TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING SCOLIOSIS REPAIR - COMPARISONWITH CVP MONITORING

Purpose: Accurate haemodynamic assessment during surgical repair of sc oliosis is crucial to the care of the patient. The purpose of this stu dy was to compare transoesophageal echocardiography (TEE) with central venous pressure monitoring in patients with spinal deformities requir ing surgery in the prone position, Methods: Twelve paediatric patients undergoing corrective spinal surgery for scoliosis/kyphosis in the pr one position were studied. Monitoring included TEE, intra-arterial and central venous pressure monitoring(CVP), Haemodynamic assessment was performed prior to and immediately after positioning the patient prone on the Relton-Hall table. Data consisted of mean arterial blood press ure (mBP), heart rate (HR), CVP, left ventricular end-systolic and end -diastolic diameters (LVESD and LVEDD respectively) and fractional sho rtening(FS). Right ventricular (RV) function and tricuspid regurgitati on (TR) were assessed qualitatively, Analysis was performed using desc riptive statistics, Student's t test, sign rank, and correlation analy sis, Results: There was an increase in CVP (8.7 mmHg to 17.7 mmHg; P < .01), and decreases in LVEDD (37.1 mm to 33.2 mm; P < .05), and mean blood pressure (75.0 mmHg to 65.7 mmHg; P < .05) when patients were pl aced in the prone position, Fractional shortening, LVESD, and HR did n ot change from the supine to the prone position, Right ventricular sys tolic function and tricuspid regurgitation were unchanged, Conclusion: These data indicate that the CVP is a misleading monitor of cardiac v olume in patients with kyphosis/scoliosis in the prone position. This is consistent with previous studies, In this clinical situation, TEE m ay be a more useful monitoring tool to assess on-line ventricular size and function.