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Field RR, Mai T, Hanna S, Harrington B, Calderon MD, Rinehart J. Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study. BMC Anesthesiol 2019; 19:191. [PMID: 31656163 PMCID: PMC6815464 DOI: 10.1186/s12871-019-0864-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/30/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. METHODS A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. RESULTS Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. CONCLUSIONS This study showed NPO periods do not influence a patient's volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.
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Affiliation(s)
- R Ryan Field
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA.
| | - Tuan Mai
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | | | - Brian Harrington
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Michael-David Calderon
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
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Yeniay O, Tekgul ZT, Okur O, Koroglu N. Unexpectedly prolonged fasting and its consequences on elderly patients undergoing spinal anesthetics. A prospective observational study1. Acta Cir Bras 2019; 34:e201900309. [PMID: 30892395 PMCID: PMC6585888 DOI: 10.1590/s0102-865020190030000009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/13/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To measure the preoperative fasting durations with respect to time of the day
and its effect on vital parameters and electrocardiogram in elderly patients
undergoing surgery under spinal anesthesia. Methods This study investigated 211 patients older than 60 years undergoing elective
surgery under spinal anesthesia. Patients scheduled for surgery in morning
hours (AM) and afternoon hours (PM) were compared. Patients fasting hours
and repeated measurements of mean arterial pressure (MAP), heart rate (HR),
peripheral oxygen saturation (Sp02) and the type and number of ischemic
electrocardiogram (ECG) signs were recorded and compared [preoperative,
zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)]. Results Mean fasting durations were 12±2.8 and 9.5±2.1 hours in AM group and 15.5±3.4
12.7±4.4 hours in PM group for foods and liquids respectively. ECG changes
were significantly more frequent in PM group and body temperatures were
significantly higher in AM group patients. Conclusion Our study has shown that fasting times in our population is far longer than
recommended and fasting prolonged>15 hours is related to a transiently
increased cardiac stress and mild hypothermia.
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Affiliation(s)
- Oguzhan Yeniay
- MD, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Intensive Care, Izmir, Turkey. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript writing; final approval
| | - Zeki Tuncel Tekgul
- Associate Professor, Izmir Bozyaka Training and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turkey. Scientific, intellectual, conception and design of the study; statistics analysis; critical revision; final approval
| | - Onur Okur
- MD, Istanbul Okmeydani Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey. Conception and design of the study, manuscript preparation and writing, critical revision, final approval
| | - Noyan Koroglu
- MD, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Department of Anesthesiology and Reanimation, Izmir, Turkey. Conception and design of the study, analysis and interpretation of data, technical procedures, manuscript preparation, final approval
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Tabibzadeh N, Wagner S, Metzger M, Flamant M, Houillier P, Boffa JJ, Vrtovsnik F, Thervet E, Stengel B, Haymann JP. Fasting Urinary Osmolality, CKD Progression, and Mortality: A Prospective Observational Study. Am J Kidney Dis 2019; 73:596-604. [PMID: 30777634 DOI: 10.1053/j.ajkd.2018.12.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/01/2018] [Indexed: 12/21/2022]
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) characterized by decreased glomerular filtration rate (GFR) is often accompanied by various degrees of impaired tubular function in the cortex and medulla. Assessment of tubular function may therefore be useful in establishing the severity of kidney disease and identifying those at greater risk for CKD progression. We explored reductions in urinary concentrating ability, a well-known feature of CKD, as a risk factor for GFR decline and end-stage renal disease (ESRD). STUDY DESIGN Prospective longitudinal cohort study. SETTING & PARTICIPANTS 2,084 adult patients with CKD stages 1 to 4 from the French NephroTest Cohort Study. PREDICTOR Fasting urinary osmolality measured using delta cryoscopy. OUTCOMES ESRD, mortality before ESRD, and measured GFR (mGFR) assessed using 51Cr-EDTA renal clearance. ANALYTICAL APPROACH Cause-specific hazards models were fit to estimate crude and adjusted associations of urinary osmolality with ESRD and death before ESRD. Linear mixed models with random intercepts were fit to evaluate the association of urinary osmolality with slope of decline in mGFR. RESULTS At baseline, mean age was 58.7±15.2 (SD) years with a median mGFR of 40.2 (IQR, 29.1-54.5) mL/min/1.73m2 and a median fasting urinary osmolality of 502.7±151.7mOsm/kg H2O. Baseline fasting urinary osmolality was strongly associated with mGFR (R=0.54; P < 0.001). 380 ESRD events and 225 deaths before ESRD occurred during a median follow-up of 5.9 (IQR, 3.8-8.2) years. Patients with lower baseline fasting urinary osmolality had higher adjusted risk for ESRD but not for mortality (HRs of 1.97 [95% CI, 1.26-3.08] and 0.99 [95% CI, 0.68-1.44], respectively, for the lowest vs highest tertile). Based on a mixed linear model adjusted for baseline mGFR and clinical characteristics, patients in the lowest tertile of baseline urinary osmolality had a steeper decline in kidney function (-4.9% ± 0.9% per year; P < 0.001) compared with patients in the highest tertile. LIMITATIONS Fasting was self-reported. CONCLUSIONS Fasting urinary osmolality may be a useful tool, in addition to GFR and albuminuria, for assessing nonglomerular damage in patients with CKD who are at higher risk for CKD progression.
