Placement of the pulmonary arterial catheter before anesthesia for cardiac surgery: a stressful, painful, unnecessary crutch.

Catheterization of the pulmonary artery (PA) in patients with cardiac or major vascular disease is a popular practice. However, controversy surrounds the question of whether the PA catheter should be inserted before or after the induction of anesthesia. Review of the literature supports insertion after induction for several reasons. First, the information provided by a PA catheter may be misleading, since it does not provide a direct measurement of left ventricular function, but rather, an indirect reflection that is subject to many variables. Second, pharmacologic intervention before anesthesia to correct hemodynamic abnormalities detected by a PA catheter has not been shown to improve induction of anesthesia or outcome after cardiac surgery. Induction of anesthesia with synthetic narcotics in patients with either normal or abnormal hemodynamic function is fast and uneventful, making insertion of a PA catheter before induction unnecessary. Finally, the act of inserting a PA catheter produces cardiovascular stimulation that can lead to myocardial ischemia. Thus, insertion of a PA catheter can be more safely and rationally performed after the induction of anesthesia.