• Case Study 3
Patient with Hypotension in PACU Following Spinal Fusion
Background: 77 year-old, 48 kg female with multiple myeloma presented with a collapsed T-12 vertebrae. On admission her hemoglobin was 9.7. Additional medical history included hypertension, a prior coronary angioplasty, and a prior carotid endarterectomy.
During the operation the patient sustained a blood loss of 1700 mL with a urine output of 400 mL. During the procedure, the patient received 4500 mL of IV fluids, 4 units of PRBC, and 250 mL Hespan. In the PACU the patient was still found to be hypotensive (70-80 mm Hg systolic) after 750 mL of IV fluid and neosynepherine were administered.
Methods: The attending physician ordered a bedside TEE using the ClariTEE™ probe (ImaCor Inc, Uniondale, NY). The probe was successfully placed, and the transgastric short-axis view (TGSAV) of the left ventricle (LV) was obtained.
Qualitative and quantitative analysis of the left ventricular size and function revealed hypovolemia, ventricular hypertrophy, and abnormal wall motion. With this information, additional fluids were aggressively administered and pressors were titrated and subsequently discontinued upon achieving normotensive blood pressure. The ClariTEE™ probe remained indwelling in the patient to enable further assessments.
Results: Patient was normotensive (140 mm Hg) in the intensive care unit the next morning.
Conclusion: Postoperative hemodynamic stability is a common complication following non-cardiac surgery. Empiric administration of IV fluids and plasma expanders is inadequate and may contribute to new problems. The ClariTEE™ probe is an effective tool for diagnosing causes of hemodynamic instability in the PACU environment due to the immediacy of the imaging and the actionable data provided to the intensivists.
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