• Padmaja Durga, Nirmala Jonnavittula, Radhakrishnan Muthuchellappan, and Gopinath Ramachandran.
• Department of Anesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, AP, India. padmajanims@yahoo.com
• J Neurosurg Anesthesiol. 2009 Apr 1;21(2):161-4.

AbstractDirect invasive arterial monitoring is performed routinely for all major neurosurgical procedures. Systolic pressure variation (SPV) used, independently or in combination with central venous pressure (CVP) allows optimal fluid management in hypovolemia and hemorrhage. This study aims to quantify SPV during graded hypovolemia using the simple technique described by Gouvea and Gouvea using Datex Ohmeda S/5, and to compare its reliability relative to other hemodynamic indicators of hypovolemia. Twenty anesthetized neurosurgical patients of ASA grade I and II patients were administered furosemide 0.5 mg/kg intravenously to obtain graded volume loss in the form of urine output. Invasive arterial pressure from radial artery and CVP were monitored using Datex OhmedaS/5 (Finland). Invasive arterial pressure label was changed to pulmonary artery label with the scale appropriate for arterial pressure. The trace was frozen in the wedge mode to reduce the sweep speed and the cursor was used to measure SPV and pulse pressure variation (PPV). Heart rate, systolic blood pressure, diastolic blood pressure, CVP at zero end-expiratory pressure, SPV and PPV are measured at baseline, and after a urine output of 200 and 500 mL. There was a significant correlation between volume loss and CVP, SPV, and PPV. The area under the curve of receiver operating characteristic analysis was >0.75 for CVP, SPV, and PPV. SPV of 7.5 mm Hg and a change of SPV by 4.5 mm Hg, a PPV of 4.5 and change in PPV by 2.5 mm Hg were the best cut-off values that corresponded to a volume change of 500 mL. This simple method enabled calculation of SPV without the computerized modules, and detected volume loss comparable to CVP.

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