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Vazquez Martinez JL. Volume load during major abdominal surgery: focusing on the fluid responsiveness. Minerva Anestesiol 2020; 86:473-475. [PMID: 32100516 DOI: 10.23736/s0375-9393.20.14328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jose L Vazquez Martinez
- Pediatric Intensive Care Unit, Pediatrics Department, University Hospital Ramón y Cajal, Madrid, Spain -
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Arterial Pressure Variation in Elective Noncardiac Surgery: Identifying Reference Distributions and Modifying Factors. Anesthesiology 2017; 126:249-259. [PMID: 27906705 DOI: 10.1097/aln.0000000000001460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic and pulse pressure variation, are demonstrated as reliable measures of fluid responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for systolic and pulse pressure variation values have not been established for euvolemic intraoperative patients. The authors sought to establish systolic and pulse pressure variation reference distributions and assess the impact of modifying factors. METHODS The authors evaluated adult patients undergoing general anesthetics for elective noncardiac surgery. Median systolic and pulse pressure variations during a 50-min postinduction period were noted for each case. Modifying factors including body mass index, age, ventilator settings, positioning, and hemodynamic management were studied via univariate and multivariable analyses. For systolic pressure variation values, effects of data entry method (manually entered vs. automated recorded) were similarly studied. RESULTS Among 1,791 cases, per-case median systolic and pulse pressure variation values formed nonparametric distributions. For each distribution, median values, interquartile ranges, and reference intervals (2.5th to 97.5th percentile) were, respectively, noted: these included manually entered systolic pressure variation (6.0, 5.0 to 7.0, and 3.0 to 11.0 mmHg), automated systolic pressure variation (4.7, 3.9 to 6.0, and 2.2 to 10.4 mmHg), and automated pulse pressure variation (7.0, 5.0 to 9.0, and 2.0 to 16.0%). Nonsupine positioning and preoperative β blocker were independently associated with altered systolic and pulse pressure variations, whereas ventilator tidal volume more than 8 ml/kg ideal body weight and peak inspiratory pressure more than 16 cm H2O demonstrated independent associations for systolic pressure variation only. CONCLUSIONS This study establishes real-world systolic and pulse pressure variation reference distributions absent in the current literature. Through a consideration of reference distributions and modifying factors, the authors' study provides further evidence for assessing intraoperative volume status and fluid management therapies.
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Kasai T, Hashiba E, Saito J, Hirota K. Effects of cardiac output on the initial distribution volume of glucose in the absence of fluid gain or loss in pigs. J Anesth 2016; 31:95-102. [PMID: 27785582 DOI: 10.1007/s00540-016-2272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
The initial distribution volume of glucose (IDVG) has been reported to be a surrogate marker of cardiac preload. However, the relationship between cardiac output and IDVG is not fully understood. We investigated the effects of cardiac output on IDVG in the absence of fluid gain or loss in pigs. MATERIALS AND METHODS Thirteen pigs were anesthetized and allocated to either the modified cardiac output group (m-CO group, n = 10) or the control group (control group, n = 3). In the m-CO group, CO was sequentially modulated from high CO (high CO) to two grades of low CO (low CO-1 and low CO-2) with dobutamine and propranolol with lidocaine, respectively, in the absence of any apparent change in basal fluid volume status. Thermodilutional CO and IDVG were measured at each CO condition. The IDVG was measured according to a one-compartment model with 2 g glucose. The same parameters were measured in the control group using the same time schedule as for the m-CO group but without inotropes and at a stable CO state. Thereafter, 250 ml of 10% dextran were infused over 15 min to compare the effects of a preload-dependent increase in CO on IDVG measurements to the effects of the pharmacological modification of CO. Data were expressed as the mean ± SD. Statistical analysis was performed with repeated measures ANOVA followed by Dunnett's test. Pearson's correlation test was also used. A P value of <0.05 was considered to indicate statistical significance. RESULTS In the m-CO group, where CO increased to 147.2 ± 26.7% of the baseline CO value in the high CO state and decreased to 65.9 ± 11.0 and 37.3 ± 14.4% of the baseline CO value in the low CO-1 state and the low CO-2 state, respectively, the IDVG did not change as CO was modified. IDVG significantly increased in response to volume loading of dextran in the control group. There was no correlation between the IDVG and CO in the m-CO group when there was no fluid gain or loss (r = 0.097, n = 40, P = 0.554), but the IDVG was well correlated with CO in the control group with volume loading (r = 0.764, n = 18, P = 0.0002). CONCLUSION This study suggests that the IDVG is dependent on the central extracellular fluid volume and not on cardiac output.
