Effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing surgery in prone position

Abstract

Objective To evaluate the effect of goal-directed fluid therapy on postoperative rehabili-tation in elderly patients undergoing surgery in the prone position. Methods Sixty patients of both sexes, aged 60-75 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective lumbar surgery in the prone position under general anesthesia, were divided into 2 groups(n=30 each)using a random number table: conventional fluid therapy group(group C)and goal-directed fluid therapy group(group G). The CNAP system was used to monitor stroke volume variation and cardiac index continuously in group G. Mean arterial pressure was maintained at 60-110 mmHg, central venous pressure at 6-12 cmH2O and urine volume more than 0.5 ml·kg-1·h-1 using conventional fluid therapy in group C. In group G, goal-directed fluid therapy was performed under the guidance of stroke volume variation, and cardiac index was maintained at 2.5-4.0 L·min-1·m-2.The requirement for crystalloid and colloid solution, total volume of fluid infused, blood loss, urine volume and requirement for vasoactive agents were recorded during operation.After anesthesia induction, at 1 h after turning to the prone position and at the end of operation, blood samples were collected from the left radial artery for blood gas analysis, and the blood lactate concentration was recorded.The volume of drainage within 3 days after operation, perioperative blood transfusion, early postoperative cardiovascular and pulmonary complications, development of oliguria and anuria, emergence time and length of hospital stay were recorded. Results Compared with group C, the requirement for crystalloid solution, total volume of fluid infused, urine volume and requirement for vasoactive agents were significantly decreased during operation, the requirement for colloid solution was increased during operation, the blood lactate concentration was decreased at 1 h after turning to the prone position and at the end of operation, the length of hospital stay was shortened, and the incidence of postoperative cardiovascular and pulmonary complications was decreased in group G(P<0.05). Conclusion Goal-directed fluid therapy can promote postoperative rehabilitation and shows a certain clinical value in elderly patients undergoing surgery in the prone position. Key words: Fluid therapy; Aged; Prone position; Rehabilitation