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Perioperative fluid administration in pancreatic surgery: comparison of three regimens

Introduction

Perioperative fluid administration represents an important issue in perioperative medicine, because an incorrect strategy is associated with increased morbidity and mortality. The aim of this study was to compare three fluid administration regimens in patients who have undergone pancreatic surgery.

Methods

A randomized prospective trial. Fifty-nine patients, American Society of Anesthesiologists class 1 to 3, were assigned to one of three perioperative fluid regimens (PFRs). Interventions: general balanced anesthesia; PFR1, liberal (21 patients): colloids and crystalloids (in a 1:3 rate) 12 ml/kg/hour; PFR2, restricted (18 patients): colloids 4 ml/kg/hour; and PFR3, goal targeted (20 patients): colloid infusion targeted to achieve stroke volume variation (SVV) <13%. Hemodynamic monitoring was performed using the Vigileo/FloTrac system (cardiac output (CO) and SVV). Recorded outcome variables were hospital length of stay, starting of enteral nutrition, bowel movement, blood transfusion, and perioperative complications.

Results

Data regarding significant differences are presented in Table 1. Hemodynamic monitoring showed a higher variability of CO and SVV in PFR1. Postoperative major complications were also higher in PFR1. Fistulas occurred in eight cases of PFR1 and in three and four cases in PFR2 and PFR3, respectively (P < 0.05).

Table 1 Main results

Conclusion

Our study in still ongoing; however, ad interim analysis suggests that a restricted or goal-targeted perioperative fluid administration seems to provide more stable hemodynamics and a reduction of major abdominal complications.

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Martini, A., Menestrina, N., Simion, D. et al. Perioperative fluid administration in pancreatic surgery: comparison of three regimens. Crit Care 13, P199 (2009). https://doi.org/10.1186/cc7363

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Keywords

  • Cardiac Output
  • Enteral Nutrition
  • Pancreatic Surgery
  • Hemodynamic Monitoring
  • Stroke Volume Variation