Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive.
OBJECTIVE
The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution.


METHODS
A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints.


RESULTS
The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups.


CONCLUSIONS
Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.
Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China. snapzhang@yahoo.com.cn
Jun
J
Zhang
Hui
H
Qiao
Zhiyong
Z
He
Yun
Y
Wang
Xuehua
X
Che
Weimin
W
Liang
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007432:Intraoperative Period; D007552:Isotonic Solutions / Q000008:administration & dosage; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D000077331:Ringer's Solution; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077331:Ringer's Solution