Graduation Date

Summer 8-19-2016

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Lani Zimmerman, RN, PhD

Second Advisor

Jane Meza PhD

Third Advisor

Jason Johanning MD, MS

Abstract

Left ventricular diastolic dysfunction (LVDD) of the heart is a condition where the heart does not relax properly. This condition is important during times of stress, as LVDD is associated with significant morbidity of elderly surgical patients. LVDD is often asymptomatic and unrecognized as many of these patients have normal ejection fractions. However, LVDD may lead to heart failure in patients with preserved systolic function, with the incidence being as high as 50% in hospitalized elderly patients. The diagnosis of LVDD is an independent risk factor for postoperative major adverse cardiac events (MACE) and negatively impacts post-surgery readmission rates. Anesthesiologists play a critical role in the care of elderly patients by managing fluid therapy during surgery. Current standard of care is to manage elderly patients with LVDD using only blood pressure monitoring. Unfortunately blood pressure monitoring is unable to detect changes in diastolic function, which fluid administration may affect. In contrast, transesophageal echocardiography (TEE) can easily measure diastolic function in real-time in the operating rooms. No current studies, however, have assessed changes to diastolic function in response to fluid boluses during noncardiac surgery. Therefore, it is important to serially evaluate LVDD intraoperatively with TEE and determine if changes in anesthetic management, specifically the response to fluid boluses, has effects on diastolic indices. The specific aim of this study is evaluate changes in left ventricular filling pressures and cardiac output in response to fluid boluses during the perioperative period. We predict echocardiographic diastolic indices are influenced by intraoperative fluid administration.

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