给予的静脉输液负荷。本研究调查了诱导前被动抬腿动作（PLRM）作为心脏麻醉前液体负荷替代方法的效果。
在6个月的时间里，120例择期进行心脏手术的成年患者纳入本研究并分为两组：PLRM组和对照组（n = 60）。使用咪达唑仑、芬太尼和顺式阿曲库铵诱导麻醉。最初，所有患者在麻醉诱导前静脉输注250 mL液体。然后在PLRM组中，从麻醉诱导前2分钟开始进行PLRM，并在气管插管后持续20分钟。在对照组中，在简单仰卧位诱导麻醉。记录PLRM前、麻醉诱导前、喉镜检查前以及气管插管后5、10和20分钟时的心率、有创平均动脉压（MAP）和中心静脉压（CVP）。比较两组的低血压发作率（MAP < 70 mmHg）和CVP变化。定义了PLRM后CVP值升高≥3 mmHg对预防低血压的预测价值。
PLRM组的低血压发生率较低（63.3%对81.6%；P值0.04），与对照组相比，PLRM组患者在麻醉注射前、喉镜检查前和插管后20分钟时的MAP较高。PLRM使CVP升高3.57±4.9 mmHg（从7.50±2.94升高至11.05±3.55 mmHg），达到峰值需要几分钟，15分钟后恢复至基线。这种变化与随后的MAP变化无关；CVP值升高≥3 mmHg可使诱导后低血压发生率降低62.50%。
诱导前PLRM可为成年心脏手术患者提供更稳定的血流动力学状态，并使麻醉诱导低血压发生率降低62.50%。PLRM引起CVP值变化的速率不能预测随后的MAP变化。
