The use of the electrical-impedance technique for the monitoring of cardiac output and limb bloodflow during anaesthesia

A need has long existed during routine anaesthesia for a convenient, noninvasive method for the monitoring of stroke volume, and hence of changes in cardiac output. If knowledge of the mean arterial blood pressure is available, it becomes possible to monitor changes occurring in the left-ventricular stroke work and the total systemic resistance. Nyboer et al. (1940) proposed the use of thoracic electrical-impedance measurements for this purpose. The system used by us, however, is based on the work of Kubicek et al. (1966). The calculation method used for the stroke volume is to some extent empirical; nonetheless the values obtained compare well with those obtained by the dye-dilution technique in patients with normal hearts and lungs.SommaireDepuis longtemps, on a besoin d'une méthode pratique, non envahissante pour suivre le volume à chaque battement et donc les changements du rendement cardiaque au coures l'anesthésie routinière. Si la pression sanguine artérielle moyenne est connue, il est alors possible de contrôler les changements de travail se produisant dans le battement ventriculaire gauche et la résistance totale de l'organisme. Nyboeret al. (1940) suggérèrent à cette fin, l'usage de mesures d'impédance électrique thoracique. Toutefois le système que nous utilisons est basé sur les travaux de Kubiceket al. (1966). La méthode de calcul de volume de battement est quelque peu empirique, malgré tout, la valeur obtenue est en bon accord avec celles obtenues par la technique de dilution de colorant pour les patients au coeur et poumons normaux.ZusammenfassungSchon lange mangelt es in der routinemäßigen Anästhesie an einer bequemen, nichtinvasiven überwachungsweise des Stossvolumens und damit auch der Veränderungen in der Herzleistung. Weiss man den durchschnittlichen Blutdruck, so ist es möglich, die Stossveränderungen in der linken Herzkammer, sowie den gesamten systemischen Widerstand zu kontrollieren. Nyboeret al. (1940) schlug vor, thorakale elektrische Impedanz-Messungen für diesen Zweck zu benutzen. Unsere Arbeitsweise basiert jedoch auf der Arbeit von Kubiceket al. (1966). Die Kalkulation für das Stossvolumen ist in mancher Beziehung empirisch, jedoch können die Werte gut mit denen verglichen werden, die durch die Farb-Verdünnungsmethode bei Patienten gewonnen wurden, deren Herz und Lunge gesund und normal sind.

[1]  B Eiseman,et al.  Transthoracic electrical impedance for the early detection of pulmonary edema. , 1969, Surgery.

[2]  N. Couch,et al.  Evaluation of an impedance flowmeter in arterial surgery. , 1971, Surgery.

[3]  I. T. Miller,et al.  Impedance plethysmography: a noninvasive means of monitoring the thoracic surgery patient. , 1970, The Journal of thoracic and cardiovascular surgery.

[4]  B Eiseman,et al.  Clinical Evaluation of Transthoracic Electrical Impedance as a Guide to Intrathoracic Fluid Volumes , 1970, Annals of surgery.

[5]  J. Mahaffey,et al.  THE CARDIOVASCULAR EFFECTS OF HALOTHANE , 1961, Anesthesiology.

[6]  S. Kira,et al.  Variations of transthoracic electrical impedance in relation with hemodynamic changes of pulmonary circulation. , 1970, Japanese heart journal.

[7]  N. T. Smith,et al.  Cardiovascular Effects of Halothane in Man , 1970, Anesthesiology.

[8]  J. Nyboer,et al.  IMPEDANCE CARDIOGRAMS AND DIFFERENTIATED‐IMPEDANCE CARDIOGRAMS‐THE ELECTRICAL IMPEDANCE CHANGES OF THE HEART IN RELATION TO ELECTROCARDIOGRAMS AND HEART SOUNDS * , 1970 .

[9]  J. Karnegis,et al.  Physiological correlates of the cardiac thoracic impedance waveform. , 1970, American heart journal.

[10]  H. Wheeler,et al.  Diagnosis of deep venous thrombosis by measurement of electrical impedance. , 1970, American journal of surgery.

[11]  R. Patterson,et al.  IMPEDANCE CARDIOGRAPHY AS A NONINVASIVE METHOD OF MONITORING CARDIAC FUNCTION AND OTHER PARAMETERS OF THE CARDIOVASCULAR SYSTEM * , 1970 .

[12]  R. Patterson,et al.  Development and evaluation of an impedance cardiac output system. , 1966, Aerospace medicine.

[13]  N. Iwatsuki,et al.  The Effect of Ēthrane on Cardiac Muscle Mechanics , 1969, Anesthesiology.

[14]  F. H. Bonjer,et al.  The Origin of the Variations of Body Impedance Occurring during the Cardiac Cycle , 1952, Circulation.

[15]  Siegel,et al.  Clinical and experimental use of thoracic impedance plethysmography in quantifying myocardial contractility. , 1970, Surgery.

[16]  R. Patterson,et al.  Development and evaluation of an impedance cardiographic system to measure cardiac output. Development of an oxygen consumption rate computing system utilizing a quadrupole mass spectrometer , 1967 .

[17]  G. Murphy,et al.  Nomograms for estimation of peripheral resistance and work of the heart. , 1969, Anesthesiology.

[18]  B. Marshall,et al.  SOME PULMONARY AND CARDIOVASCULAR EFFECTS OF ENFLURANE (ETHRANE) ANAESTHESIA WITH VARYING Paco2 IN MAN , 1971 .

[19]  W. L. Cooley The calculation of cardiac stroke volume from variations in transthoracic electrical impedance. , 1972, Biomedical engineering.

[20]  J. Neville,et al.  Clinical and Laboratory Evaluation of a New Inhalation Agent: Compound 347 (CHF2-O-CF2-CHF Cl) , 1968, Anesthesiology.

[21]  H. Hufnagel,et al.  Transthoracic electrical impedance s a guide to intravascular overload. , 1971, Archives of surgery.

[22]  J. Greenfield,et al.  Evaluation of Thoracic Impedance Plethysmography as an Indicator of Stroke Volume in Man , 1969, The American journal of the medical sciences.

[23]  P. A. Philips,et al.  Bioelectric impedance. New developments and clinical application. , 1971, Archives of surgery.

[24]  Van de Water Jm,et al.  Pulmonary extravascular water volume: measurement and significance in critically ill patients. , 1970 .

[25]  L. Baker,et al.  Thoracic impedance changes following saline injection into right and left ventricles. , 1972, Journal of applied physiology.

[26]  R. Allison THE EFFECTS OF AGING, VASCULAR DISEASE AND HYPERTENSION ON THE PERIPHERAL PULSE VOLUME , 1968, Journal of the American Geriatrics Society.

[27]  Cooley Wl The calculation of cardiac stroke volume from variations in transthoracic electrical impedance. , 1972 .

[28]  H. J. Lowe,et al.  Quantitative Closed‐Circuit Halothane Anesthesia: A Clinical Study Employing a New Pressurized Temperature‐Compensated Vaporizer , 1968, Anesthesia and analgesia.

[29]  P E Leaverton,et al.  The First Derivative Thoracic Impedance Cardiogram , 1970, Circulation.

[30]  R. Lauer,et al.  Evaluation of impedance cardiac output in children. , 1971, Pediatrics.