Effect of intraoperative fluid management on outcome after intraabdominal surgery.
BACKGROUND
The debate over the correct perioperative fluid management is unresolved.


METHODS
The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days.


RESULTS
The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P < 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P < 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P < 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG.


CONCLUSIONS
In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.
Department of Anesthesia and Critical Care Medicine, Hadassah Hebrew University and Medical Center, Jerusalem, Israel.
Vadim
V
Nisanevich
Itamar
I
Felsenstein
Gidon
G
Almogy
Charles
C
Weissman
Sharon
S
Einav
Idit
I
Matot
D000005:Abdomen / Q000502:physiology / Q000601:surgery*; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001826:Body Fluids / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011446:Prospective Studies; D000077325:Ringer's Lactate; D016896:Treatment Outcome
D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate