Abstract
The circulatory effects of a rapid infusion of plasma substitute with intravenous administration of nitroglycerine (TNG) were investigated in low pressure systems of anesthetized patients by measuring various hemodynamic parameters. Measurements were made when the systolic blood pressure reached 70–80% of the control value after intravenous administration of TNG at 1≈2μg/kg/min and a 3.5% modified gelatin solution (Haernaccel®) at a rate of 0.5 ml/kg/min. After the TNG was administered, the mean circulatory filling pressure (Pms) decreased, and the venous to arterial capacitance ratio (Cv/CA) increased; however, they returned to control values after a rapid Haemaccel® infusion. Changes in the pressure gradient between the X and Y valley of the right atrial pressure wave decreased to 70 ± 14% of the control value when TNG was given and recovered to 106 ± 22% by infusion. Pulmonary vascular resistance (PVR) decreased to 70 ± 24% of the control value when TNG was administered and was restored to 96 ± 40% by a rapid infusion. In the left ventricle, the mean velocity of myocardial circumferential fiber shortening (VCF) decreased in all cases when TNG was given and it recovered by a rapid infusion. In the right ventricle, VCF did not always decrease, and in a few case increased, but all cases recovered by a Haemaccel® rapid infusion. We conclude that the augmentation of the right ventricular preload reserve is achieved by administration of TNG and infusion of a plasma substitute.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sibbald WJ, Driedger AA: Right ventricular function in acute disease states: Pathophysiologic considerations. Crit Care Med 11:339–345, 1983
Ross JJr: Afterload mismatch and preload reserve: Conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis 18:255264, 1976
Muteki T, Aragaki T, Veda N, Shinozaki M, Takagi T: Clinical evaluation of the fiberoptic electrocardiography and blood pressure measuring system —electromechanical analysis of right atrial pressure changes during surgery. J Jpn Soc Clin Anesth 4:18–28, 1984
Muteki T, Shinozaki M, Tokutomi Y, Yamashita T, Goto S, Kono 1, Bekki S: Computer-based cardiovascular data acquisition as an aid to clinical decision-making. J Jpn Soc Clin Anesth 3: 107117, 1983
Gauer OH, Henry J: Circulatory basis of fluid volume control. Physiol Rev 43:423–481, 1963
Muteki T, Bekki S, Yamamoto H, Sakanashi K, Shinozaki M, Yamasaki T: Clinical significance of monitoring right atrial function in critically ill patients. Proceedings of the First WPACCM Congress. Edited by Sivagnanaratham, 1982, pp 84-90 .
Parmley WW, Talbot L: Correlation of pressures, volumes, heart sounds and the electrocardiogram, Heat as a pump (Chapter 11): Handbook of Physiology. Section 2. The cardiovascular system Vol. 1 The Heart. Edited by Berne RM, Sperelakis N and Geiger SR. Maryland, American Physiology Society, 1979, p 438
Guyton AC, Jones CE, Coleman TG: Mean circulatory pressure, mean systemic pressure, and mean pulmonary pressure and their effect on venous return. Circulatory Physiology: Cardiac Output and its Regulation (Chapter 12). Edited by Guyton AC. Philadelphia, WB Saunders, 1973, pp 205–221
Hori M: Venous return. Resp Circulat 20:644656, 1972
Scott DB, Slawson KB, Taylor SH: The circulatory effects of the Valsalva mamoeuvre during anesthesia and thoracotomy. Cardiovasc Res 3:331–337, 1969
Buda AJ, Pinski MR, Ingels NB, Daughters GT, Stinson EB, Alderman EL: Effect of intrathoracic pressure on left ventricular performance. New Engl J Med 301:453–459, 1979
Robertson D, Stevens RM, Friesinger GC, Oates JA: The effect of the Valsalva maneuver on echocardiographic dimension in man. Circulation 55:596–602, 1977
Little WC, Kenntbarr W, Crawford MH: Altered effect of the Valsalva maneuver on left ventricular volume in patients with cardiomyopathy. Circulation 71:227 -233, 1985
Santamore WP, Heckman JL, Bove AA: Right and left ventricular pressure-volume response to respiratory maneuvers. J Appl Physiol 57:15201527, 1984
Muteki T: Current concepts on intra-operative use of the plasma substitute (Haemaccel) with maintenance of preload reserve of right-side cardiac function under anesthesia. RACS Foundation Symposium on Fluid Replacement. Hong Kong, Excerpta Medica, 1985, pp 77–90
Yonemura E, Nakamura M, Fukushima K: Effect of changes in preload, afterload and inotropic state on the force-velocity curves in ejection phase during anesthesia. Jpn J Anesth 32:776783, 1983
Suga H, Sagawa K: Mathematical interrelationship between instantaneous ventricular pressurevolume ratio and myocardial force-velocity relation. Ann Biomed Eng 1:160–181, 1972
Togawa T: Graphic analysis of circulatory equilibrium. New Approaches in Cardiac Mechanics. Edited by Kitamura K, Abe K and Sagawa K. Tokyo, Japan Scientific Societies Press, 1986, pp 195–202
Ohishi K, Iwakuma I, Watanabe S, Aragaki T, Goto S, Kono I, Muteki T: Augmentation of RV preload reserve due to an infusion with i.v, TNG. Jpn J Anesth 35:S311, 1986
Strobeck JE, Sonnenblick EH: The interrelationship of myocardial and ventricular function. New Approaches in Cardiac Mechanics. Edited by Kitamura K, Abe H and Sagawa K. Tokyo, Japan Scientific Societies Press, 1986, pp 135–154
Author information
Authors and Affiliations
About this article
Cite this article
Ohishi, K., Muteki, T., Shinozaki, M. et al. Clinical significance of mean circulatory filling pressure and cardiac preload under anesthesia. J Anesth 1, 35–43 (1987). https://doi.org/10.1007/s0054070010035
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s0054070010035