L Meng, P.M. Heerdt British Journal of Anaesthesia

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Perioperative goal-directed haemodynamic therapy based on flow parameters: a concept in evolution L Meng, P.M. Heerdt British Journal of Anaesthesia Volume 117, Pages iii3-iii17 (December 2016) DOI: 10.1093/bja/aew363 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Changes in mean arterial blood pressure (MAP), cardiac output (CO) measured using oesophageal Doppler, and cerebral tissue oxygen saturation (SctO2) measured using near-infrared spectroscopy after phenylephrine and ephedrine bolus treatments, respectively, in two propofol-anaesthetized patients. (A–C) Recordings during phenylephrine treatment. (D–F) Recordings during ephedrine treatment. Vertical arrows indicate the drug administration time. Measurements show the divergent changes in MAP and cardiac output, and that change in tissue oxygenation is in accordance with change in cardiac output, not BP. (Reproduced with permission, from: Meng L, Cannesson M, Alexander BS, Yu Z, Kain ZN, Cerussi AE, Tromberg BJ, Mantulin WW. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011 Aug;107(2):209-17). British Journal of Anaesthesia 2016 117, iii3-iii17DOI: (10.1093/bja/aew363) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Examples of beat-to-beat and mean intra- and extrathoracic haemodynamic measurements, obtained during studies of controlled haemorrhage in anaesthetised swine ventilated with an 8 m1 kg −1 tidal volume (unpublished data obtained under a protocol approved by the Institutional Animal Care and Use Committee of Weill Cornell Medical College). For these studies, airway pressure was recorded at the tracheal tube, and pleural pressure estimated from oesophageal pressure. Left ventricular pressure and volume were measured with a micromanometer/conductance catheter placed via a femoral artery. Ventilation-induced oscillations over 5 cycles of positive pressure ventilation are depicted both at normo- and hypovolaemia. British Journal of Anaesthesia 2016 117, iii3-iii17DOI: (10.1093/bja/aew363) Copyright © 2016 The Author(s) Terms and Conditions