title: Intraoperative Fluid Restriction in Pancreatic Surgery: A Double Blinded Randomised Controlled Trial.
abstract: BACKGROUND
  Perioperative fluid restriction in a variety of operations has shown improvement of: complications, recovery of gastrointestinal function and length of stay (LOS). We investigated effects of crystalloid fluid restriction in pancreatic surgery. Our hypothesis: enhanced recovery of gastrointestinal function.
  
  
  METHODS
  In this double-blinded randomized trial, patients scheduled to undergo pancreatoduodenectomy (PD) were randomized: standard (S:10ml/kg/hr) or restricted (R:5ml/kg/hr) fluid protocols.
  
  
  METHODS
  gastric emptying scintigraphically assessed on postoperative day 7.
  
  
  RESULTS
  In 66 randomized patients, complications and 6-year survival were analyzed. 54 patients were analyzed in intention to treat: 24 S-group and 30 R-group. 32 patients actually underwent a PD and 16 patients had a palliative gastrojejunostomy bypass operation in the full protocol analysis. The median gastric emptying time (T½) was 104 minutes (S-group, 95% confidence interval: 74-369) versus 159 minutes (R-group, 95% confidence interval: 61-204) (P = 0.893, NS). Delayed gastric emptying occurred in 10 patients in the S-group and in 13 patients in the R-group (45% and 50%, P = 0.779, NS). The primary outcome parameter, gastric emptying time, did not show a statistically significant difference between groups.
  
  
  CONCLUSIONS
  A fluid regimen of 10ml/kg/hr or 5ml/kg/hr during pancreatic surgery did not lead to statistically significant differences in gastric emptying. A larger study would be needed to draw definite conclusions about fluid restriction in pancreatic surgery.
  
  
  BACKGROUND
  ISRCTN62621488.
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ganapathy
authors.initials: G
authors.lastname: van Samkar
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Wietse J
authors.initials: WJ
authors.lastname: Eshuis
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Roelof J
authors.initials: RJ
authors.lastname: Bennink
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Preckel
authors.affiliation: Department of Anesthesiology, University of Ghent, Ghent, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: de Hert
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010166:Palliative Care; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000473:pathology; D011184:Postoperative Period; D000077325:Ringer's Lactate; D016896:Treatment Outcome
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate