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

Czajka, S; Marczenko, Konstanty; Włodarczyk, Martyna; Szczepańska, Anna; Mrowiec, Sławomir; Krzych, Łukasz J.

doi:10.1007/5584_2020_597

Cited by 3 publications

(2 citation statements)

References 35 publications

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“…While searching for reports in the literature on the relationship between volume of blood lost or intensity of intraoperative fluid therapy and diuresis, we came across the work of Ishihara et al [ 64 ], who observed an association between increased volume of fluids administered and higher diuresis in a group of patients where goal-directed therapy principles were followed [ 30 , 64 ]. Czajka et al [ 65 ] also reported a positive correlation between blood loss and ASA PS class.…”

Section: Discussionmentioning

confidence: 97%

A Single-Center Retrospective Study of Selected Clinical Parameters and Intraoperative Fluid Management of Patients Undergoing Pancreatoduodenectomy

et al. 2022

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Background Pancreatoduodenectomy is an extensive procedure with a very high risk of complications. Appropriate intraoperative fluid therapy is a subject of ongoing debate. The aim of this retrospective study was to analyze the relationship between selected preoperative parameters, intraoperative fluid therapy, and catecholamines administration during pancreatoduodenectomy. Material/Methods : From 2011 through 2017, among pancreatoduodenectomies performed at a single university hospital, 192 patients met the inclusion criteria of the study: 105 (54.7%) males and 87 (45.3%) females with a mean age of 60.06 (±11.63) years. Correlations were assessed between sex, age, body mass index (BMI), selected comorbidities, surgery duration, American Society of Anesthesiologists (ASA) Physical Status (PS) scale, preoperative endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative catecholamine administration, intraoperative fluid supply, red blood cell (RBC) concentrate and fresh frozen plasma (FFP) supply, blood loss, and diuresis. Results A need for catecholamines has been shown to be more frequent in smokers ( P =0.01), patients with cardiovascular comorbidities ( P =0.037), high ASA PS scores ( P =0.003), and preoperative ERCP ( P =0.011). The need for intraoperative transfusion of RBC concentrate was more frequent in smokers ( P =0.005). Surgical time was significantly longer in males ( P =0.014). Among females, liberal intraoperative fluid therapy (>7.9 ml/kg/h) was more frequent in patients with thyroid comorbidities ( P =0.003). Conclusions The findings of this retrospective study demonstrate the influence of comorbidities, ASA PS class, and catecholamine use on fluid therapy during pancreatoduodenectomy.

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Section: Discussionmentioning

confidence: 97%

A Single-Center Retrospective Study of Selected Clinical Parameters and Intraoperative Fluid Management of Patients Undergoing Pancreatoduodenectomy

et al. 2022

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“…In physiological conditions, the EG allows intravascular fluid to enter tissues through endothelial pressure, attributable to microvessels without a reabsorptive function and protein‐rich interstitial fluid participates circulating through the lymphatic circulation (Şentürk et al., 2017; Woodcock & Woodcock, 2012). Therefore, it is particularly important for postoperative recovery to avoid excessive or insufficient fluid volume during surgery, with the aim of avoiding EG degradation and maintaining normal vascular permeability (Czajka et al., 2021; Heming et al., 2020). Surgery and the occurrence of sepsis, haemorrhagic shock and hyperglycaemia have been found to result in degradation, shedding and destruction of the EG, leading to an increase in vascular permeability.…”

