RESEARCH ARTICLE


The Feasibility and Applications of Non-invasive Cardiac Monitoring in Obese Patients Undergoing Day-case Surgery: Results of a Prospective Observational Study



P. Sansone1, L.G. Giaccari1, U. Colella2, F. Coppolino1, M.C. Pace1, M.B. Passavanti, V. Pota1, C. Aurilio1, *
1 Department of Women, Children and General and Specialist Surgery, University of Campania “Luigi Vanvitelli” – Naples, Italy
2 Department of Anaesthesia and Intensive Care, AORN “Azienda Ospedaliera dei Colli” – Naples, Italy


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Creative Commons License
© 2020 Sansone et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Women, Children, General and Specialistic Surgery. University of Campania “L. Vanvitelli”, Piazza Miraglia 2 80138 – Napoli, Italy; E-mail: caterina.aurilio@unicampania.it


Abstract

Aims:

This prospective observational study evaluates the utility of non-invasive cardiac monitoring in obese patients in the day-surgery case, considering factors, such as Body Mass Index (BMI) and anaesthesia technique.

Background:

Obese patients are more likely to be admitted to hospital or to get hospitalized because they are more prone to concomitant diseases and obesity itself is not a contraindication to day surgery. Obese patients are a high-risk patient population that may particularly benefit from monitoring perioperative haemodynamic variations.

Methods:

In this observational study, we compared haemodynamic variations between overweight or obese and normal weight patients undergoing day-case surgery. We adopted NICOM® as a non-invasive cardiac output monitoring.

Objective:

The aim of the current study was to investigate the haemodynamic impact of BMI and anaesthesia technique during day-case surgery procedures. The other goal was to evaluate the feasibility and applications of non-invasive cardiac output monitoring among the obese population in day-surgery.

Results:

74 patients were included in the study. 34 were overweight or obese (weight 84 ± 10 kg, height 160 ± 10 cm, BMI ≈ 30 kg/m2), 40 were normal weight (weight 63 ± 15 kg, height 160 ± 10 cm, BMI ≈ 22 kg/m2). Compared to normal-weight patients, obese patients show an increase in blood pressure with a return to baseline values at the end of surgery (p < 0.05). The Cardiac Output (CO) shows a similar trend, whereas the heart rate is normal. A decrease in the Cardiac Index (CI) during the operation was noticed in both groups, the one in obese patients (p = 0.24) being greater. In the same way, the Stroke Volume Index (SVI) was lower in obese patients during surgery (p < 0.05). In spinal anaesthesia, the Total Peripheral Resistance Index (TPRI) was not statistically different between the groups of study. As for the TPRI in obese patients, we reported values similar to the ones in non-obese patients in spinal anaesthesia. In local anesthesia, TPRI was higher in obese patients than in non-obese.

Conclusion:

Cardiovascular alterations in relation to obesity include an increase in blood pressure, CO and SV. An inadequate monitoring of haemodynamic parameters is a risk factor for perioperative complications. NICOM® provides a continuous, non-invasive haemodynamic measurement.

Keywords: Obese, Day-case surgery, NICOM®, Non-invasive cardiac monitoring, Cardiac output (CO), Cardiac index (CI), Stroke volume index (SVI), Total peripheral resistance index (TPRI).