Influence of volume loading on intraoperative hemodynamics and perioperative fluid retention in patients with valvular regurgitation undergoing prosthetic replacement.
Preload and afterload were controlled intraoperatively in 2 groups of patients with valvular regurgitation and congestive heart failure in order to determine the effect of fluid loading on weight gain and subsequent recovery. As a part of their anesthetic management before cardiopulmonary bypass, 16 patients were given 1 liter of crystalloid with nitroprusside infused at 1 microgram/kg/min and 16 received 4 liters of crystalloid with nitroprusside at 4 micrograms/kg/min. Arterial and filling pressures were kept the same in both groups. Heart rate and vascular resistance became significantly lower and cardiac index and stroke volume significantly higher in the fluid-augmented group. The transition to cardiopulmonary bypass was smoother for the fluid-augmented patients. All patients survived, and 2 in each group were ventilated beyond 24 hours. The mean weight gain at surgery was the same in the 2 groups (3 kg). For the first 2 postoperative days, body weight remained unchanged and thereafter, both groups lost weight at 0.6 kg/day. Preoperative weight was reached on day 7 and discharge occurred on day 15, 2 kg below control. Thus, a modest operative weight gain in these patients is inevitable, benign, and independent of the volume of fluid infused before bypass.
D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001835:Body Weight; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy; D006333:Heart Failure / Q000601:surgery*; D006339:Heart Rate; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D009599:Nitroprusside / Q000008:administration & dosage; D010952:Plasma Substitutes / Q000008:administration & dosage; D011300:Preoperative Care; D013318:Stroke Volume; D014655:Vascular Resistance; D014882:Water-Electrolyte Balance
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D009599:Nitroprusside