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Cardiac output (CO) is measured using Mostcare. Mean systemic filling pressure (MSFP) and vascular resistances are calculated using venous return curves constructed by measuring steady-state arterial and venous pressures and cardiac output (CO) during inspiratory hold manoeuvres at increasing plateau pressures. Measurements are performed at three incremental levels of targeted sevoflurane concentrations.
Tracheal intubation is performed after anesthesia induction with sevoflurane. Radial arterial is cannulated and pressure transducer is connected to MostCare (core technique PRAM). HR, MAP, CVP, CO, SVR, PPV, and dp/dt are recorded at three incremental levels of targeted sevoflurane concentrations. MSFP and vascular resistances are calculated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Exposure | The patient receives three increasing target end-tidal concentrations of sevoflurane, depending on what is hemodynamically (i.e. arterial hypotension) feasible in the individual patient. |
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| Measure | Description | Time Frame |
|---|---|---|
| cardiac output | Cardiac output is monitored using Mostcare via a radial arterial catheter connected to the pressure transducer. | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |
| mean systemic filling pressure | Mean systemic filling pressure (MSFP) is calculated using venous return curve constructed by measuring steady-state arterial and venous pressures and CO during inspiratory hold manoeuvres at increasing plateau pressures. The CVP and CO data are fitted by linear regression to define the venous return curve. We define MSFP by extrapolation to zero flow. | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |
| vascular resistance | Total systemic vascular resistance (Rsys) is calculated as the ratio of the pressure difference between mean Pa and mean CVP and CO. The resistance downstream to MSFP is taken to reflect the resistance to venous return (Rv) and is calculated as the ratio of the pressure difference between MSFP and CVP and CO. Systemic arterial resistance (Ra) is taken to be the difference between systemic and venous resistance. | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |
| Measure | Description | Time Frame |
|---|---|---|
| mean arterial pressure | Systemic arterial blood pressure is monitored via a radial arterial catheter connected to a pressure transducer. | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |
| central venous pressure |
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Inclusion Criteria:
Exclusion Criteria:
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The study enrolls patients 3-10 years, with American Association of Anesthesiologists (ASA) physical status score I-III, scheduled for major elective surgery that dictates the use of invasive hemodynamic monitoring including CVP and continuous arterial blood pressure monitoring. Patients with symptomatic peripheral vascular disease or pulmonary disease, aberrant cardiovascular anatomy, significant valvular regurgitation, or severe arrhythmias are excluded.
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| Name | Affiliation | Role |
|---|---|---|
| Xuan Wang, MD | Children's Hospital of Fudan University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Children's hospital of Fudan university | Shanghai | China |
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CVP is measured with a catheter inserted through the right internal jugular vein. |
| Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |
| pulse pressure variation | PPV is obtained from Mostcare. | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |
| dP/dt | dP/dt is obtained from Mostcare. | Hemodynamic parameters are recorded after 15 min of equilibration at each sevoflurane concentration. |