TY - JOUR
T1 - The efficacy of routine central venous monitoring in major head and neck surgery
T2 - A retrospective review
AU - Jensen, Niels F.
AU - Todd, Michael M.
AU - Block, Robert I.
AU - Hegtvedt, Raymond L.
AU - McCulloch, Timothy M.
PY - 1995/3
Y1 - 1995/3
N2 - Study Objective: To further define the efficacy of routine central venous catheter placement for major head and neck surgery from the standpoint of fluid and blood administration, and various other parameters of perioperative management. Design: Randomized, retrospective chart review. Setting: University-affiliated medical center. Patients: 104 patients who had undergone major head and neck surgery (defined as surgery lasting longer than 4 hours with a predicted blood loss of 500 ml or greater) at the University of Iowa Hospitals and Clinics between 1985 and 1992. Measurements and Main Results: Central venous monitoring was used in 51 of the 104 (49%) procedures. Patients with and without central monitors did not differ in age, weight, preoperative laboratory values (i.e., hemoglobin (Hb), blood urea nitrogen (BUN), creatinine), incidence of significant cardiac or renal disease, or a smoking history exceeding 30 pack years. In addition, these patients did not differ with respect to the following intraoperative characteristics: general type of anesthetic; duration of surgery; estimate of blood loss; Hb values; lowest urine output per hour; development of oliguria; total urine output; amount of replacement of blood, colloid, or crystalloid; development of systolic blood pressure less than 70 mmHg; or use of a myocutaneous flap. Patients also did not differ with respect to the following postoperative characteristics: duration of stay in the surgical intensive care unit or hospital, BUN or creatinine values on days 1 and 2, total urine output or the development of oliguria on days 1 through 3, incidence of reintubation, fever on days 1 through 5, wound dehiscence, death, myocardial infarction, or the development of pneumonia, pulmonary edema, or sepsis. Patients with central monitors had a greater incidence of having a tracheostomy performed and a slightly lower Hb level on the first postoperative day than those without central monitors. Conclusions: The study raises doubt about the efficacy of routine central venous catheter placement as a necessary guide for fluid and blood administration for these procedures, or as a necessary adjunct for several other parameters of perioperative management. It suggests the need for a randomized, prospective evaluation.
AB - Study Objective: To further define the efficacy of routine central venous catheter placement for major head and neck surgery from the standpoint of fluid and blood administration, and various other parameters of perioperative management. Design: Randomized, retrospective chart review. Setting: University-affiliated medical center. Patients: 104 patients who had undergone major head and neck surgery (defined as surgery lasting longer than 4 hours with a predicted blood loss of 500 ml or greater) at the University of Iowa Hospitals and Clinics between 1985 and 1992. Measurements and Main Results: Central venous monitoring was used in 51 of the 104 (49%) procedures. Patients with and without central monitors did not differ in age, weight, preoperative laboratory values (i.e., hemoglobin (Hb), blood urea nitrogen (BUN), creatinine), incidence of significant cardiac or renal disease, or a smoking history exceeding 30 pack years. In addition, these patients did not differ with respect to the following intraoperative characteristics: general type of anesthetic; duration of surgery; estimate of blood loss; Hb values; lowest urine output per hour; development of oliguria; total urine output; amount of replacement of blood, colloid, or crystalloid; development of systolic blood pressure less than 70 mmHg; or use of a myocutaneous flap. Patients also did not differ with respect to the following postoperative characteristics: duration of stay in the surgical intensive care unit or hospital, BUN or creatinine values on days 1 and 2, total urine output or the development of oliguria on days 1 through 3, incidence of reintubation, fever on days 1 through 5, wound dehiscence, death, myocardial infarction, or the development of pneumonia, pulmonary edema, or sepsis. Patients with central monitors had a greater incidence of having a tracheostomy performed and a slightly lower Hb level on the first postoperative day than those without central monitors. Conclusions: The study raises doubt about the efficacy of routine central venous catheter placement as a necessary guide for fluid and blood administration for these procedures, or as a necessary adjunct for several other parameters of perioperative management. It suggests the need for a randomized, prospective evaluation.
KW - Catheterization
KW - central venous
KW - head and neck
KW - monitoring of
KW - surgery
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U2 - 10.1016/0952-8180(94)00025-Y
DO - 10.1016/0952-8180(94)00025-Y
M3 - Review article
C2 - 7598919
AN - SCOPUS:0028940893
SN - 0952-8180
VL - 7
SP - 119
EP - 125
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
IS - 2
ER -