Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma.
OBJECTIVE
To investigate whether intraoperative fluid management contributes to postoperative respiratory disturbances in esophagectomy for carcinoma.


METHODS
Retrospective study.


METHODS
Operating room and postanesthetic care unit of the cancer center.


METHODS
From 1997 to 2000, 112 ASA physical status I, II, and III patients with primary carcinoma of the esophagus undergoing transthoracic esophagectomy.


METHODS
As of 1998, we altered fluid management during esophagectomy to save intraoperative fluid administration. Then, we investigated postoperative respiratory disturbances after esophagectomy in the period from 1998 to 2000 (late period) compared with the period from 1997 to 1998 (early period). We also investigated the relationship between perioperative risk factors and postoperative respiratory disturbances. The need for frequent (>10) bronchoscopic suctioning of sputum during postoperative period, the need for tracheostomy, and failure in the removal of endotracheal tube (ETT) (extubation) on the first postoperative day (1 POD) were investigated for respiratory disturbances after surgery.


RESULTS
Intraoperative volume balance decreased more so in the late period compared with early period (p < 0.0,001). The need for tracheostomy, bronchoscopic suctioning, and extubation failure on 1 POD were more frequent in the early period than in the late period (p = 0.0083, p = 0.0319, and p = 0.0024, respectively). The hospital recovery period after surgery was shortened during the late period (p = 0.032). Intraoperative volume balance affected the need for tracheostomy and frequent bronchoscopy postoperatively.


CONCLUSIONS
Careful intraoperative fluid administration may decrease postoperative respiratory disturbances.
Kita
Takashi
T
Department of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. tkita@cvn.bai.ne.jp
Mammoto
Tadanori
T
Kishi
Yoshihiko
Y
D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D002277:Carcinoma / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control*; D012120:Respiration Disorders / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013396:Suction; D014139:Tracheostomy