الفهرس 
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Abstract
Background: Infants left cardiac output (CO) can be calculated noninvasively with electrical cardiometry (EC) which utilizes the thoracic electrical bioimpedance during cardiac cycle or through a minimal invasive approach via transesophageal doppler probes (TED) which measures the speed of blood flow in the descending aorta.
Extrahepatic biliary atresia is an inflammatory, progressive, fibrosclerosing cholangiopathy of infancy that results in destruction and obstruction of the biliary tract, disease progression leads to hepatic fibrosis, cirrhosis with portal hypertension, liver failure, and death within 2 to 3 years. Current treatment is surgical hepatoportoenterostomy (Kasai procedure) for the relief of biliary obstruction.
Aim: was to compare the Transesophageal Doppler (TED) with Electrical Cardiometry (EC) and investigate both relationship with one another and with the central venous pressure (CVP) regarding haemodynamics and fluid management in infants undergoing surgical hepatoportoenterostomy.
Methods: A prospective randomized study. 42 infants: TED gp (n=21), and EC gp, (n=21). Following induction of anesthesia, a flexible TED probe was passed orally into mid-esophagus until aortic blood flow signals were best identified. Cardiometry four skin sensors were applied at same time. Ringer’s acetate infused intraoperative at 6 m l/ kg/h for basal fluid requirements. Additional boluses of colloids (10ml/kg) were infused guided with corrected flow time (FTc)(mSec) in TED and stroke volume variation (SVV%) in EC,
Results: A good degree of reliability was found between TED and EC CO: post-induction, (Intra-class correlation (ICC) =0.693, p<0.001), first hour (ICC=0.744, p<0.001), second hour (ICC=0.739, p<0.001), third hour (ICC=0.769, p<0.001) and fourth hour (ICC= 0.617, p=0.002). EC CO was constantly higher than TED CO (l/min) 0.95[0.87-1.2] vs 0.9[0.7-1.1] p=0.001 post-induction and 1.02[0.87-1.31] vs 0.8[0.7-1.25], p=0.001, mid-surgery respectively. The Bland and Altman comparison of CO (l/min) between EC and TED showed reasonable bias [mean] but broad limits of agreement (±2 SD): Post-induction: 0.122 (0.636 to -0.391), Hour (h) 1: 0.147 (0.605 to -0.310), Hour (h) 2: 0.130 (0.616 to -0.356), Hour (h) 3: 0.162 (0.578 to -0.253), Hour (h) 4: 0.172 (0.724 to -0.379). A negative correlation existed between FTc and stroke volume variation. Both were affect by diathermy. TED probes required frequent repositioning.
Conclusion: EC CO was consistently higher than TED CO. Bias (mean CO difference between the 2 techniques) was reasonable but precision (±2SD) was wide in range. Trend changes in CO could be tracked by both, but more studies investigating their absolute values compared to the ‘gold standard’ thermodilution technique are needed in this age group.