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Affiliation(s)
- Nahid Tabibzadeh
- Sorbonne Université, Inserm UMR_S 1155, Paris, France; Unit of Renal Physiology, AP-HP Hôpital Tenon, Paris, France
| | - Sandra Wagner
- CESP, Inserm U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France; FCRIN INI-CRCT, France
| | - Marie Metzger
- CESP, Inserm U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France
| | - Martin Flamant
- Université Paris Diderot, Paris, France; Unit of Renal Physiology, AP-HP Hôpital Bichat, Paris, France
| | - Pascal Houillier
- Université Paris Descartes, INSERM UMR_S1138, Paris, France; Unit of Renal Physiology, AP-HP Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Jacques Boffa
- Sorbonne Université, Inserm UMR_S 1155, Paris, France; Unit of Nephrology, AP-HP Hôpital Tenon, Paris, France
| | - Francois Vrtovsnik
- Université Paris Diderot, Paris, France; Unit of Nephrology, AP-HP Hôpital Bichat, Paris, France
| | - Eric Thervet
- Université Paris Descartes, INSERM UMR_S1138, Paris, France; Unit of Nephrology, AP-HP Hôpital Européen Georges Pompidou, Paris, France
| | - Bénédicte Stengel
- CESP, Inserm U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France; FCRIN INI-CRCT, France.
| | - Jean-Philippe Haymann
- Sorbonne Université, Inserm UMR_S 1155, Paris, France; Unit of Renal Physiology, AP-HP Hôpital Tenon, Paris, France
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Danielsson EJD, Lejbman I, Åkeson J. Fluid deficits during prolonged overnight fasting in young healthy adults. Acta Anaesthesiol Scand 2019; 63:195-199. [PMID: 30238969 DOI: 10.1111/aas.13254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/02/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Overnight fasting is often prolonged before scheduled surgery, and the extent of perioperative fluid replacement may influence outcome. In clinical practice, basic requirements are estimated at 1.2-2.0 mL·kg-1 ·h-1 , but there is little contemporary clinical data on what deficits result from complete fasting. This prospective preclinical study was designed to determine total fluid loss during overnight fasting, prolonged during daytime. METHODS Twenty (10 female) healthy adult volunteers, aged 24 (range 21-46) years, fasted from 22:00 until 16:00, and had their body weight and urine output measured at predefined time intervals. RESULTS The median (interquartile range) fluid deficits were 0.82 (0.73-1.00) kg, corresponding to 1.26 (1.11-1.41) g·kg-1 ·h-1 for the initial overnight fasting period, 0.59 (0.40-0.70) kg and 0.99 (0.83-1.31) g·kg-1 ·h-1 for the consecutive daytime period, and 1.47 (1.27-1.64) kg and 1.19 (1.05-1.28) g·kg-1 ·h-1 for the total period of fasting. Urine output accounted for 52% of total weight loss and was 36% of the baseline hourly level during the last four-hour period of fasting. CONCLUSIONS Ten hours of overnight fasting in young adults induces fluid deficits at the lower limit of estimated intervals referred to in clinical practice, and hourly weight loss gradually decreases further during prolonged daytime fasting. These findings indicate that current routine procedures do slightly overestimate fluid deficits resulting from prolonged fasting in perioperative clinical practice.
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Affiliation(s)
- Erik J. D. Danielsson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - Ilja Lejbman
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
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Warne LN, Bauquier SH, Pengelly J, Neck D, Swinney G. STANDARDS OF CARE Anaesthesia guidelines for dogs and cats. Aust Vet J 2018; 96:413-427. [PMID: 30370594 DOI: 10.1111/avj.12762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L N Warne
- Lecturer in Veterinary Anaesthesia, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - S H Bauquier
- Board of Directors - Regional Officer, American College of Veterinary Anesthesia and Analgesia; Senior Lecturer in Veterinary Anaesthesia, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, Australia
| | - J Pengelly
- Vice President, Veterinary Nurses Council of Australia; Chair, National Industry Advisory Group for Veterinary Nurses; Training Consultant, Animal Industries Resource Centre; Veterinary Nurse, East Port Veterinary Hospital, Port Macquarie, New South Wales, Australia
| | - D Neck
- Deputy Board Member, Veterinary Surgeons' Board of Western Australia; Cottesloe Vet, Cottesloe, Western Australia, Australia
| | - G Swinney
- Medical Affairs Veterinarian and Internal Medicine Consultant Australia and New Zealand, IDEXX Laboratories Pty Ltd, Rydalmere, New South Wales, Australia
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Alves DR, Ribeiras R. [Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?]. Rev Bras Anestesiol 2017; 67:172-179. [PMID: 28040236 DOI: 10.1016/j.bjan.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment not be promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. METHODS We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6h. Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. RESULTS Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. CONCLUSION Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.