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Affiliation(s)
- Toshinori Kasai
- Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8563, Japan.
| | - Eiji Hashiba
- Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8563, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8563, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8563, Japan
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Zhang X, Feng J, Zhu P, Luan H, Wu Y, Zhao Z. Ultrasonographic measurements of the inferior vena cava variation as a predictor of fluid responsiveness in patients undergoing anesthesia for surgery. J Surg Res 2016; 204:118-22. [PMID: 27451877 DOI: 10.1016/j.jss.2016.03.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Both hypovolemia and hypervolemia are connected with increased morbidity and mortality in the treatment and prognosis of patients. An accurate assessment of volume state allows the optimization of organ perfusion and oxygen supply. Recently, ultrasonography has been used to detect hypovolemia in critically ill patients and perioperative patients. The objective of our study was to assess the correlation between inferior vena cava (IVC) variation obtained with ultrasound and stroke volume variation (SVV) measured by the Vigileo/FloTrac monitor, as fluid responsiveness indicators, in patients undergoing anesthesia for surgery. METHODS Forty patients (American Society of Anesthesiologists grades I and II) scheduled for elective gastrointestinal surgery were enrolled in our study. After anesthesia induction, 6% hydroxyethyl starch solution was administered to patients as an intravenous (IV) fluid. The IVC diameters were measured with ultrasonography. SVV and stroke volume index (SVI) were obtained from the Vigileo monitor. All data were collected both before and after fluid challenge. RESULTS Forty patients underwent IVC sonographic measurements and SVV calculation. After fluid challenge, mean arterial pressure, central venous pressure, SVI, and IVC diameters increased significantly, whereas SVV decreased markedly. The correlation coefficient between the increase in SVI and the baseline of IVC variation after an IV fluid was 0.710, and receiver operating characteristic (ROC) curve was 0.85. The correlation coefficient between the increase in SVI and the baseline of SVV was 0.803 with an ROC curve of 0.93. Central venous pressure had no significant correlation with SVI. CONCLUSIONS Our data show that IVC variation and SVV proved to be reliable predictors of fluid responsiveness in patients undergoing anesthesia for surgery with mechanical ventilation.
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Affiliation(s)
- Xiaobao Zhang
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China
| | - Jiying Feng
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China
| | - Pin Zhu
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China
| | - Hengfei Luan
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China
| | - Yong Wu
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China.
| | - Zhibin Zhao
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China.
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The comparison between stroke volume variation and filling pressure as an estimate of right ventricular preload in patients undergoing renal transplantation. J Anesth 2014; 29:40-6. [DOI: 10.1007/s00540-014-1870-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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Lu W, Dong J, Xu Z, Shen H, Zheng J. The pleth variability index as an indicator of the central extracellular fluid volume in mechanically ventilated patients after anesthesia induction: comparison with initial distribution volume of glucose. Med Sci Monit 2014; 20:386-92. [PMID: 24608263 PMCID: PMC3958567 DOI: 10.12659/msm.890073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The pleth variability index (PVI) has been demonstrated to be a useful, noninvasive indicator of continuous fluid responsiveness. Whether PVI can be used to assess the changes of intravascular volume status remains to be elucidated. Material/Methods Using correlation analysis and receiver operating characteristic (ROC) curves, we sought a correlation between PVI and the initial distribution volume of glucose (IDVG), evaluating PVI as an indicator of the central extracellular fluid volume after anesthesia induction in patients undergoing elective abdominal surgery. Results Strong negative correlations existed between IDVG and PVI (r=−0.72), IDVG, and pulse pressure variation (PPV) (r=−0.73), and between IDVG and systolic pressure variation (SPV) (r=−0.53), P<0.01. Strong positive correlations existed between PPV and PVI (r=0.66), PVI and SPV (r=0.49), and between PPV and SPV (r=0.59), P<0.01. The areas under the ROC curve of IDVG, PVI, and SPV were significantly different from the area under a reference line. The optimal cutoff values (followed by sensitivity and specificity in parentheses) comparable to PPV over 11% as the threshold of hypovolemia were IDVG 94.5 mL/kg (75%, 100%), PVI 13% (91.7%, 77.8%), and SPV 7% (41.7%, 100%). Conclusions Our results show that strong correlations exist among IDVG, PVI, PPV, and SPV in the evaluation of volemia. PVI can serve as a useful, noninvasive indicator of continuous central extracellular fluid volume for those patients not requiring invasive hemodynamic monitoring, but needs attention to changes in intravascular volume status for optimal fluid management.
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Affiliation(s)
- Wenqing Lu
- Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Jing Dong
- Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Zifeng Xu
- Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Hao Shen
- Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland)
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Ishihara H, Hashiba E, Okawa H, Saito J, Kasai T, Tsubo T. Basic and clinical assessment of initial distribution volume of glucose in hemodynamically stable pediatric intensive care patients. J Intensive Care 2014; 2:59. [PMID: 25774299 PMCID: PMC4358717 DOI: 10.1186/s40560-014-0059-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/15/2014] [Indexed: 11/23/2022] Open
Abstract
Background Initial distribution volume of glucose (IDVG), which is not associated with significant modification of glucose metabolism, has been proposed as an indicator of the central extracellular fluid volume status in adults. However, data on IDVG in children are lacking. This study examined pharmacokinetic data on IDVG in children and compared IDVG with other clinical variables. Methods In total, 128 daily data sets from 60 consecutive pediatric intensive care patients (body weight ≥8.0 kg), consisting mostly of children undergoing cardiovascular surgery, were studied. Either 1 or 2 g of glucose based on body weight (approximately 0.1 g/kg) was administered. IDVG could not be determined from ten data sets from eight children because of body movement-associated glucose fluctuation during measurement. In the remaining 113 data sets from 55 children, IDVG was determined by applying the one-compartment model. Approximated IDVG based on the incremental plasma glucose level at 3 min postinjection (1-point IDVG), and approximated IDVG based on incremental plasma glucose levels at 3 and 5 min postinjection (2-point IDVG), were also calculated. Postoperative daily IDVG and the relationship between IDVG and cardiac output or circulating blood volume (CBV) were evaluated when data were available. Results Convergence was assumed in each glucose clearance curve. Mean indexed IDVG (IDVGI) of the first measurement in 55 children was 144 ± 22 (SD) mL/kg, which was associated with a plasma glucose disappearance rate (Ke-glucose) of 0.094 ± 0.033/min. Bias and precision were smaller between 2-point IDVG and standard IDVG than between 1-point IDVG and standard IDVG (−0.02 ± 0.13 L versus 0.07 ± 0.20 L, p <0.001). Postoperative IDVGI in 37 children after cardiovascular surgery increased daily on postoperative days 1–2 (p ≤0.011). Linear correlations were observed between IDVGI and indexed cardiac output (r = 0.588, n = 28, p <0.001) and between IDVGI and indexed CBV (r = 0.547, n = 25, p = 0.0047). Conclusions IDVG is a potential marker of fluid volume status in children, even though body movement-associated glucose fluctuation is a major limitation. Two-point IDVG is preferable to 1-point IDVG for approximated IDVG.
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Affiliation(s)
- Hironori Ishihara
- Department of Anesthesiology, Kuroishi-Kousei Hospital, 9-1 Tateishi, Kuroishi-shi, Aomori 036-0351 Japan
| | - Eiji Hashiba
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan
| | - Hirobumi Okawa
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan
| | - Toshinori Kasai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan
| | - Toshihito Tsubo
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan
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Corrected right ventricular end-diastolic volume and initial distribution volume of glucose correlate with cardiac output after cardiac surgery. J Anesth 2013; 27:512-20. [PMID: 23455772 DOI: 10.1007/s00540-013-1558-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Appropriate adjustment of cardiac preload is essential to maintain cardiac output (CO), especially in patients after cardiac surgery. This study was intended to determine whether index of right ventricular end-diastolic volume (RVEDVI), corrected RVEDVI using ejection fraction (cRVEDVI), index of initial distribution volume of glucose (IDVGI), or cardiac filling pressures are correlated with cardiac index (CI) following cardiac surgery in the presence or absence of arrhythmias. METHODS Eighty-six consecutive cardiac surgical patients were studied. Patients were divided into two groups: the non-arrhythmia (NA) group (n = 72) and the arrhythmia (A) group (n = 14). Three sets of measurements were performed: on admission to the ICU and daily on the first 2 postoperative days. The relationship between each cardiac preload variable and cardiac index (CI) was evaluated. A p value less than 0.05 indicated statistically significant differences. RESULTS Each studied variable was not different between the two groups immediately after admission to the ICU. cRVEDVI had a linear correlation with CI in both group (NA group: r = 0.67, n = 216, p < 0.001; A group: r = 0.77, n = 42, p < 0.001), but RVEDVI had a poor correlation with CI (NA group: r = 0.27, n = 216, p < 0.001; A group: r = 0.19, n = 42, p = 0.036). IDVGI had a linear correlation with CI (NA group: r = 0.49, n = 216, p < 0.001; A group: r = 0.61, n = 42, p < 0.001), Cardiac filling pressures had no correlation with CI. CONCLUSION Our results demonstrated that cRVEDVI and IDVGI were correlated with CI in the presence or absence of arrhythmias. cRVEDVI and IDVGI have potential as indirect cardiac preload markers following cardiac surgery.
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Ishihara H, Hashiba E, Okawa H, Saito J, Kasai T, Tsubo T. Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy. Perioper Med (Lond) 2013; 2:3. [PMID: 24472615 PMCID: PMC3964321 DOI: 10.1186/2047-0525-2-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 02/08/2013] [Indexed: 11/17/2022] Open
Abstract
Background Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity. Methods Forty-three consecutive non-arrhythmic patients undergoing abdominothoracic esophagectomy were studied. SVV, PPV, cardiac index (CI), and indexed ITBV (ITBVI) were postoperatively measured by single transpulmonary thermodilution (PiCCO system) after patient admission to the intensive care unit (ICU) on the operative day. Indexed IDVG (IDVGI) was then determined using the incremental plasma glucose concentration 3 min after the intravenous administration of 5 g glucose. Fluid responsiveness was defined by an increase in CI >15% compared with pre-loading CI following fluid volume loading with 250 mL of 10% low molecular weight dextran. Results Twenty-three patients were responsive to fluids while 20 were not. The area under the receiver-operating characteristic (ROC) curve was the highest for CVP (0.690) and the lowest for ITBVI (0.584), but there was no statistical difference between tested variables. Pre-loading IDVGI (r = −0.523, P <0.001), SVV (r = 0.348, P = 0.026) and CVP (r = −0.307, P = 0.046), but not PPV or ITBVI, were correlated with a percentage increase in CI after fluid volume loading. Conclusions These results suggest that none of the tested variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy.
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Affiliation(s)
- Hironori Ishihara
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi 036-8562, Japan.
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Kang WS, Lee J, Shin H, Kim SH, Kim TY, Seo D, Yoon TG. Noninvasive Cardiac Output Monitoring in Paediatric Cardiac Surgery: Correlation between Change in Thoracic Fluid Content and Change in Patient Body Weight. J Int Med Res 2012; 40:2295-304. [DOI: 10.1177/030006051204000627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Change in thoracic fluid content (TFC) derived via a bioreactance technique with a noninvasive cardiac output monitoring device (NICOM) reportedly shows a good correlation with the amount of fluid removed. The present study prospectively evaluated the utility and clinical application of TFC in the intraoperative fluid management of paediatric patients with congenital heart disease, undergoing cardiac surgery with bioreactance-based noninvasive monitoring. Methods: Haemodynamic parameters, patient body weight and parameters derived from the NICOM device (including cardiac output, cardiac index, TFC, percentage change in TFC compared with baseline [TFCd0%] and stroke volume variation) were recorded after anaesthesia induction but before surgical incision, and just before departure from the operating room to the intensive care unit. Results: In the 80 paediatric patients included in this study, linear regression analyses demonstrated good correlations between body weight gain and TFCd0%, between body weight gain % and TFCd0%, and between intra -operative fluid balance and TFCd0%. Conclusion: TFCd0% may be a useful indicator for intraoperative fluid management in paediatric patients with congenital heart disease, undergoing cardiac surgery.
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Affiliation(s)
- W-S Kang
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jh Lee
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hj Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - T-Y Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dm Seo
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - T-G Yoon
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
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Jacob M, Chappell D. Effects of perioperative fasting on haemodynamics and intravascular volumes. Best Pract Res Clin Anaesthesiol 2012; 26:421-30. [DOI: 10.1016/j.bpa.2012.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/10/2012] [Indexed: 12/15/2022]
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Zhang J, Qiao H, He Z, Wang Y, Che X, Liang W. Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive. Clinics (Sao Paulo) 2012; 67:1149-55. [PMID: 23070341 PMCID: PMC3460017 DOI: 10.6061/clinics/2012(10)06] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/28/2012] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution. METHOD A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints. RESULTS The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups. CONCLUSION Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.
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Affiliation(s)
- Jun Zhang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
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