Conventional Fluid Management Versus Goal-Directed Fluid Management In Elective Colorectal Surgery

Abstract

Background: Optimum perioperative fluid therapy is important to improve the outcome of surgical patients, so the assessment of a patient's volume status accurately is an important goal for the anesthesiologist to achieve hemodynamic stability and adequate tissue oxygenation. Objective: This study compared intraoperative goal-directed fluid therapy (GDFT) versus conventional fluid therapy (CVFT) using noninvasive electrical cardiometry with measuring serum lactate, serum creatinine levels, stroke volume optimization, and postoperative complication. Methods: One hundred patients ASA I -II, both sexes, aged 21-65 years scheduled for elective colorectal surgery were randomized into 2 groups (50 subjects each). GDFT group used Stroke volume optimization, and CVFT used the conventional method of fluid administration. Hemodynamic variables, amount of fluid given, serum lactate, serum creatinine, and postoperative complication were noted. Results: Serum lactate levels were insignificant intra& postoperative except at 6 hrs. postoperative was higher in GDFT 1,79±0.21 than CVFT 1.68±0.23with p value=0.02 but still within normal limits. CVFT received significantly more crystalloids 2750(1500-4000) than GDFT 2250 (1000-3350) with p value=0.002, whereas GDFT received more colloids 350(200-1000) than CVFT 250(0-1000) with p value=0.024. Total fluid received were higher in CVFT 3550(2000-5600) than GDFT 2750(1500-5000) with p-value=0.005. Conclusions: GDFT results in a decreased total volume of crystalloids and fluid given to patients. However, both groups didn't alter organ perfusion inspite of serum lactate being higher in GDFT and with no differences in postoperative complications in both groups.

Enhanced Recovery after Surgery (ERAS)

“…Important factors to consider include the following [22]: Individualization: GDFT considers variables like the patient's age, weight, comorbidities, and surgical treatment. This individualised strategy avoids both dehydration and overhydration, both of which may have severe effects on results [23].…”