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Alves DR, Ribeiras R. Does fasting influence preload responsiveness in ASA 1 and 2 volunteers? Braz J Anesthesiol 2016; 67:172-179. [PMID: 28236865 DOI: 10.1016/j.bjane.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/09/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. METHODS We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. RESULTS Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. CONCLUSION Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.
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8
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[Preoperative fasting guidelines: an update]. ACTA ACUST UNITED AC 2014; 62:145-56. [PMID: 25443866 DOI: 10.1016/j.redar.2014.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022]
Abstract
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.
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Smorenberg A, Ince C, Groeneveld ABJ. Dose and type of crystalloid fluid therapy in adult hospitalized patients. Perioper Med (Lond) 2013; 2:17. [PMID: 24472418 PMCID: PMC3964340 DOI: 10.1186/2047-0525-2-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 07/04/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE In this narrative review, an overview is given of the pros and cons of various crystalloid fluids used for infusion during initial resuscitation or maintenance phases in adult hospitalized patients. Special emphasis is given on dose, composition of fluids, presence of buffers (in balanced solutions) and electrolytes, according to recent literature. We also review the use of hypertonic solutions. METHODS We extracted relevant clinical literature in English specifically examining patient-oriented outcomes related to fluid volume and type. RESULTS A restrictive fluid therapy prevents complications seen with liberal, large-volume therapy, even though restrictive fluid loading with crystalloids may not demonstrate large hemodynamic effects in surgical or septic patients. Hypertonic solutions may serve the purpose of small volume resuscitation but carry the disadvantage of hypernatremia. Hypotonic solutions are contraindicated in (impending) cerebral edema, whereas hypertonic solutions are probably more helpful in ameliorating than in preventing this condition and improving outcome. Balanced solutions offer a better approach for plasma composition than unbalanced ones, and the evidence for benefits in patient morbidity and mortality is increasing, particularly by helping to prevent acute kidney injury. CONCLUSIONS Isotonic and hypertonic crystalloid fluids are the fluids of choice for resuscitation from hypovolemia and shock. The evidence that balanced solutions are superior to unbalanced ones is increasing. Hypertonic saline is effective in mannitol-refractory intracranial hypertension, whereas hypotonic solutions are contraindicated in this condition.
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Affiliation(s)
- Annemieke Smorenberg
- Department of Intensive Care, Erasmus Medical Centre, ‘s-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Can Ince
- Department of Intensive Care, Erasmus Medical Centre, ‘s-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - AB Johan Groeneveld
- Department of Intensive Care, Erasmus Medical Centre, ‘s-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
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Iwayama S, Tatara T, Osugi T, Hirose M. Preoperative oral rehydration solution intake volume does not affect relative change of mean arterial blood pressure and crystalloid redistribution during general anesthesia in low-risk patients: an observational cohort study. J Anesth 2013; 28:132-5. [PMID: 23828452 DOI: 10.1007/s00540-013-1670-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 06/23/2013] [Indexed: 01/21/2023]
Abstract
Despite the implementation of liberal preoperative fasting routines, it is unclear whether preoperative oral rehydration solution intake volume affects blood pressure during general anesthesia. We enrolled 60 patients (American Society of Anesthesiologists status I/II) undergoing tympanoplasty. Patients drank 200-1,000 ml oral rehydration solution until 2-3 h before anesthesia induction. Anesthesia was induced by propofol and maintained with sevoflurane and remifentanil. Coinciding with anesthesia induction, 15 ml/kg Ringer's acetate solution was administered intravenously over 60 min followed by 1 ml/kg Ringer's acetate solution over the next 30 min. Mean arterial blood pressure (MAP) and whole-body bioelectrical resistance for extracellular fluid (R e) during anesthesia were compared between retrospectively classified intake groups of oral rehydration solution. There were no differences in mean MAP during the 30-90 min period relative to baseline [0.67 (0.60-0.74), 0.65 (0.61-0.76), 0.64 (0.60-0.70), P = 0.96] and relative R e at 90 min [0.945 (0.018), 0.944 (0.021), 0.943 (0.021), P = 0.95] between the small (n = 14), intermediate (n = 29), and large (n = 17) intake groups. The intake volume of preoperative oral rehydration solution does not affect the magnitude of hypotension during general anesthesia in low-risk patients undergoing minor surgery.
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Affiliation(s)
- Sachiko Iwayama
- Department of Anesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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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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