title: Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study.
abstract: OBJECTIVE
  The objective of this study was to investigate the effects of 2 levels of intraoperative fluid administration on perioperative physiology and outcome after laparoscopic cholecystectomy.
  
  
  BACKGROUND
  Intraoperative fluid administration is variable as a result of limited knowledge of physiological and clinical effects of different fluid substitution regimens.
  
  
  METHODS
  In a double-blind study, 48 ASA I-II patients undergoing laparoscopic cholecystectomy were randomized to 15 mL/kg (group 1) or 40 mL/kg (group 2) intraoperative administration of lactated Ringer's solution (LR). All other aspects of perioperative management as well as preoperative fluid status were standardized. Primary outcome parameters were assessed repeatedly for the first 24 postoperative hours and included pulmonary function (spirometry), exercise capacity (submaximal treadmill test), cardiovascular hormonal responses, balance function, pain, nausea and vomiting, recovery, and hospital stay.
  
  
  RESULTS
  Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR led to significant improvements in postoperative pulmonary function and exercise capacity and a reduced stress response (aldosterone, antidiuretic hormone, and angiotensin II). Nausea, general well-being, thirst, dizziness, drowsiness, fatigue, and balance function were also significantly improved, as well as significantly more patients fulfilled discharge criteria and were discharged on the day of surgery with the high-volume fluid substitution.
  
  
  CONCLUSIONS
  Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR improves postoperative organ functions and recovery and shortens hospital stay after laparoscopic cholecystectomy.
authors.affiliation: Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark. kathrine.holte@dadlnet.dk
authors.forename: Kathrine
authors.initials: K
authors.lastname: Holte
authors.forename: Birthe
authors.initials: B
authors.lastname: Klarskov
authors.forename: Dorte Stig
authors.initials: DS
authors.lastname: Christensen
authors.forename: Claus
authors.initials: C
authors.lastname: Lund
authors.forename: Kristine Grubbe
authors.initials: KG
authors.lastname: Nielsen
authors.forename: Peter
authors.initials: P
authors.lastname: Bie
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D017079:Exercise Tolerance; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting; D004856:Postural Balance; D012123:Pulmonary Ventilation; D000077325:Ringer's Lactate
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate