Muthachen Nilima R, Sethuraman Manikandan
Anaesthesiology, St John's Medical College Hospital, Bangalore, IND.
Neuroanesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, IND.
Cureus. 2025 Aug 6;17(8):e89516. doi: 10.7759/cureus.89516. eCollection 2025 Aug.
Maintaining hemodynamic stability during the perioperative period of major neurosurgical procedures is of paramount importance. A major challenge for anesthesiologists during hemodynamic fluctuations is identifying the underlying cause to guide appropriate therapy. Limited literature is available on the utility of transesophageal echocardiography (TEE) during hemodynamic fluctuations in major neurosurgery. We prospectively investigated the role of TEE-derived measures of preload, myocardial contractility, and afterload to evaluate the causes of hemodynamic instability during neurosurgery.
Sixty-three adult patients (American Society of Anesthesiologists (ASA) risk grades 1 and 2) undergoing elective neurosurgical procedures in Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, India, were included. An episode of significant hemodynamic instability was defined as a change of ±20% of either heart rate or blood pressure or both from the baseline. During each episode, TEE was used to identify changes in preload, myocardial contractility, and afterload, and these data were used to ascertain the cause of hemodynamic instability. For each of the variables, i.e., heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure (MAP), a chi-square test was used to assess significant changes in the TEE variables measured between those with significant changes and those without. A p-value of <0.05 was taken as statistically significant.
A total of 137 episodes of significant changes in heart rate and blood pressure were observed. Bradycardia was associated with improved preload variables. Tachycardia was associated with increased stroke volume variation (SVV), superior vena cava collapsibility index (SVC-CI), increased myocardial contractility, increased cardiac output (CO), reduced stroke volume (SV), and increased systemic vascular resistance (SVR). A decrease in SBP was associated with a decrease in preload indices. An increase in SBP showed a significant increase in SVR. A decrease in MAP was associated with preserved SVC-CI, but a significant reduction in CO. An increase in MAP was associated with a significant reduction in SV and an increase in SVR.
By integrating TEE measures of preload, afterload, and contractility, we gain better insight into the clinical context, which enables us to respond effectively and target therapy appropriately during the perioperative period.
在重大神经外科手术的围手术期维持血流动力学稳定至关重要。在血流动力学波动期间，麻醉医生面临的一个主要挑战是确定潜在原因以指导适当的治疗。关于经食管超声心动图（TEE）在重大神经外科手术血流动力学波动期间的应用，现有文献有限。我们前瞻性地研究了TEE得出的前负荷、心肌收缩力和后负荷测量值在评估神经外科手术期间血流动力学不稳定原因方面的作用。
纳入了在印度特里凡得琅市斯里奇特拉蒂鲁纳尔医学科学与技术研究所（SCTIMST）接受择期神经外科手术的63例成年患者（美国麻醉医师协会（ASA）风险等级为1和2）。显著血流动力学不稳定发作定义为心率或血压或两者较基线变化±20%。在每次发作期间，使用TEE识别前负荷、心肌收缩力和后负荷的变化，这些数据用于确定血流动力学不稳定的原因。对于每个变量，即心率（HR）、收缩压（SBP）和平均动脉压（MAP），使用卡方检验评估在有显著变化者和无显著变化者之间测量的TEE变量的显著变化。p值<0.05被视为具有统计学意义。
共观察到137次心率和血压的显著变化发作。心动过缓与前负荷变量改善相关。心动过速与每搏量变异（SVV）增加、上腔静脉塌陷指数（SVC-CI）增加、心肌收缩力增加、心输出量（CO）增加、每搏量（SV）减少和全身血管阻力（SVR）增加相关。SBP降低与前负荷指标降低相关。SBP升高显示SVR显著升高。MAP降低与SVC-CI保持不变但CO显著降低相关。MAP升高与SV显著降低和SVR增加相关。
通过整合TEE测量的前负荷、后负荷和收缩力，我们能更好地洞察临床情况，这使我们能够在围手术期有效应对并进行适当的靶向治疗。
