• Shiroh Nakamoto, Hiromi Shii, Takahiko Kaneko, Yukari Okano, and Tsuneo Tatara.
• Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya 663-8501.
• Masui. 2012 Dec 1;61(12):1342-6.

AbstractPerioperative fluid management for cases with severely compromised cardiac function undergoing major non-cardiac surgery remains a challenge. Dynamic parameters such as stroke volume variation (SVV) and cardiac index obtained by arterial pulse contour analysis may not be sufficient for fluid optimization because individualized optimal parameter values are difficult to determine in cardiac patients. We report two cases of abdominal surgery with severe pre-existing impairment of cardiac function (ejection fraction < 30%) complicated by severe pulmonary and renal dysfunction. In Case 1, because of unreliably high SVV values due to a sudden onset of cardiac arrhythmia, we performed colloid bolus infusion targeting central venous oxygen saturation (ScvO2) above 80%. In Case 2, cardiac index and stroke volume index remained unchanged despite the decrease of SVV after colloid bolus infusion. Infusion of dobutamine was useful for maintaining the ScvO2 above 75% in a rather hypovolemic state (SVV of 10-15%). Our cases suggest that the use of central venous oxygen saturation together with arterial pulse contour analysis may aid decision-making for individualized fluid optimization and use of inotropics in severely compromised cardiac patients undergoing major abdominal surgery.

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