Hemodynamic monitoring of patients undergoing abdominal aortic surgery.

Cardiac decompensation is clearly the major complication of aortic reconstructive surgery that leads to morbidity. Major changes in intravascular volume, third spacing, and increased systemic vascular resistance are extremely stressful to the diseased heart. Hemodynamic monitoring is readily available to provide an accurate evaluation of myocardial sensitivity and to allow for appropriate pharmacologic manipulation to preclude cardiac catastrophe. We believe all patients undergoing abdominal aortic reconstructive surgery should receive the benefit of pulmonary artery catheterization and intraarterial monitoring. The only requirement is a staff of surgeons, anesthesiologists, and nurses capable of correct interpretation of the data and use of drug therapy based on this information. The benefits are an accurate assessment of cardiac function with the ability to modulate the patient's hemodynamic values, preventing volume shifts, hypertensive and hypotensive crises, and abnormal fluctuations in preload and afterload, and ultimately a safer perioperative course.