Rajeev Damodaran Sarojini1, Sanjay Sahadevan2, Jayakumar Christhudas3
BACKGROUND
There are extensive variations in central venous pressure during intraoperative
period of a major neurosurgical patients. Monitoring of central venous pressure
is vital for guiding the administration of fluids, blood and blood products. Central
venous pressure (CVP) also measures the intracranial pressure indirectly.
Increased intracranial pressure thereby reduces the cerebral blood flow, leading
to cerebral ischemia.
METHODS
This is a prospective study where 25 major neurosurgical cases posted for
elective major neurosurgery were selected. Right subclavian vein was selected
for cannulation, by blind technique in all these cases. CVP was recorded every 15
minutes. Central venous catheter was connected to a pressure transducer linked
to a multichannel monitor; zeroing was done and the CVP reading obtained.
RESULTS
Central venous pressure reading was done serially and showed the trends in
haemodynamics in various stages of surgery. Initial intraoperative periods
showed lower values due to intravenous (I / V) induction of anaesthesia, use of
mannitol and diuretics. Later on, the trends changed to higher side subsequent
to administration of fluids and blood as required.
CONCLUSIONS
Monitoring of CVP is an important component of haemodynamic monitoring
along with non-invasive blood pressure (NIBP), intra-arterial blood pressure
(IABP), and urine output. Central venous pressure can be used to aspirate an air
embolism occurring during the intraoperative period after employing Durant’s
position.
