title: Influence of "liberal" versus "restrictive" intraoperative fluid administration on elimination of a postoperative fluid load.
abstract: BACKGROUND
  Previously, the authors found "liberal" fluid administration (approximately 3 l Ringer's lactate [RL]) to improve early rehabilitation after laparoscopic cholecystectomy, suggesting functional hypovolemia to be present in patients receiving "restrictive" fluid administration (approximately 1 l RL). Because volume kinetic analysis after a volume load may distinguish between hypovolemic versus normovolemic states, the authors applied volume kinetic analysis after laparoscopic cholecystectomy to explain the difference in outcome between 3 and 1 l RL.
  
  
  METHODS
  In a prospective, nonrandomized trial, the authors studied 20 patients undergoing laparoscopic cholecystectomy. Ten patients received 15 ml/kg RL (group 1) and 10 patients received 40 ml/kg RL (group 2) intraoperatively. All other aspects of perioperative management were standardized. A 12.5-ml/kg RL volume load was infused preoperatively and 4 h postoperatively. The distribution and elimination of the fluid load was estimated using volume kinetic analysis.
  
  
  RESULTS
  Patient baseline demographics and intraoperative data did not differ between groups, except for intraoperative RL, having a median of 1,118 ml (range, 900-1,400 ml) in group 1 compared with a median of 2,960 ml (range, 2,000-3,960 ml) in group 2 (P<0.01). There were no significant preoperative versus postoperative differences in the size of the body fluid space expanded by infused fluid (V), whereas the clearance constant kr was higher postoperatively versus preoperatively (P=0.03). The preoperative versus postoperative changes in volume kinetics including V were not different between the two groups.
  
  
  CONCLUSIONS
  Elimination of an intravenous fluid load was increased after laparoscopic cholecystectomy per se but not influenced by the amount of intraoperative fluid administration.
authors.affiliation: Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark. kathrine.holte@dadlnet.dk
authors.forename: Kathrine
authors.initials: K
authors.lastname: Holte
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hahn
authors.forename: Lisbet
authors.initials: L
authors.lastname: Ravn
authors.forename: Kasper G
authors.initials: KG
authors.lastname: Bertelsen
authors.forename: Stinus
authors.initials: S
authors.lastname: Hansen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D003198:Computer Simulation; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D020896:Hypovolemia / Q000517:prevention & control; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000077325:Ringer's Lactate
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate