Fluid Therapy in Patients Undergoing Abdominal Surgery: A Bumpy Road Towards Individualized Management
Prudent intraoperative fluid replacement therapy, inotropes, and vasoactive drugs should be guided by adequate hemodynamic monitoring. The study aimed to evaluate the single-centre practice on intraoperative fluid therapy in abdominal surgery (AS). The ev
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Fluid Therapy in Patients Undergoing Abdominal Surgery: A Bumpy Road Towards Individualized Management Szymon Czajka, Konstanty Marczenko, Martyna Włodarczyk, Anna J. Szczepańska, Marek Olakowski, Sławomir Mrowiec, and Łukasz J. Krzych Abstract
Prudent intraoperative fluid replacement therapy, inotropes, and vasoactive drugs should be guided by adequate hemodynamic monitoring. The study aimed to evaluate the single-centre practice on intraoperative fluid therapy in abdominal surgery (AS). The evaluation, based on a review of medical files, included 235 patients (103 men), aged 60 15 years who underwent AS between September and November 2017. Fluid therapy was analyzed in terms of quality and quantity. There were 124 high-risk patients according to the American Society of Anaesthesiologists Classification (ASA Class 3+) and 89 high-risk procedures performed. The median duration of procedures was 175 (IQR 106–284) min. S. Czajka (*), A. J. Szczepańska, and Ł. J. Krzych Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland e-mail: [email protected] K. Marczenko, M. Olakowski, and S. Mrowiec Department of Gastrointestinal Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland M. Włodarczyk Students’ Scientific Society, Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
Eleven patients died post-operatively. The median fluids volume was 10.4 mL/kg/h of anaesthesia, including 9.1 mL/kg/h of crystalloids and 2.7 mL/kg/h of synthetic colloids. Patients undergoing longer than the median procedures received significantly fewer fluids than those who underwent shorter procedures. The volume of fluids in the longer procedures depended on the procedural risk classification and was significantly greater in high-risk patients undergoing high-risk surgery. Patients who died received significantly more fluids than survivors. In all patients, a non-invasive blood pressure monitoring was used and only six patients had therapy guided by metabolic equilibrium. The fluid therapy used was liberal but complied with the recommendations regarding the type of fluid and risk-adjusted dosing. Hemodynamic monitoring was suboptimal and requires modifications. In conclusion, the optimization of intraoperative fluid therapy requires a balanced and standardized approach consistent with treatment procedures. Keywords
Abdominal surgery · Fluid replacement therapy · Hemodynamic monitoring · Intraoperative condition · Surgical risk
S. Czajka et al.
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Introduction
More than 300 million surgical procedures are performed worldwide every year, and the number is constantly growing due to increasing clinical needs, ageing population, and the development of surgical techniques (WHO 2020; Rose et al. 2015). Patients undergoing major surgery are at high risk of increased postoperative morbidity and mortality. The practice regarding fluid balance is crucial for the safe and effective i
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