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  • 2022-RA-1347-ESGO The impact of the induction of anaesthesia and the opening of the abdominal cavity on haemodynamic parameters in cytoreductive debulking surgery

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Ovarian cancer
2022-RA-1347-ESGO The impact of the induction of anaesthesia and the opening of the abdominal cavity on haemodynamic parameters in cytoreductive debulking surgery
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  1. Charlotte Middel1,
  2. Matthias Stetzuhn1,
  3. Nadine Sander1,
  4. Björn Kalkbrenner1,
  5. Timo Tigges2,
  6. Alexandru-Gabriel Pielmus2,
  7. Claudia Spies1,
  8. Klaus Pietzner3,
  9. Michael Klum2,
  10. Clarissa von Haefen1,
  11. Oliver Hunsicker1,
  12. Jalid Sehouli3,
  13. Frank Konietschke4 and
  14. Aarne Feldheiser5,1
  1. 1Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  2. 2Department of Electronics and Medical Signal Processing, Technical University, Berlin, Germany
  3. 3Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
  4. 4Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  5. 5Department of Anaesthesiology and Intensive Care Medicine, Evangelische Kliniken Essen-Mitte, Essen, Germany

Abstract

Introduction/Background High-risk surgery frequently is associated with haemodynamic instability leading to the administration of high amounts of intravenous fluids and catecholamines to stabilize cardiovascular function. The haemodynamic instability is commonly attributed to the inflammatory response related to surgical trauma. In this study, we investigated also, how the induction of anaesthesia and the opening of the abdominal cavity impact haemodynamics.

Methodology In a prospective, observational, monocentric study, haemodynamic measurements were obtained by the non-invasive methodology of thoracic electrical cardiometry (EC) in 29 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. The change of haemodynamic parameters was analyzed from the day prior to surgery to the first intraoperative measurement by non-parametric longitudinal data analysis in a two-factorial experiment (dependent factor time).

Results Median age of patients was 59 [25-quartile 50; 75-quartile 61] years. 8 (28%) patients had a diagnosis of arterial hypertension, otherwise, no cardiovascular diseases were shown. The FIGO stages were in 22 (75%) patients above stage IIIc and 9 (31%) patients had more than 500 ml of ascites.

The relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median -19 [25-quartile -26%; 75-quartile -10%]%, p<0.0001), stroke volume index (SVI, -9.5 [-15.3;3.2]%, p=0.0038), cardiac index (CI, -24.5 [-32;-13]%, p<0.0001) and the inotropic marker index of contractility (ICON, -17.5 [-35.3;-0.8]%, p<0.0001).

Abstract 2022-RA-1347-ESGO Figure 1
Abstract 2022-RA-1347-ESGO Figure 1

Conclusion Substantial changes in HR, SVI, CI, and ICON occurred from the day prior to surgery to the first intraoperative measurement, indicating that patients without relevant cardiovascular morbidity showed reduced cardiocirculatory flow and cardiac function. Furthermore, these data indicate that pharmacological modulation might optimize haemodynamic care during high-risk gynaecological surgery.

https://doi.org/10.1136/ijgc-2022-ESGO.695

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