Preoperative Carbohydrate Load and Intraoperative Goal-Directed Fluid Therapy for Elderly Patients Undergoing Open Gastrointestinal Operation: A Prospective Randomized Controlled Trial

Abstract

Background: At present it remains uncertain as to whether carbohydrate (200 ml) loaded 2 hours before anesthesia induction combined with intraoperative goal-directed fluid therapy (GDFT) is beneficial to elderly patients undergoing gastrointestinal operations. As such, a randomized controlled trial was designed to evaluate the relative impact of perioperative fluid optimisation versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.Methods: A total of 120 elderly patients undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) load 2 hours before anesthesia induction. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic information, intraoperative parameters and postoperative outcomes were recorded.Results: Patients in the GDFT group were administered less crystalloid fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p = 0.000) and produced less urine output (200 ml [150-300] vs 400 ml [290-500]; p = 0.000) relative to patients in the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (55 ± 13.9 hours vs 65 ± 22.6 hours; p = 0.004) and oral intake (72 ± 17.4 hours vs 85 ± 27.5 hours; p = 0.002), as well as a reduction in the rate of postoperative complications (14 (25.5%) vs 27(47.4%) patients; p = 0.016). However, postoperative hospitalization or hospitalization expenses were similar between groups.Conclusions: Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration: ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=29899