Pre‐operative fluid bolus for improved haemodynamic stability during minor surgery: A prospectively randomized clinical trial

Kratz, Thomas; Hinterobermaier, J.; Timmesfeld, Nina; Kratz, Caroline; Wulf, Hinnerk; Steinfeldt, Thorsten; Zoremba, Martin; Aust, H.

doi:10.1111/aas.13157

Cited by 9 publications

(7 citation statements)

References 42 publications

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“… 15 Similarly, lower incidence (41.5 vs. 56.6%) of postinduction hemodynamic instability was seen with preinduction preloading of 8 mL/kg Ringer's acetate as compared with no preloading. 7 In our study, too, we observed a significant difference in the occurrence of hypotension (26.7 vs. 86.7%) with and without fluid preloading. An earlier study demonstrated preoperative volume loading with 8 mL/kg Ringer's lactate to be more effective than preinduction administration of ephedrine in maintaining hemodynamic stability during rapid-sequence induction with propofol without HR increase during intubation.…”

Section: Discussionsupporting

confidence: 52%

“… 1 6 One of the measures used to minimize postinduction hypotension is preloading with intravenous fluids. The effect of preanesthetic fluid loading on ameliorating postinduction hypotension is equivocal, with some studies showing reduction in the incidence of hypotension with preanesthetic fluid loading, 7 while others observing no beneficial effect. 8 Therefore, for better understanding of postinduction hypotension, it is important to evaluate its mechanisms and assess the impact of fluid preloading by going beyond the routine blood pressure (BP) measurements and studying the advanced cardiac and hemodynamic parameters.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

Paul

Sriganesh

Chakrabarti

et al. 2022

JNRP

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Purpose Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery. Methods This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone. Results The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use. Conclusion Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period. Registration number of Clinical Trial The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018).

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

Paul

Sriganesh

Chakrabarti

et al. 2022

JNRP

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“…Administration of crystalloid preload before or during induction has some, but limited, effect on reducing the incidence of hemodynamic instability. 11,12 Increasing the injection time did not attenuate blood pressure reduction. 13 The use of bispectral cerebral monitoring (BIS) as a titration tool may not lower the induction dose or the incidence and degree of arterial hypotension.…”

Section: Introductionmentioning

confidence: 86%

Hemodynamic effects of a low versus a high dose of propofol during induction of anesthesia. A randomized trial

Sjøen

Falk

Hauge

et al. 2023

Acta Anaesthesiol Scand

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BackgroundHypotension is common after anesthesia induction with propofol and is associated with increased morbidity. It is important to examine the effects of the proposed interventions to limit preventable hypotension, as suggested by the reduction in the dose of propofol. Our objective was to investigate whether a high dose of propofol is inferior to a low dose with respect to changes in systolic arterial blood pressure (SAP).MethodsThis randomized, double‐blind, dose‐controlled, non‐inferiority study included 68 healthy women scheduled for gynecological surgery at the Day Surgery Unit, Haugesund Hospital, Norway. The patients were randomly allocated 1:1 to a low or high dose (1.4 mg/kg total body weight (TBW) versus 2.7 mg/kg TBW of propofol corresponding to maximal effect site concentrations (Ce) of 2.0 μg/mL versus 4.0 μg/mL. The dose of remifentanil was 1.9–2.0 μg/kg TBW, with maximal Ce of 5.0 ng/mL. The patients were observed for 450 s from the start of the infusions. The first 150 s was the sedation period, after which a bolus of propofol and remifentanil was administered. Baseline was defined as 55–5 s before the bolus doses. LiDCOplus was used for invasive beat‐to‐beat hemodynamic monitoring of changes in SAP, heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). A difference of 10 mmHg in the change in SAP was considered to be clinically important.ResultsThe SAP change difference for low versus high dose was −2.9 mmHg (95% CI −9.0–3.1). The relative changes for low versus high dose were SAP −31% versus −36%, (p < .01); HR −24% versus −20%, (p = .09); SVR −20% versus −31%, (p < .001); SV −16% versus −20%, (p = .04); and CO −35% versus −32%, (p = .33).ConclusionA high dose of propofol was not inferior to a low dose, and a reduction in the dose of propofol did not result in clinically important attenuation of major hemodynamic changes during induction in healthy women.Trial RegistrationClinicalTrials.gov identifier NCT 03861364, January 3, 2019.

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“…Intravenous fluid administration remains the most common intervention to support cardiac output, arterial blood pressure and tissue perfusion in haemodynamically compromised patients . The administration of a bolus of fluid prior to the induction of anaesthesia is widely practiced to mitigate post‐induction arterial hypotension . The optimal strategy for fluid administration to maintain intravascular volume remains controversial with an accumulating body of evidence suggesting that inappropriate fluid therapy is associated with increased mortality and morbidity .…”

Section: Introductionmentioning

confidence: 99%

The stop‐flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography

Yastrebov

Åneman

Slama

et al. 2019

Acta Anaesthesiol Scand

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Background:The distending intravascular pressure at no flow conditions reflects the stressed volume. While this haemodynamic variable is recognised as clinically important, there is a paucity of reports of its range and responsiveness to volume expansion in patients without cardiovascular disease and no reports of correlations to echocardiographic assessments of left ventricular filling.Methods: Twenty-seven awake (13 male), spontaneously breathing patients without any history of cardiopulmonary, vascular or renal disease were studied prior to induction of anaesthesia. The no-flow equilibrium pressure in the arm following rapid circulatory occlusion (P arm ) was measured via a radial arterial catheter. Transthoracic echocardiography was used to measure left ventricular end diastolic area and volume as well as the diameter of the inferior vena cava. The P arm and echocardiographic variables were measured before and after administration of 500 mL 0.9% NaCl over 10 minutes. Changes were analysed by paired t test, Pearson's correlation and multiple linear regression. Results: P arm increased overall from 22 ± 5 mm Hg to 25 ± 6 mm Hg (mean difference 3.0 ± 4.5 mm Hg, P = 0.002) following the fluid bolus with corresponding increases in arterial pressure and echocardiographic variables. Variability in the direction of the P arm response reflected concomitant changes in vascular compliance. Only weak correlations were observed between changes in P arm and inferior vena cava diameter indexed to body surface area (R 2 = 0.29, P = 0.01). Conclusion: Preoperative measurements of P arm increased following acute expansion of the intravascular volume. Echocardiography demonstrated poor correlation with P arm .

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Pre‐operative fluid bolus for improved haemodynamic stability during minor surgery: A prospectively randomized clinical trial

Cited by 9 publications

References 42 publications

Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

Hemodynamic effects of a low versus a high dose of propofol during induction of anesthesia. A randomized trial

The stop‐flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography

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