Fluid Therapy In Abdominal Surgery Research Articles

Use of Acetate-Buffered Crystalloid Solutions for Fluid Therapy in Abdominal Surgery (Review)

Infusion therapy is one of the most frequently prescribed treatments in hospitalized patients. Fluid maintenance and resuscitation is an important strategy in major surgery. Acetate-buffered balanced crystalloid fluids may influence acid-base status, intracellular and extracellular water content, plasma electrolyte composition and have a favorable impact on renal, hepatic, and splanchnic microcirculation. Aim was to evaluate current evidence of efficacy and safety of acetate-buffered crystalloid solutions for fluid therapy in abdominal surgery in adults. Materials and methods . Medline, the Cochrane Library, eLIBRARY.ru were searched up to 31 May 2020 (additional search in November 2020) using the key words «acetate» AND «buffers» OR «buffered» AND «crys-talloid solutions» OR «crystalloids». Studies published after 2009 in English and Russian were included. Systematic review was conducted in accordance with PRISMA guidelines using specified PICO(S) criteria. Results . The total of 62 studies were identified from all databases. Out of them 11 full-text publications were considered eligible, 6 of them were included into the final review. Acetate-buffered crystalloid solutions have a favorable impact on microcirculation. Metabolic alkalosis after the fluid infusion did not occur in all the studies; potassium levels remained stable, also. Conclusion . Efficacy (based on acid-base status, hemodynamic parameters) of the acetate-buffered crystalloid solutions for fluid therapy during the abdominal surgery in adults patients was confirmed with the A level of evidence.

Fluid Therapy in Patients Undergoing Abdominal Surgery: A Bumpy Road Towards Individualized Management.

Prudent intraoperative fluid replacement therapy, inotropes, and vasoactive drugs should be guided by adequate hemodynamic monitoring. The study aimed to evaluate the single-centre practice on intraoperative fluid therapy in abdominal surgery (AS). The evaluation, based on a review of medical files, included 235 patients (103 men), aged 60±15years who underwent AS between September and November 2017. Fluid therapy was analyzed in terms of quality and quantity. There were 124 high-risk patients according to the American Society of Anaesthesiologists Classification (ASA Class 3+) and 89 high-risk procedures performed. The median duration of procedures was 175 (IQR 106-284) min. Eleven patients died post-operatively. The median fluids volume was 10.4mL/kg/h of anaesthesia, including 9.1mL/kg/h of crystalloids and 2.7mL/kg/h of synthetic colloids. Patients undergoing longer than the median procedures received significantly fewer fluids than those who underwent shorter procedures. The volume of fluids in the longer procedures depended on the procedural risk classification and was significantly greater in high-risk patients undergoing high-risk surgery. Patients who died received significantly more fluids than survivors. In all patients, a non-invasive blood pressure monitoring was used and only six patients had therapy guided by metabolic equilibrium. The fluid therapy used was liberal but complied with the recommendations regarding the type of fluid and risk-adjusted dosing. Hemodynamic monitoring was suboptimal and requires modifications. In conclusion, the optimization of intraoperative fluid therapy requires a balanced and standardized approach consistent with treatment procedures.

Fluid therapy in the perioperative setting-a clinical review.

BackgroundPerioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice.ResultsPreoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance. Hence, the intake of fluid (preferably containing carbohydrates) should be encouraged up to 2 h prior to surgery in order to avoid dehydration. Excessive intravenous fluid administration adds to tissue inflammation and edema formation, thereby compromising tissue healing.During major abdominal surgery a “zero-balance” intraoperative fluid strategy aims at avoiding fluid overload (and comparable to the so-called restrictive approach) as well as goal-directed fluid therapy (GDT). Both proved to significantly reduce postoperative complications when compared to “standard fluid therapy”. Trials comparing “restrictive” or zero-balance and GDT have shown equal results, as long as fluid overload is avoided in the GDT group as well (categorized as “zero-balance GDT”).It is possible that high-risk surgical patients, such as those undergoing acute surgery, may benefit from the continuous monitoring of circulatory status that the GDT provides. Data on this group of patients is not available at present, but trials are ongoing.ConclusionIn elective surgery, the zero-balance approach has shown to reduce postoperative complications and is easily applied for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1–2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being.

Microcirculatory changes during goal-directed or mean arterial pressure-guided fluid therapy in abdominal surgery

This study compared the effect of pulse pressure variation (PPV) and cardiac index (CI)-guided fluid therapy versus mean arterial pressure (MAP)-guided fluid therapy on microcirculatory perfusion in patients undergoing abdominal surgery.