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Effect of Anesthesia and Positive Pressure Ventilation on Early Postburn Hemodynamic Instability

 

作者: LI-JUAN JIN,   CHERYL LALONDE,   ROBERT DEMLING,  

 

期刊: The Journal of Trauma: Injury, Infection, and Critical Care  (OVID Available online 1986)
卷期: Volume 26, issue 1  

页码: 26-33

 

ISSN:0022-5282

 

年代: 1986

 

出版商: OVID

 

数据来源: OVID

 

摘要:

Our purpose was to determine the effect of anesthesia and positive pressure ventilation, PPV, on early postburn (1–12 hr) cardiopulmonary changes. Adult sheep were given a 40% full-thickness TBS burn not involving chest wall. Halothane anesthesia and PPV alone decreased cardiac output by 20% but also decreased oxygen demands by 30% from the awake state. Systemic vascular resistance, SVR, was increased by 40% over the awake state in the first several hours postburn: cardiac output was decreased despite baseline filling pressures. Low molecular weight dextran, LMWD, prevented the increased SVR by decreasing resistance to flow.A continued decrease in cardiac output was evident during the next 6–12 hr postburn with anesthesia while awake sheep values returned to baseline. Fluid requirements to maintain filling pressures also increased by 30% over the awake state. Static lung compliance, CSTAT, decreased from a baseline of 43 ± 5 to 32 ± 4 ml/cm H2O with anesthesia and ventilation. This was due to nonburn chest wall edema: lung water was normal. The 7-cm H2O increase in inspiratory pressure necessary to maintain constant volume was the cause of the decreased cardiac output, because maintaining pressure constant resulted in no decrease in cardiac output. &OV0312;O2remained relatively constant due to increased O2extraction. LMWD prevented the CSTATchanges and, in turn, the decreased output.We conclude that both the increase in SVR and decrease in CSTATpostburn resulted in a significant decrease in cardiac output with anesthesia not seen in the awake burn state. The decreased output was, however, in large part compensated for by decreased O2demands and increased O2extraction.

 

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