Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery.
OBJECTIVE
To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome.


METHODS
Randomised controlled trial with double blinding between inotrope groups.


METHODS
York District Hospital, England.


METHODS
138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions.


METHODS
Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care.


METHODS
Hospital mortality and morbidity.


RESULTS
Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P=0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital.


CONCLUSIONS
Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.
Wilson
J
J
Department of Anaesthetics, York District Hospital, York YO31 8HE. jonathan@critbase.demon.co.uk
Woods
I
I
Fawcett
J
J
Whall
R
R
Dibb
W
W
Morris
C
C
McManus
E
E
D000368:Aged; D004298:Dopamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004837:Epinephrine / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D010100:Oxygen / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; C046318:dopexamine; D010100:Oxygen; D004298:Dopamine; D004837:Epinephrine