OBJECTIVE:The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution.METHOD:A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints.RESULTS:The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups.CONCLUSION:Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.

Adopting the scaling functions of B-spline wavelet on the interval (BSWI) as trial functions, a new finite element method (FEM) of BSWI is presented. Instead of traditional polynomial interpolation, scaling functions at the certain scale have been adopted to form the shape functions and construct wavelet-based elements. Unlike the process of wavelets added directly in the other wavelet numerical methods, the element displacement field represented by the coefficients of wavelets expansions is transformed from wavelet space to physical space via the corresponding transformation matrix. The transformation matrix is the key to construct wavelet-based elements freely as long as we can ensure its non-singularity. Then, classes of C 0 and C 1 type elements are constructed. And the lifting scheme of BSWI elements is also discussed. The numerical examples indicate that the BSWI elements have higher efficiency and precision than traditional finite element method in solving 1D structural problems especially for geometric nonlinear, variable cross-section and loading cases.

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In patients undergoing supratentorial tumor resection, goal-directed HES therapy was not superior to goal-directed LR therapy for brain relaxation or cerebral metabolism, although less fluid was needed to maintain the target SVV in the HES-based group than in the LR-based group.

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