Hemodynamic changes in critically ill patients during induction of anesthesia.

: Hemodynamic changes resulting from anesthesia and endotracheal intubation were studied in 32 critically ill patients. Cardiac preload, afterload, and output were measured utilizing Swan-Ganz catheter, arterial catheter, and thermodilution technique. Group I: 15 patients with known cardiac disease. Group II: 10 patients with no known cardiac disease, but with non-specific ECG findings and/or mild cardiomegaly shown by x-ray. Group III: seven patients with no known cardiac disease and without the ECG and x-ray findings of group II. Anesthesia and endotracheal intubation caused an increase in heart rate, systemic arterial pressure, central venous pressure, and pulmonary artery wedge pressure, and a decrease in cardiac output and left ventricular function. Left ventricular function curves showed: group I - severe depression with no recovery; group II - moderate depression with only partial recovery; group III - moderate depression with full recovery. The severity of cardiovascular changes seen varied with the degree of pre-existing cardiac disease. It is concluded that patients with non-specific ECG findings and/or cardiomegaly indicated by x-ray have an increased risk of cardiac dysfunction during anesthesia and require similar preoperative and intraoperative management as do patients with cardiac disease.