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Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol in children
Author(s) -
Kardos A.,
Földesi C.,
Nagy A.,
Sáringer A.,
Kiss A.,
Kiss G.,
Marschalkó P.,
Szabó M.
Publication year - 2006
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2006.01073.x
Subject(s) - medicine , trendelenburg position , anesthesia , propofol , supine position , cardiac index , fentanyl , blood pressure , heart rate , impedance cardiography , vascular resistance , cardiac output , hemodynamics , stroke volume , mean arterial pressure
Background and objective: Induction of anaesthesia may cause decreased cardiac output and blood pressure. Head‐down tilt is often the first clinical step to treat hypotension. The objective of this randomized single centre study was to determine, with the use of impedance cardiography (ICG), whether Trendelenburg positioning modifies the haemodynamic response to propofol/fentanyl induction of anaesthesia in ASA I children. Methods: Thirty ASA I children aged between 7 and 16 years scheduled for elective minor orthopaedic surgery were included. After intravenous induction with propofol and fentanyl in the head‐down group (HDG, n = 15), 5 min of 20° head‐down tilt was applied. In the supine group (SG, n = 15), no change in the supine position was made. Heart rate (HR), mean arterial blood pressure (MABP), end‐tidal carbon dioxide (ETCO 2 ), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI) and Heather index (HI) were recorded before (B), at 3 (A 3 ), 5 (A 5 ) and 8 (A 8 ) minutes after induction in each group. Results: After induction, a significant decrease in CI, MABP, HR and HI was recorded in both groups. In the study group, significantly lower values of HR (66 vs. 78 beat/min) and higher values of SVI (42.9 vs. 40.6 ml/min/m 2 ) were measured at A 3 compared with the control group. After induction, no difference in CI and SVRI was found between the two groups. Conclusion: The present study shows that cardiac performance is not improved by Trendelenburg positioning after propofol/fentanyl induction of anaesthesia in children.