Abstract
BackgroundPerioperative subcutaneous tissue oxygen tension (PsqO2) is substantially reduced in obese surgical patients. Goal-directed fluid therapy optimizes cardiac performance and thus tissue perfusion and oxygen delivery. We therefore tested the hypothesis that intra- and postoperative PsqO2 is significantly reduced in obese patients undergoing standard fluid management compared to goal-directed fluid administration.MethodsWe randomly assigned 60 obese patients (BMI ≥ 30 kg/m2) undergoing laparoscopic bariatric surgery to receive either esophageal Doppler-guided goal-directed fluid management or conventional fluid treatment. Our primary outcome parameter was intra- and postoperative PsqO2 measured with a polarographic electrode in the subcutaneous tissue of the upper arm. A random effects linear regression model was used to analyze the effect of intervention.ResultsOverall, mean (± SD) PsqO2 was significantly higher in obese patients receiving goal-directed therapy compared to conventional fluid therapy (65.8 ± 28.0 mmHg vs. 53.7 ± 21.7, respectively; repeated measures design adjusted difference: 13.0 mmHg [95% CI 2.3 to 23.7; p = 0.017]). No effect was seen intraoperatively (69.6 ± 27.9 mmHg vs. 61.4 ± 28.8, difference: 9.7 mmHg [95% CI -3.8 to 23.2; p = 0.160]); however, goal-directed fluid management improved PsqO2 in the early postoperative phase (63.1 ± 27.9 mmHg vs. 48.4 ± 12.5, difference: 14.5 mmHg [95% CI 4.1 to 24.9; p = 0.006]). Intraoperative fluid requirements did not differ between the two groups.ConclusionsGoal-directed fluid therapy improved subcutaneous tissue oxygenation in obese patients. This effect was more pronounced in the early postoperative period.Clinical Trial Number and RegistryThe study was registered at ClinicalTrials.gov (NCT 01052519).
Highlights
Obesity is a major health care problem and its prevalence is rapidly increasing worldwide [1]
We evaluated perioperative subcutaneous tissue oxygenation in obese patients receiving goal-directed fluid therapy (GDFT) compared to conventional fluid treatment
All included patients received the allocated intervention according to the protocol; there were no cases in which the Measurement of intra- and postoperative subcutaneous tissue oxygen tension was performed in all of the included patients
Summary
Obesity is a major health care problem and its prevalence is rapidly increasing worldwide [1]. In obese patients undergoing anesthesia and surgery, subcutaneous tissue oxygen tension (PsqO2) was substantially reduced compared to nonobese patients, and even supplemental oxygen failed to increase tissue oxygen availability [14, 15]. Beside factors such as the capillary rarefication of adipose tissue [16] and the increased sympathetic activity with subsequent alphaadrenergic vasoconstriction [17], a suboptimal intravascular volume status might have contributed to the observed tissue hypoxia. We tested the hypothesis that intra- and postoperative PsqO2 is significantly reduced in obese patients undergoing conventional fluid management (control group) compared to goal-directed fluid administration. We tested the hypothesis that intra- and postoperative PsqO2 is significantly reduced in obese patients undergoing standard fluid management compared to goal-directed fluid administration
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