Objective:Goal-directed fluid therapy (GDFT) was associated with improved outcomes after surgery. Noninvasive Cardiac Output Monitoring (NICOM) has proved to be a good choice for guiding GDFT. This study evaluated the effect of GDFT based on NICOM on prognosis in elderly patients undergoing resection of gastrointestinal tumor.Methods:Fifty patients scheduled for elective laparoscopic radical resection for stomach, colon or rectal cancer in Yongchuan Hospital of Chongqing Medical University between November 2014 and December 2015 were included and randomly divided into two groups: conventional fluid therapy (group C, n=25) and goal-directed fluid therapy (group G, n=25). The primary outcome was moderate or severe postoperative complications within 30 days.Results:Finally, 45 patients successfully completed the study (group G, n=22; group C, n=23). There were no difference of the duration of surgery, the requirement of vasoactive agents and the bleeding volume between two groups (P>0.05). Total fluids infused were 2956±629 ml (group C) and 2259±454 ml (group G) (P<0.05), while the requirement of colloid was increased in group G (1103±285ml vs 855±226ml) (P<0.05). The MAP and the mean CI were higher in group G (P<0.05). Compared with group C, the time when the patients passed the flatus and the length of hospital stay after operation were shortened in group G (12.6±2.4day vs17.2±2.6day), the incidence of postoperative complications were significantly lower in group G (P<0.05).Conclusions:Goal-directed fluid therapy based on NICOM was significantly associated with improvement of prognosis in elderly patients undergoing resection of gastrointestinal tumor which reduced postoperative complications.

This study evaluates the hemodynamic effects of the administration of 10% pentastarch solution (PS) during the initial treatment of hypovolemia in trauma patients. This prospective randomized phase II study included trauma patients admitted to the emergency room with hemorrhagic hypovolemia: systolic blood pressure (SBP) < 90 mmHg. Upon admission, the patients were randomized to receive 10% PS (n = 12) or isotonic 0.9% NaCl solution (IS) (n = 11), infused intravenously in 250-ml boluses, repeated until SBP > 100 mmHg. Blood pressure, infused volumes necessary to maintain SBP, and overall survival rates were determined and compared between groups. SBP increased significantly following either IS (from 64.4 +/- 9.2 mmHg to 111.1 +/- 6.3 mmHg), or PS (from 63.7 +/- 10.6 mmHg to 108.1 +/- 9.8 mmHg) when compared to admission values (p < 0.05). Endovenous volumes infused were greater (p = 0.001) in IS patients (1420 +/- 298 ml) than in PS patients (356 +/- 64 ml). No blood was transfused into PS patients, compared to 370 +/- 140 ml of red blood cells transfused into IS patients (p = 0.015). Mortality rates were similar in the two groups (p = 0.725). We concluded that PS is a safe, efficient method for inducing hemodynamic recovery of hypovolemic trauma patients, with a clear reduction in the intravenous volumes required for acute resuscitation.

Objective:To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation.Methods:Eighty patients, aged 35-75, American Society of Anesthesiology (ASA) classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group (group Pro), propofol combined with epidural anesthesia group (group Pro+Epi), isoflurane group (group Iso) and isoflurane combined with epidural anesthesia group (group Iso+ Epi), 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position (T1), 30min after bilateral lung ventilation (T2), 15min after one lung ventilation (T3), 30min after one lung ventilation (T4), 60min after one lung ventilation (T5), 180min after one lung ventilation (T6), intrapulmonary shunt (Qs/Qt) was calculated according to the correlation formula.Results:Qs/Qt values at T2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T3-6 was significantly higher than that of T2 (P< 0.05); PaO2 at T2-6 were significantly higher than that of T1, with PaO2 at T3-6 were significantly lower than T2 (P< 0.05). Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T3-5 (P< 0.05). There was no significant difference in PaO2 between groups (P> 0.05). CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T1 (P<0.05), and were significantly higher than that of propofol group (P<0.05). MAP at T3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T1 (P <0.05). Heart rate at T4-6 in group Iso were significantly higher than T1, and higher than group Pro and group Iso+Epi (P <0.05).Conclusion:One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen.

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