Section: Discussionmentioning

confidence: 99%

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

Liu

Chen

Gao

et al. 2021

Experimental Physiology

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New Findings What is the central question of this study?Massive infusion can destroy the endothelial glycocalyx. We compared the serum concentrations of endothelial glycocalyx components and atrial natriuretic peptide and the outcomes of patients with different levels of stroke volume variation (SVV). What is the main finding and its importance?With a decrease in SVV, the serum concentrations of endothelial glycocalyx components and atrial natriuretic peptide increased, whereas the oxygenation index decreased. When the intraoperative SVV was maintained at 7−10%, the patients had better postoperative recovery and shorter postoperative hospital stays. Therefore, it is advisable to maintain the SVV between 7 and 10%. Abstract Dynamic haemodynamic parameters, such as stroke volume variation (SVV), can be used for blood volume monitoring. However, studies have determined the SVV threshold but not the optimal level. The endothelial glycocalyx (EG) plays an important role in maintaining vascular permeability. Moreover, rapid and massive infusion can lead to the degradation, shedding and destruction of the EG. We aimed to explore the effects of different SVV values (11–14, 7–10 or 3–6%) on the EG in 54 patients who were scheduled for elective colorectal tumour surgery and to identify the optimal peri‐operative fluid therapy strategy. The concentrations of EG degradation products (heparin sulphate, hyaluronic acid and syndecan‐1) and atrial natriuretic peptide were higher when the SVV was maintained between 3 and 6% after fluid therapy compared with pre‐infusion (P < 0.05). Comparison of postoperative complications and hospitalization time among the three SVV levels was not statistically significant (P > 0.05). The postoperative hospitalization time in patients with SVV of 7–10% was shorter than that in patients with SVV of 3–6%. Infusion of a large volume of fluid, with increasing EG degeneration and atrial natriuretic peptide concentrations, might be related to postoperative outcomes.

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Adequacy of Anesthesia Guidance for Combined General/Epidural Anesthesia in Patients Undergoing Open Abdominal Infrarenal Aortic Aneurysm Repair; Preliminary Report on Hemodynamic Stability and Pain Perception

Stasiowski,

Król,

Wodecki

et al. 2024

Pharmaceuticals

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Background/Objectives: Hemodynamic instability and inappropriate postoperative pain perception (IPPP) with their consequences constitute an anesthesiological challenge in patients undergoing primary elective open lumbar infrarenal aortic aneurysm repair (OLIAAR) under general anesthesia (GA), as suboptimal administration of intravenous rescue opioid analgesics (IROAs), whose titration is optimized by Adequacy of Anaesthesia (AoA) guidance, constitutes a risk of adverse events. Intravenous or thoracic epidural anesthesia (TEA) techniques of preventive analgesia have been added to GA to minimize these adverse events. Methods: Seventy-five patients undergoing OLIAAR were randomly assigned to receive TEA with 0.2% ropivacaine (RPV) with fentanyl (FNT) 2.5 μg/mL (RPV group) or 0.2% bupivacaine (BPV) with FNT 2.5 μg/mL (BPV group) or intravenous metamizole/tramadol (MT group). IROA using FNT during GA was administered under AoA guidance. Systemic morphine was administered as a rescue agent in all groups postoperatively in the case of IPPP, assessed using the Numeric Pain Rating Score > 3. The maximum score at admission and the minimum at discharge from the postoperative care unit to the Department of Vascular Surgery, perioperative hemodynamic stability, and demand for rescue opioid analgesia were analyzed. Results: Ultimately, 57 patients were analyzed. In 49% of patients undergoing OLIAAR, preventive analgesia did not prevent the incidence of IPPP, which was not statistically significant between groups. No case of acute postoperative pain perception was noted in the RPV group, but at the cost of statistically significant minimum mean arterial pressure values, reflecting hemodynamic instability, with clinical significance < 65mmHg. Demand for postoperative morphine was not statistically significantly different between groups, contrary to significantly lower doses of IROA using FNT in patients receiving TEA. Conclusions: AoA guidance for IROA administration with FNT blunted the preventive analgesia effect of TEA compared with intravenous MT that ensured proper perioperative hemodynamic stability along with adequate postoperative pain control with acceptable demand for postoperative morphine.

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

Cited by 3 publications

References 35 publications

A Single-Center Retrospective Study of Selected Clinical Parameters and Intraoperative Fluid Management of Patients Undergoing Pancreatoduodenectomy

A Single-Center Retrospective Study of Selected Clinical Parameters and Intraoperative Fluid Management of Patients Undergoing Pancreatoduodenectomy

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

Adequacy of Anesthesia Guidance for Combined General/Epidural Anesthesia in Patients Undergoing Open Abdominal Infrarenal Aortic Aneurysm Repair; Preliminary Report on Hemodynamic Stability and Pain Perception

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