Abstract
Cross-clamping of the abdominal aorta can be associated with significant changes in haemodynamic variables. However, intraoperative changes in extravascular lung water (EVLW) have not been studied. Nine patients undergoing elective surgery, either aortic aneurysm repair or aorto-bifemoral grafting, were monitored invasively with arterial lines, pulmonary artery catheters and Edwards lung water catheters inserted in either the brachial or axillary artery. Determinations of EVLW were made prior to and five minutes after application of the aortic cross-clamp and at 30-minute intervals during the course of the operation. Baseline EVLW was found to be 7− 9ml·kg− 1. There were no significant changes in haemodynamic variables and no changes in EVLW with cross-clamping of the aorta. The EVLW did not change during the course of surgery. The EVLW did not increase in the absence of sustained elevation of pulmonary capillary wedge pressure. One patient developed an axillary artery thrombosis which required thrombectomy at the site of lung water catheter insertion. Two other patients lost their distal pulses without overt ischaemic changes. It was felt that such relatively high incidence of complications precluded further use of the lung water catheter in the axillary or brachial artery.
Résumé
D’aucuns ont rapporté des perturbations hémodynamiques lors du clampage de l’aorte abdominale sans mesurer cependant la quantite de liquide interstitiel pulmonaire (EVLW). Neuf patients subissant une résection élective d’anévrysme aortique ou un pontage aorto-bifémoral ont été choisis pour cette étude. On lew installait d’abord un cathéter intra-artériel et un de type Swan-Ganz puis ensuite un cathéter d’Edwards pour mesure de l’EVLW par l’artére humerale ou axillaire. On mesurait alors l’EVLW juste avant et cinq minutes après le clampage aortique et aux 30 minutes par la suite, jusqu’à la fin de l’intervention. Les valeurs de départ de l’EVLW allait de 7 à 9 ml·kg.−1 Nous n’avons pas note de changement significatif des variables hemodynamiques non plus que de l’EVLW lors du clampage aortique et cette dernière variable est demeurée stable pendant l’intervention, tout comme la pression capillaire pulmonaire. On a par ailleurs noté une disparition des pouls en aval du site d’insertion du cathéter à EVLW sans manifestation ischémique cependant, mais un autre patient a du subir une thrombectomie axillaire. Ce taux de complication disqualifie done les artères humérales et axillaires comme voie d’entrée pour le cathéter à EVLW.
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Work supported by grants from the Medical Research Council of Canada.
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Kowalski, S., Downs, A.R., Lye, C. et al. Measurement of extra-vascular lung water during abdominal aortic surgery. Can J Anaesth 36, 283–288 (1989). https://doi.org/10.1007/BF03010766
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DOI: https://doi.org/10.1007/BF03010766