CON: Fluid restriction for cardiac patients during major noncardiac surgery should be replaced by goal-directed intravascular fluid administration.

Anesthesia and analgesia (Impact Factor: 3.42). 03/2006; 102(2):344-6. DOI: 10.1213/01.ane.0000196511.48033.0b
Source: PubMed

ABSTRACT oncerns have been expressed that over- hydration may result in pulmonary edema, car- diac complications, delayed recovery of gastro- intestinal motility, compromised tissue oxygenation, wound healing problems, and blood coagulation im- pairment (1-3). Patients with a cardiac comorbidity undergoing major noncardiac surgery may be partic- ularly vulnerable and, therefore, perioperative fluid restriction might appear to be beneficial. However, there are at least 4 prospective random- ized trials showing that a goal-directed perioperative plasma volume expansion decreases major postoper- ative morbidity and the duration of hospitalization significantly (4-7). In all these studies, stroke volume in the descending aorta was assessed by esophageal Doppler monitoring. Two hundred mL of colloids were given over 10 min and stroke volume was as- sessed every 15 min. This was repeated until no fur- ther increase in stroke volume was detected. Indeed,

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    ABSTRACT: The purpose of this prospective, observational study was to respiratory variation of stroke volume (stroke volume variation, SVV) against central venous pressure (CVP) and pulmonary artery diastolic pressure (PADP) as an estimate of right and left ventricular preload.
    Journal of Anesthesia 06/2014; 29(1). · 1.12 Impact Factor
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    ABSTRACT: Background/Purpose Ideal fluid management during surgery still poses a clinical dilemma gauging the benefits and adverse effects. This randomized controlled trial compared the tissue perfusion and coagulation profiles under clinically equivalent hydroxyethyl starch (HES 130/0.4) and lactated Ringer's solution (LR). Methods Eighty-four patients undergoing major abdominal surgery were randomized to receive either HES or LR. Tissue perfusion parameters using heart rate, arterial blood pressure, central venous pressure, cardiac index, stroke volume index, and central venous oxygen saturation were measured at T0 (baseline), T1 (start of surgery), T2 (1 hour after start of surgery), and T3 (end of surgery). Coagulation parameters using thrombelastography (TEG) were measured at T0 (baseline), T4 (after 15 mL/kg fluid transfused), and T5 (24 hours after baseline). Results The total amount of fluid administrated was 1547.9 ± 424.0 mL in HES group and 2303.1 ± 1033.7 mL in LR group (p < 0.001). The parameters of tissue perfusion and TEG did not differ significantly between groups at any time point except for a transient decrease in clot kinetic and clot strength at T4 for HES group. There was no significant difference in blood loss and consumption of blood products between the two fluids. Conclusion HES 130/0.4 is a more efficient intravascular volume expander to maintain tissue perfusion than conventional crystalloid. Transient hypocoagulability induced by HES 130/0.4 does not warrant excessive blood loss and blood transfusion.
    Journal of the Formosan Medical Association. 07/2014; 113(7):429-435.
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    ABSTRACT: Die korrekte perioperative Flüssigkeitsbilanz ist Grundlage einer zielgerichteten Infusionspraxis. Weder Ausgangsstatus noch perioperative Veränderungen der Flüssigkeitsräume lassen sich jedoch in der täglichen Routine verlässlich bestimmen. Insbesondere die insensiblen Verluste werden nach wie vor nicht einheitlich beurteilt, und deren Substitution erfolgt daher zum großen Teil empirisch. Die vorliegende Arbeit soll die wissenschaftliche Datenlage zu diesem Thema vermitteln.Präoperative Nüchternheit (10 h) erzeugt per se keine relevante Hypovolämie. Die Gesamtevaporation über Haut, Atemwege und Wundfläche während großer abdominaler Eingriffe beträgt beim Erwachsenen weniger als 1 ml/kg/h. Ein perioperativ inkonstant auftretender Flüssigkeits- und Proteinshift in das Interstitium scheint hypervolämieassoziiert und somit vermeidbar zu sein. Die entscheidende Rolle spielt hierbei die Zerstörung der endothelialen Glykokalyx, deren weitere pathophysiologische Bedeutung bislang nur ansatzweise bekannt ist. Klinische Studien konnten den Zusammenhang zwischen Flüssigkeitsrestriktion und verbessertem Outcome nach großen abdominalen Eingriffen demonstrieren.
    Der Anaesthesist 01/2007; 56(8). · 0.74 Impact Factor


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