Physiologic responses to massive intraoperative hemorrhage
K. Waxman and W. C. Shoemaker
In five patients who had massive, sudden, intraoperative hemorrhage,
defined as loss of more than 1 L of blood in less than ten minutes, mean
arterial pressure was initially maintained, and there were early increases
in both systemic and pulmonary vascular resistance; however, cardiac output
and oxygen delivery decreased. During control of hemorrhage and replacement
of blood, wedge pressure and central venous pressure increased, and mean
arterial pressure was maintained; however, cardiac output and oxygen
delivery decreased, and oxygen consumption decreased below prehemorrhage
levels. Three patients died postoperatively of multiple organ failure. The
data indicate that anesthesia and operation affect both cardiopulmonary
performance and peripheral oxygen transport, such that the ordinary
physiologic response to hemorrhage are lessened. The absence of
compensatory increase in oxygen consumption after resuscitation may have
contributed to the high postoperative mortality.
