THE EFFICACY OF ROUTINE CENTRAL VENOUS MONITORING IN MAJOR HEAD AND NECK-SURGERY - A RETROSPECTIVE REVIEW

被引:4
作者
JENSEN, NF
TODD, MM
BLOCK, RI
HEGTVEDT, RL
MCCULLOCH, TM
机构
[1] Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City
关键词
CATHETERIZATION; CENTRAL VENOUS; MONITORING OF; SURGERY; HEAD AND NECK;
D O I
10.1016/0952-8180(94)00025-Y
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Study Objective: To further define the efficacy of routine central venous catheter placement for major head and neck surgery from the standpoint of fluid and blood administration, and various other parameters of perioperative management. Design: Randomized, retrospective chart review. Setting: University-affiliated medical center. Patients: 104 patients who had undergone major head and neck surgery (defined as surgery lasting longer than 4 hours with a predicted blood loss of 500 ml or greater) at the University of Iowa Hospitals and Clinics between 1985 and 1992. Measurements and Main Results: Central venous monitoring was used in 51 of the 104 (49%) procedures. Patients with and without central monitors did not differ in age, weight, preoperative laboratory values [i.e., hemoglobin (Hb), blood urea nitrogen (BUN), creatinine), incidence of significant cardiac or renal disease, or a smoking history exceeding 30 pack years. In addition, these patients did not differ with respect to the following intraoperative characteristics: general type of anesthetic; duration of surgery; estimate of blood loss; Hb values; lowest urine output per hour; development of oliguria; total urine output; amount of replacement of blood, colloid or crystalloid; development of systolic blood pressure less than 70 mmHg; or use of a myocutaneous flap. Patients also did not differ with respect to the following postoperative characteristics: duration of stay in the surgical intensive care unit or hospital, BUN or creatinine values on days 1 and 2, total urine output or the development of oliguria on days 1 through 3, incidence of reintubation, fever on days 1 through 5, wound dehiscence, death, myocardial infarction, or the development of pneumonia, pulmonary edema, or sepsis. Patients with central monitors had a greater incidence of having a tracheostomy performed and a slightly lower Hb level on the first postoperative day than those without central monitors. Conclusions: The study raises doubt about the efficacy of routine central venous catheter placement as a necessary guide for fluid and blood administration for these procedures, or as a necessary adjunct for several other parameters of perioperative management. It suggests the need for a randomized, prospective evaluation
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页码:119 / 125
页数:7
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[1]  
Eddy, Uncertainty, outcomes, and the quality of medical care, Joint Commission on Accreditation of Healthcare Organizations (JCAHO): Cornerstones of Health Care in the Nineties: Forging a Framework of Excellence, (1990)
[2]  
Otto, Central venous pressure monitoring, Monitoring in Anesthesia and Critical Care Medicine, pp. 169-210, (1990)
[3]  
Dzelzkalns, Stanley, Placement of the pulmonary arterial catheter before anesthesia for cardiac surgery: a stressful, painful, unnecessary crutch, J Clin Monit, 1, pp. 197-200, (1985)
[4]  
Streisand, Clark, Pace, Pulmonary arterial catheterization before anesthesia in patients undergoing cardiac surgery. Placement of the pulmonary arterial catheter before anesthesia for cardiac surgery: safe, intelligent, and appropriate use of invasive hemodynamic monitoring, J Clin Monit, 1, pp. 193-197, (1985)
[5]  
Sanford, Internal jugular vein cannulation versus vein cannulation. An anesthesiologist's view: the right internal jugular vein, J Clin Monit, 1, pp. 58-60, (1985)
[6]  
Horrow, Metz, Thickman, Frederic, Prior carotid surgery does not affect the reliability of landmarks for location of the internal jugular vein, Anesth Analg, 66, pp. 452-456, (1987)
[7]  
Hoyt, Internal jugular vein cannulation versus subclavian vein cannulation. A surgeon's view: the subclavian vein, J Clin Monit, 1, pp. 61-63, (1985)
[8]  
Oda, Fukushima, Hirota, Tanaka, Aono, Sato, Forum. The para-carotid approach for internal jugular catheterization, Anaesthesia, 36, pp. 896-900, (1981)
[9]  
Tyden, Cannulation of the internal jugular vein—500 cases, Acta Anaesthesiol Scand, 26, pp. 485-488, (1982)
[10]  
Webre, Arens, Use of cephalic and basilic veins for introduction of central venous catheters, Anesthesiology, 38, pp. 389-392, (1973)