Anesthetics affect peripheral venous pressure waveforms and the cross-talk with arterial pressure

Ali Z Al-Alawi,Melvin S Dassinger,Jeffrey M Burford,Kaylee R Henry,Kevin W Sexton,Hanna K Jensen,Md Abul Hayat,Jingxian Wu,Joseph Sanford,Morten O Jensen,Lauren D Crimmins,Patrick C Bonasso

doi:10.1007/s10877-020-00632-6

Abstract

Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two pediatric cohorts were studied to test the effect of anesthetic agents on the PVP waveform and cross-talk between peripheral veins and arteries: (1) dehydration setting in a pyloromyotomy using the infused anesthetic propofol and (2) hemorrhage setting during elective surgery for craniosynostosis with the inhaled anesthetic isoflurane. PVP waveforms were collected from 39 patients that received propofol and 9 that received isoflurane. A multiple analysis of variance test determined if anesthetics influence the PVP waveform. A prediction system was built using k-nearest neighbor (k-NN) to distinguish between: (1) PVP waveforms with and without propofol and (2) different minimum alveolar concentration (MAC) groups of isoflurane. 52 porcine, 5 propofol, and 7 isoflurane subjects were used to determine the cross-talk between veins and arteries at the heart and respiratory rate frequency during: (a) during and after bleeding with constant anesthesia, (b) before and after propofol, and (c) at each MAC value. PVP waveforms are influenced by anesthetics, determined by MANOVA: p value < 0.01, η2 = 0.478 for hypovolemic, and η2 = 0.388 for euvolemic conditions. The k-NN prediction models had 82% and 77% accuracy for detecting propofol and MAC, respectively. The cross-talk relationship at each stage was: (a) ρ = 0.95, (b) ρ = 0.96, and (c) could not be evaluated using this cohort. Future research should consider anesthetic agents when analyzing PVP waveforms developing future clinical monitoring technology that uses PVP.

Highlights

During trauma or illness, dehydration can become lifethreatening if it is not diagnosed and treated before organ damage occurs
No other peripheral venous pressure (PVP) signal analysis algorithms take into account the confounding factor of anesthetics or the heart rate of a patient, which is an important limitation of PVP research
For the pyloric stenosis patients, data points were collected over the entire operation, and for the craniosynostosis patients, data points were collected from the first instance of isoflurane throughout the procedure until isoflurane administration was ceased

Summary

Introduction

Dehydration can become lifethreatening if it is not diagnosed and treated before organ damage occurs. Assessing dehydration can be complicated, as there is not a universal method for predicting the fluid volume status of a dehydrated child or adult, and often vital signs are unable to predict fluid loss before severe side effects become present [1]. Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume, especially in cases of dehydration and hemorrhage [6, 7], and may provide earlier sensitivity in detection of loss of blood. Bonasso et al demonstrated that PVP waveforms are more sensitive in predicting volume loss than vital signs in a large animal model of bleeding [8]. PVP waveforms can potentially be confounded by parameters other than volume status, such as anesthetic agents, while collecting the data [8]. No other PVP signal analysis algorithms take into account the confounding factor of anesthetics or the heart rate of a patient, which is an important limitation of PVP research

Methods

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Discussion

Conclusion