Abstract
Intraoperative fluid management is quite important in terms of postoperative organ perfusion and complications. Different fluid management protocols are in use for this purpose. Our primary goal was to compare the effects of conventional fluid management (CFM) with the Pleth Variability Index (PVI) guided goal-directed fluid management (GDFM) protocols on the amount of crystalloids administered, blood lactate, and serum creatinine levels during the intraoperative period. The length of hospital stay was our secondary goal. Seventy ASA I–II elective colorectal surgery patients were randomly assigned to CFM or GDFM for fluid management. The hemodynamic data and the data obtained from ABG were recorded at the end of induction and during the follow-up period at 1 h intervals. In the preoperative period and at 24 h postoperatively, blood samples were taken for the measurement of hemoglobin, Na, K, Cl, serum creatinine, albumin and blood lactate. In the first 24 h after surgery, oliguria and the time of first bowel movement were recorded. Length of hospital stay was also recorded. Intraoperative crystalloid administration and urine output were statistically significantly higher in CFM group (p < 0.001, p: 0.018). The end-surgery fluid balance was significantly lower in Group GDFM. Preoperative and postoperative Na, K, Cl, serum albumin, serum creatinine, lactate and hemoglobin values were similar between the groups. The time to passage of stool was significantly short in Group-GDFM compared to Group-CFM (p = 0.016). The length of hospital stay was found to be similar in both group. PVI-guided GDFM might be an alternative to CFM in ASA I–II patients undergoing elective colorectal surgery. However, further studies need to be carried out to search the efficiency and safety of PVI.
Highlights
Intraoperative fluid management is quite important in terms of postoperative organ perfusion and complications [1]
The patients were randomized by double-blind closed envelope method and divided into two groups: 35 patients were in the conventional fluid management group (GroupCFM) and 35 patients were in the Pleth Variability Index (PVI)-based goal-directed fluid management group (Group-GDFM)
The heart rate (HR) was similar in both groups at the end of the first hours while it was significantly higher at 2nd hours in Group-GDFM (p: 0.026)
Summary
Intraoperative fluid management is quite important in terms of postoperative organ perfusion and complications [1]. Various complications such as acute renal failure, hypotension, arrhythmia, anastomosis leak may occur secondary to intraoperative hypovolemia whereas hypervolemia may cause pulmonary edema, postoperative pneumonia, prolonged mechanical ventilation, delayed wound healing, edema in the gastrointestinal system (GIS), and decreased GIS motility [2,3,4,5]. Our primary goal was to compare the effects of both fluid management protocols on the amount of crystalloids administered, blood lactate, and serum creatinine levels during the intraoperative period.
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