title: Perioperative fluid guidance with transthoracic echocardiography and pulse-contour device in morbidly obese patients.
abstract: BACKGROUND
  In bariatric surgery, non- or mini-invasive modalities for cardiovascular monitoring are addressed to meet individual variability in hydration needs. The aim of the study was to compare conventional monitoring to an individualized goal-directed therapy (IGDT) regarding the need of perioperative fluids and cardiovascular stability.
  
  
  METHODS
  Fifty morbidly obese patients were consecutively scheduled for laparoscopic bariatric surgery (ClinicalTrials.gov Identifier: NCT01873183). The intervention group (IG, n=30) was investigated preoperatively with transthoracic echocardiography (TTE) and rehydrated with colloid fluids if a low level of venous return was detected. During surgery, IGDT was continued with a pulse-contour device (FloTrac™). In the control group (CG, n=20), conventional monitoring was conducted. The type and amount of perioperative fluids infused, vasoactive/inotropic drugs administered, and blood pressure levels were registered.
  
  
  RESULTS
  In the IG, 213 ± 204 mL colloid fluids were administered as preoperative rehydration vs. no preoperative fluids in the CG (p<0.001). During surgery, there was no difference in the fluids administered between the groups. Mean arterial blood pressures were higher in the IG vs. the CG both after induction of anesthesia and during surgery (p=0.001 and p=0.001).
  
  
  CONCLUSIONS
  In morbidly obese patients suspected of being hypovolemic, increased cardiovascular stability may be reached by preoperative rehydration. The management of rehydration should be individualized. Additional invasive monitoring does not appear to have any effect on outcomes in obesity surgery.
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden, tomi.poso@anestesi.umu.se.
authors.forename: Tomi
authors.initials: T
authors.lastname: Pösö
authors.forename: Ola
authors.initials: O
authors.lastname: Winsö
authors.forename: Roman
authors.initials: R
authors.lastname: Aroch
authors.forename: Doris
authors.initials: D
authors.lastname: Kesek
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D001794:Blood Pressure; D001810:Blood Volume; D002302:Cardiac Output; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*