Topics in Anaesthesia and Critical Care

Transcription

1 Topics in Anaesthesia and Critical Care H.K.F. VAN SAENE, L. SILVESTRI, M.A. DE LA CAL (Ens) Infection Control in the Intensive Care Unit 1998, 380 pp, ISBN J. MILIC-EMILI (ED) Applied Physiology in Respiratory Mechanics 1998, 246 pp, ISBN X G. GUARNIERI, F. ISCRA (Ens) Metabolism and Artificial Nutrition in the Critically Ill 1999, 130 pp, ISBN J. MILIC -EMILI, U. LUCANGELO, A. PESENTI, W.A. ZIN (Ens) Basics of Respiratory Mechanism and Artificial Ventilation 1999,268 pp,lsbn M. TIENGO, V.A. PALADIN!, N. RAwAL (Ens) Regional Anaesthesia, Analgesia and Pain Management 1999, 362 pp, ISBN I. SALVO, D. VIDYASAGAR (Ens) Anaesthesia and Intensive Care in Neonates and Children 1999, 324 pp, ISBN G. BERLOT, H. DELOOZ,A. GULLO (Ens) Trauma Operative Procedures 1999, 210 pp, ISBN G.L. ATLEE, J.-1. VINCENT (Ens) Critical Care Cardiology in the Perioperative Period 2000, 214 pp, ISBN M.A. TIENGO (ED) Neuroscience: Focus on Acute and Chronic Pain 2000,214 pp, ISBN X Anestesia e Medicina Critica G. SLAVICH (ED) Elettrocardiografia Clinica 1997,328 pp, ISBN G.L. ALATI, B. ALLARIA, G. BERLOT, A. GULLO, A. LUZZANI, G. MARTINELLI, 1. TORELLI (Ens) Anestesia e Malattie Concomitanti - Fisiopatologia e clinica del periodo perioperatorio 1997, 382 pp, fsbn B. ALLARIA, M. V. BALDASSARE, A. GULLO, A. LUZZANI, G. MANANI, G. MARTINELLI, A. PASETTO, 1. TORELLI (Ens) Farmacologia Generale e Speciale in Anestesiologia Clinica 1997,312 pp, ISBN A. GULLO {ED} Anestesia Clinica 1998, 506 pp, ISBN A. GULLO, L. GATTINONI Medicina Intensiva e Perioperatoria 2000, 863 pp, ISBN

2 Critical Care Cardiology in the Perioperative Period

3 Springer-Verlag Italia Srl.

4 J.L. Atlee J.-L.Vincent (Eds) Critical Care Cardiology in the Perioperative Period Series edited by Antonino Gullo Springer

5 J.L. ATLEE Department of Anaesthesiology Medical College of Wisconsin Froedtert Memorial Lutheran Hospital Milwaukee, WI, USA J.-L. Vincent Department of Intensive Care Erasme Hospital Free University of Brussels Brussels, Belgium Series Topics in Anaesthesia and Critical Care edited by A. GULLO, MD Department of Clinical Science - Section of Anaesthesia, Intensive Care and Pain Clinic University of Trieste, Cattinara Hospital, Trieste, Italy Springer-Verlag Italia 2001 Originally published by Springer-Verlag Italia, Milano in 2001 ISBN ISBN (ebook) DOI / Library of Congress Cataloging-in-Publication Data: Applied for This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the Italian Copyright Law in its current version, and permission for use must always be obtained from Springer-Verlag Italia Sri. Violations are liable for prosecution under the Italian Copyright Law. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: the publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Simona Colombo Typesetting and layout: Photo Life, Milan SPIN:

6 Preface The peri-operative period represents a crucial phase not only for the patient, but also for the surgical and anaesthesiological team which must coordinate harmoniously to ensure the patient's rapid functional recovery. Therefore, an interdisciplinary approach to peri-operative care is essential, both in terms of clinical competency and of instrumental monitoring. Obviously, patient monitoring and all diagnostic and treatment procedures must be modulated in relation to the actual situation. Above all, the pre-operative evaluation of the patient's health conditions and surgical needs has to follow standardized protocols_ It is important to determine the functional state of the patient and, in particular, the functional reserves of the cardiovascular system. Determining the surgical indications and carrying out the intervention both depend on the rigorous control of the patient's homeostasis throughout the perioperative phase. Anesthesiological protocols are by now codified and familiar to all experienced operators. On this basis, I wished to offer votaries of this field, in particular anesthesiologists, surgeons, cardiologists, internists and intensive care physicians, an update on the more relevant problems that arise during peri-operative care_ The focus of this volume is on surgery patients (including those undergoing non-cardiac interventions) whose clinical conditions require special strategies for the prevention and eventual treatment of critical conditions. Considering the innumerable pathophysiological and clinical situations that may develop in the peri-operative period, continuous education is essential. It is particularly opportune to stress the importance of first-hand experience and the ability to interpret the multiplicity of the hemodynamic complications that can occur in the delicate phase of the peri-operative period. Sure progress has come from the availability of sophisticated means of hemodynamic monitoring, particularly the noninvasive techniques such as transesophageal echocardiography (TEE) and intra-esophageal echo Doppler ultrasound. In addition to methods for monitoring blood pressure, it is now routine to perform bedside monitoring of cardiac volumes, myocardial contractility, and organ perfusion based on entidal C0 2 levels_ These methods are now commonplace in modern clinical practice. In this context, the management of arrhythmias assumes an important role. The correct and timely diagnosis of arrhythmias and the appropriate use of the different anti-arrhythmic drugs depend on an accurate knowledge of current medical practices. Therefore, the chapter on temporary pacing for the treatment

7 VI Preface of dangerous arrhythmias is extremely important basically for the training process. The contributions on monitoring for myocardial ischaemia in the peri-operative period and on the principal trials of novel clinical approaches to acute myocardial infarction are germane to this volume. Another interesting contribution focuses on dilated cardiomyopathy and on the different therapeutic options for this disorder. In addition, two chapters are dedicated to the care of patients undergoing surgical intervention for myocardial revascularization. These patients require different strategies of intervention to improve ventricular failure and to treat secondary complications due to cardiac dysfunction. Finally, this volume could not fail to include a chapter on cardiogenic pulmonary edema that often characterizes the clinical iter of patients with cardiac insufficiency. In light of this brief preface, I have valid motives to retain that this volume will arouse interest in both researchers and experts of this subject. It will also be informative for young physicians who are completing their training. I wish to thank all the authors for their valuable contributions and for helping to bring this initiative to a fulfillment. I particularly thank my friends and colleagues J.L. Atlee and J.-L. Vincent, with whose efforts this volume became possible. Trieste, November 2000 Antonino Gullo University Medical School Trieste, Italy

8 Contents BASIC MECHANIMS OF THE CARDIOVASCULAR SYSTEM Chapter 1 - Preoperative Cardiac Evaluation J.L. Atlee... 3 MEASUREMENT AND APPLICATIONS OF THE CARDIOVASCULAR SYSTEM Chapter 2 - How to Interpret Cardiac Output and Haemodynamic Indexes J.-L. Vincent, G.S. Yalavatti MONITORING OF THE CARDIOVASCULAR SYSTEM Chapter 3 - Computer-Based Cardiovascular Monitoring in the Intensive Care Unit B. Allaria, M. Dei Poli, F. D'Elia, M. Favaro Chapter 4 - Trans esophageal Echocardiography at the Bedside in the Diagnosis of Cardiovascular Dysfunction C. Sorbara, R. Bona to Chapter 5 - Advances in Echocardiographic Evaluation of Critically Ill Patients J. Gorcsan III, S.R. Gunn Chapter 6 - Echo Doppler Aortic Blood Flow Measurement. Technique, Devices, Problems and Progress R. Muchada, P. Tortoli, F. Guidi CLINICAL SPECTRUM OF CARDIOVASCULAR DYSFUNCTION (FIRST PART) Chapter 7 - Dangerous Perioperative Arrhythmias: Diagnosis and Management J.L. Atlee Chapter 8 - Physiologic Imbalance as a Cause of Cardiac Arrhytmias F. Schiraldi, P. Ferraro, F. Paladino

9 VIII Contents Chapter 9 - Temporary Pacing for Prevention and Management of Perioperative Arrhythmias J.L. Atlee CLINICAL SPECTRUM OF CARDIOVASCULAR DYSFUNCTION (SECOND PART) Chapter 10 - Detection and Significance of Myocardial Ischemia in the Perioperative Period B. Allaria, M. Dei Poli Chapter 11 - Dilated Cardiomyopathy and Steps in the Treatment G. Sinagra, A. Di Lenarda, G. Sabbadini Chapter 12 - Management Strategies for Acute Myocardial Infarction A.G. Rebuzzi, E. De Marco Chapter 13 -Management of Cardiovascular Dysfunction after Cardiac Surgery H. Metzler Chapter 14- Complications in the Periopertive Period of Coronary Artery Bypass Grafting V. Piriou, A. Aouifi, J, J. Leh ot Chapter 15 - Diagnosis and Management of Pulmonary Edema in the Perioperative Period J.L. Atlee, E. Segal Main Symbols Subject Index

10 Contributors Allaria B. Intensive Care Unit, Istituto Nazionale dei Tumori, Milan, Italy AouifiA. Service d' Anesthesie Reanimation, Hopi tal Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France Atlee J.L. Department of Anesthesiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA Bonato R. Department of Pharmacology and Anaesthesiology, University Hospital Medical School, Padua, Italy DeiPoli M. Intensive Care Unit, Istituto Nazionale dei Tumori, Milan, Italy D'Elia F. Intensive Care Unit, Istituto Nazionale dei Tumori, Milan, Italy DeMarco E. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy Di Lenarda A. Department of Cardiology, Ospedale Maggiore, Trieste, Italy FavaroM. Intensive Care Unit, Istituto Nazionale dei Tumori, Milan, Italy Ferraro P. Department of Emergency Medicine, S. Paolo Hospital, Naples, Italy Gorcsan J. III Divisions of Medicine and Critical Care Medicine, University of Pittsburgh, PA,USA Guidi F. Anaesthesia and Intensive Care, Eugene Andre Hospital, Lyon, France

11 X Contributors GunnS.R. Divisions of Medicine and Critical Care Medicine, University of Pittsburgh, PA,USA LehotJ.J. Infirmerie Protestante, Caluire, France Metzler H. Department of Anaesthesiology and Intensive Care Medicine, University of Graz, Austria MuchadaR. Anaesthesia and Intensive Care, Eugene Andre Hospital, Lyon, France Paladino F. Department of Emergency Medicine, S. Paolo Hospital, Naples, Italy Piriou V. Infirmerie Protestante, Caluire, France Rebuzzi A. G. Insitute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy Sabbadini G. Department of Internal Medicine and Geriatrics, University of Trieste, Italy Schiraldi F. Department of Emergency Medicine, S. Paolo Hospital, Naples, Italy Segal E. General ICU, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Israel Sinagra G. Department of Cardiology, Ospedale Maggiore, Trieste, Italy Sorbara C. Department of Pharmacology and Anaesthesiology, University Hospital Medical School, Padua, Italy Tortoli P. Anaesthesia and Intensive Care, Eugene Andre Hospital, Lyon, France Vincent J.-L. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium Yalavatti G. S. Department of Intensive Care, Breach Candy Hospital, Mumbai, India