Holte K, Klarskov B, Christensen DS, Lund C, Nielsen KG, Bie P, Kehlet H: Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: A randomized, double-blind study

Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
Annals of Surgery (Impact Factor: 8.33). 12/2004; 240(5):892-9. DOI: 10.1097/01.sla.0000143269.96649.3b
Source: PubMed

ABSTRACT The objective of this study was to investigate the effects of 2 levels of intraoperative fluid administration on perioperative physiology and outcome after laparoscopic cholecystectomy.
Intraoperative fluid administration is variable as a result of limited knowledge of physiological and clinical effects of different fluid substitution regimens.
In a double-blind study, 48 ASA I-II patients undergoing laparoscopic cholecystectomy were randomized to 15 mL/kg (group 1) or 40 mL/kg (group 2) intraoperative administration of lactated Ringer's solution (LR). All other aspects of perioperative management as well as preoperative fluid status were standardized. Primary outcome parameters were assessed repeatedly for the first 24 postoperative hours and included pulmonary function (spirometry), exercise capacity (submaximal treadmill test), cardiovascular hormonal responses, balance function, pain, nausea and vomiting, recovery, and hospital stay.
Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR led to significant improvements in postoperative pulmonary function and exercise capacity and a reduced stress response (aldosterone, antidiuretic hormone, and angiotensin II). Nausea, general well-being, thirst, dizziness, drowsiness, fatigue, and balance function were also significantly improved, as well as significantly more patients fulfilled discharge criteria and were discharged on the day of surgery with the high-volume fluid substitution.
Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR improves postoperative organ functions and recovery and shortens hospital stay after laparoscopic cholecystectomy.

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Available from: Peter Bie, Jun 26, 2014
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    • "Several studies have investigated different types and amounts of fluids for perioperative fluid replacement and the conclusion of the appropriate volume to administer cannot be made [9]. The aim of this prospective randomized study was to investigate and compare the effect of intraoperative fluid administration with two different volumes of Ringer's lactate (LR), 4 ml kg À1 h À1 vs 8 ml kg À1 h À1 on CK activity, incidence of rhabdomyolysis and renal function during the postoperative period, after laparoscopic nephrectomy. "
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    ABSTRACT: Background Creatine kinase (CK) is a muscle-specific enzyme, which can be associated with muscle tissue damage. Rhabdomyolysis is a serious postoperative complication following severe muscle destruction. Lengthy procedures, high body mass index and lateral decubitus position are common risk factors.Objectives The objective of this study was to investigate the effect of intraoperative fluid administration with two different volumes on CK levels, kidney function and the incidence of rhabdomyolysis after laparoscopic nephrectomy.Methods In this prospective randomized study, 100 adult patients, ASA physical status II and III scheduled for laparoscopic nephrectomy were included and, randomized into two equal groups. Patients in Group I received maintenance infusion of Lactated Ringer’s solution 4 ml kg−1 h−1, while patients in Group II received intraoperative infusion 8 ml kg−1 h−1 till the end of surgery. Total intraoperative fluid, urine output and, blood loss were all calculated. CK was measured preoperative (T0), immediately postoperative (T1), 12 h postoperative (T2) and at 24, 48, 72 and, 96 h postoperative (T3–T6). Serum creatinine was measured preoperative {baseline (T0)}, 12 h postoperative (T1) then, daily for 3 days (T2–T4). Skin changes as erythema and, induration were monitored.ResultsInsignificant differences were reported between the two groups in terms of patient demographics, operative time, intraoperative blood loss and serum creatinine. Intraoperative fluid intake was significantly higher among patients of Group II {2388 (308.8) vs 1284 (233.3) ml}. CK levels were higher in Group I patients in the first 72 h after surgery. Rhabdomyolysis was diagnosed in six patients (6%); only one had elevated serum creatinine and oliguria.Conclusions Intraoperative administration of 8 ml kg−1 h−1 compared with 4 ml kg−1 h−1 Lactated Ringer’s solution led to significant reduction in CK levels as a marker of rhabdomyolysis during laparoscopic nephrectomy.
    07/2012; 28(3):211–215. DOI:10.1016/j.egja.2012.04.001
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    • "régimes de remplissage peropératoire (15 vs 40 -1 ) chez des patients devant bénéficier d'une cholécystectomie laparoscopique [5] "
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    ABSTRACT: Ein regulärer Hydratationsstatus und Normovolämie sind Ziele der intra-/perioperativen Flüssigkeits- sowie Volumentherapie und gleichzeitig Voraussetzungen für eine adäquate Hämodynamik zur Sicherstellung einer ausreichenden Gewebeoxygenierung. Die physiologischen und pathophysiologischen Effekte der Flüssigkeits- und Volumentherapie beruhen auf den pharmakologischen Eigenschaften der verwendeten Infusionslösung, dem applizierten Volumen und – nach neueren Erkenntnissen – auch auf dem Zeitpunkt der Flüssigkeitsgabe. In der perioperativen Phase unterliegt der Organismus den hormonellen Bedingungen der metabolischen Stressantwort, die neben den perioperativen Änderungen der Gefäßpermeabilität zu berücksichtigen sind. Das Ziel des hämodynamischen Monitorings im OP ist es, Informationen über die Hämodynamik und das globale Sauerstoffangebot zu gewinnen, die eine Abschätzung des intravasalen Volumenstatus des Patienten erlauben. Dies kann die Volumen- und Flüssigkeitstherapie im Sinne einer Konstanthaltung des Herzzeitvolumens verbessern, das vor allen Dingen für Risikopatienten relevant ist. Eine verbesserte und hypovoläme Zustände vermeidende Volumentherapie kann das postoperative Outcome der Patienten positiv beeinflussen. Ziel dieser Arbeit ist es, dem Leser einen Überblick über die aktuell im klinischen Alltag zur Verfügung stehenden Monitoringverfahren zur Einschätzung des perioperativen Volumenstatus zu geben; hierzu werden jeweils das Messprinzip, die Messparameter sowie die Vor- und Nachteile des jeweiligen Verfahrens dargestellt. Weiter wird diskutiert, welche Monitoringverfahren in klinischen Studien schon zur zielgerichteten perioperativen Flüssigkeits- und Volumentherapie („goal-directed therapy“) untersucht wurden. A regular hydration status and compensated vascular filling are targets of perioperative fluid and volume management and, in parallel, represent precautions for sufficient stroke volume and cardiac output to maintain tissue oxygenation. The physiological and pathophysiological effects of fluid and volume replacement mainly depend on the pharmacological properties of the solutions used, the magnitude of the applied volume as well as the timing of volume replacement during surgery. In the perioperative setting surgical stress induces physiological and hormonal adaptations of the body, which in conjunction with an increased permeability of the vascular endothelial layer influence fluid and volume management. The target of haemodynamic monitoring in the operation room is to collect data on haemodynamics and global oxygen transport, which enable the anaesthetist to estimate the volume status of the vascular system. Particularly in high risk patients this may improve fluid and volume therapy with respect to maintaining cardiac output. A goal-directed volume management aiming at preventing hypovolaemia may improve the outcome after surgery. The objective of this article is to review the monitoring devices that are currently used to assess haemodynamics and filling status in the perioperative setting. Methods and principles for measuring haemodynamic variables, the measured and calculated parameters as well as clinical benefits and shortcomings of each device are described. Furthermore, the results for monitoring devices from clinical studies of goal-directed fluid and volume therapy which have been published will be discussed.
    Der Anaesthesist 08/2009; 58(8):764-786. DOI:10.1007/s00101-009-1590-4 · 0.74 Impact Factor
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