Influence of pre-operative fluid infusion on volume status during oesophageal resection--a prospective trial.
BACKGROUND
Perioperative fluid therapy is controversially debated in surgery. In malnourished and hypovolaemic patients, a restrictive fluid regimen may lead to hypoperfusion and increased incidence of complications. The present prospective cohort study was performed to assess whether pre-operative i.v. fluid administration improves intraoperative cardiac preload in patients undergoing oesophageal resection.


METHODS
Intraoperatively, the intrathoracic blood volume index (ITBVI) was monitored in 44 consecutive patients undergoing elective oesophagectomies with the transthoracic thermodilution technique. Twenty-two of these patients received a pre-operative i.v. fluid loading with a balanced crystalloid solution (1 ml/kg/h over 48 h).


RESULTS
After induction of anaesthesia ITBVI was low but not different between the groups [767 (512-1314) vs. 775 (531-1200) ml/m(2), P=0.81]. In the intervention group, the extravascular lung water increased above normal levels during the operation. The groups did not differ in cardiac output, blood pressure, heart rate and central venous pressure. Post-operative morbidity was not different between the cohorts.


CONCLUSIONS
Pre-operative i.v. fluid loading with crystalloid solutions could not be shown to improve the intraoperative volume status and cardiac function in this study. Randomised trials with other volume replacement techniques are recommended.
Raue
W
W
Department of General, Visceral, Vascular and Thoracic Surgery, Charité- University Medicine Berlin, Berlin, Germany. wieland.raue@charite.de
Haase
O
O
Langelotz
C
C
Neuss
H
H
Müller
J M
JM
Schwenk
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002319:Cardiovascular System; D000077324:Crystalloid Solutions; D004935:Esophageal Diseases / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions