Goal-directed use of balanced solutions for laparoscopic surgery in obese patients

Authors

  • S. I. Vorotyntsev Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2018.4.137102

Keywords:

obesity, laparoscopic surgery, fluid therapy, solutions

Abstract

Modern guidelines for infusion therapy in laparoscopic surgery of patients with obesity are ambiguous due to insufficient number of clinical researches.

The aim of our work was to evaluate the effect of goal-directed infusion therapy with balanced solutions on hemodynamics, electrolyte balance, renal function and incidence of perioperative complications of laparoscopic surgery in obese patients.

Materials and methods. The study included 54 obese patients (BMI >30 kg/m2) who were performed laparoscopic surgery in case of the diaphragmatic hernia, colon tumors, postoperative ventral hernia and morbid obesity. In the group A (n = 26) goal-directed infusion therapy by balanced solutions Gelaspan and Sterofundin (B. Braun, Germany) was used. Impedance measuring technology using the monitor Utas 300 (Ukraine) was used to determine the target stroke volume (SV). In the group B (n = 28) infusion therapy was performed by unbalanced solutions (6 % HES and 0.9 % NaCl), focusing on fluid deficiency according to changes in blood pressure (BP), heart rate (HR), and diuresis. The incidence of hypotension and total volume of infusion therapy (TVIT) were evaluated intraoperatively, changes in BP and HR were compared. After surgery diuresis, blood Na+, K+, Cl and creatinine concentrations, diuretic use frequency and incidence of cardiac, respiratory, hemorrhagic and infectious complications were controlled. Statistical analysis was performed using the Statistica for Windows software version 6.0.

Results. The incidence of hypotension in the group B was almost 2 times more than in the group A (P < 0.05). At the stage after the trachea intubation in the group B BP decreased by 16 % and the HR increased by 25 % from the baseline levels (P < 0.05), in group the A the values of BP and HR remained unchanged (P > 0.05). Intraoperative TVIT in the group B was 23 % higher due to crystalloid, and diuresis intensity was twice less than in the group A (P < 0.05). Concentrations of electrolytes and creatinine blood level did not change significantly in the study groups. After surgery in the group B 25 % of patients were prescribed diuretic and in the group A diuretic was not prescribed in any case (P < 0.05). In-hospital mortality in both groups was zero, no serious complications were observed.

Conclusions. Goal-directed infusion therapy with balanced solutions in laparoscopic surgery in obese patients halved the incidence of intraoperative hemodynamic instability, reduces the volume loading of crystalloids by 23 % during surgery and provides adequate perioperative diuresis without additional stimulation.

References

Doherty, M., & Buggy, D. J. (2012) Intraoperative fluids: how much is too much? British Journal of Anaesthesia, 109(1), 69–79. doi: 10.1093/bja/aes171.

Miller, T. E., Roche, A. M., & Mythen, M. (2015) Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anesth, 62(2), 158–168. doi: 10.1007/s12630-014-0266-y.

Chong, M. A., Wang, Y., Berbenetz, N. M., & McConachie, I. (2018) Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes? Eur J Anaesthesiol, 35(7), 469–483. doi: 10.1097/EJA.0000000000000778.

Bennett, V. A., & Cecconi, M. (2017) Perioperative fluid management: From physiology to improving clinical outcomes. Indian J Anaesth., 61(8), 614–21. doi: 10.4103/ija.IJA_456_17.

Hahn, R. G. (2017) Adverse effects of crystalloid and colloid fluids. Anaesthesiology Intensive Therapy, 49(4), 303–308. doi: 10.5603/AIT.a2017.0045.

Ingrande, J., & Brodsky, J. B. (2013) Intraoperative fluid management and bariatric surgery. Int Anesthesiol Clin., 51(3), 80–9. doi: 10.1097/AIA.0b013e3182960847.

Matot, I., Paskaleva, R., Eid, L., Cohen, K., Khalaileh, A., Elazary, R., & Keidaret, A. (2012) Effect of the volume of fluids administered on intraoperative oliguria in laparoscopic bariatric surgery: a randomized controlled trial. Arch Surg. 147(3), 228–34. doi: 10.1001/archsurg.2011.308.

Lemmens, H. J., Bernstein, D. P., & Brodsky, J. B. (2006) Estimating Blood Volume in Obese and Morbidly Obese Patients. Obesity Surgery, 16(6), 773–776. doi: 10.1381/096089206777346673.

Jain, A. K., & Dutta, A. (2010) Stroke volume variation as a guide to fluid administration in morbidly obese patients undergoing laparoscopic bariatric surgery. Obes Surg, 20(6), 709–15. doi: 10.1007/s11695-009-0070-x.

Nguyen, N. T., & Wolfe, B. M. (2005) The Physiologic Effects of Pneumoperitoneum in the Morbidly Obese. Ann Surg., 241(2), 219–226. doi: 10.1097/01.sla.0000151791.93571.70.

Thorell, A., MacCormick, A. D., Awad, S., Reynolds, N., Roulin, D., Demartines, N., et al. (2016) Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg., 40(9), 2065–83. doi: 10.1007/s00268-016-3492-3.

Langer, T., Santini, A., Scotti, E., Regenmortel, N. V., Malbrain, M. L., & Caironi, P. (2015) Intravenous balanced solutions: from physiology to clinical evidence. Anaesthesiology Intensive Therapy., 47, 78–88. doi: 10.5603/AIT.a2015.0079.

Raghunathan, K., Murray, P. T., Beattie, W. S., Lobo, D. N., Myburgh, J., Sladen, S., et al. (2014) Choice of fluid in acute illness: what should be given? An international consensus. British Journal of Anaesthesia., 113(5), 772–83. doi: 10.1093/bja/aeu301.

Young, P., Bailey, M., Beasley, R., Henderson, S., Mackle, D., McArthur, C., et al. (2015) Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial. JAMA., 314(16), 1701–10. doi: 10.1001/jama.2015.12334.

Feldheiser, A., Pavlova, V., Bonomo, T., Jones, A., Fotopoulou, C., Sehouli, J., et al. (2013) Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm. British Journal of Anaesthesia., 110(2), 231–40. doi: 10.1093/bja/aes377.

De Baerdemaeker, L. E. C., Mortier, E. P., & Struys, M. M. R. F. (2004) MMRF. Pharmacokinetics in obese patients. Continuing Education in Anaesthesia, Critical Care & Pain., 4(5), 152–155. doi: 10.1093/bjaceaccp/mkh042.

Bundgaard-Nielsen, M., Secher, N. H., & Kehlet, H. (2009) «Liberal» vs. «restrictive» perioperative fluid therapy – a critical assessment of the evidence. Acta Anaesthesiol Scand., 53(7), 843–851. doi: 10.1111/j.1399-6576.2009.02029.x.

Varadhan, K. K., & Lobo, D. N. (2010) A meta-analysis of randomized controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right. Proc Nutr Soc. 69(4), 488–498. doi: 10.1017/S0029665110001734.

de Menezes, E. J. E, dos Santos, F. P. V., Azaro, E., Melo, C. A., Fahel, E., Batista, P. B. (2005) Prevention of rhabdomyolysis in bariatric surgery. Obes Surg, 15(6), 874–9. doi: 10.1381/0960892054222669.

Schuster, R., Alami, R. S., Curet, M. J., Paulraj, N., Morton, J. M., Brodsky, J. B., et al. (2006) Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery. Obes Surg., 16(7), 848–51. doi: 10.1381/096089206777822197.

Domi, R., & Laho, H. (2012) Anesthetic challenges in the obese patient. J Anesth., 26(5), 758–765. doi: 10.1007/s00540-012-1408-4.

Nossaman, V. E., Richardson, W. S. 3rd, Wooldridge, J. B., & Nossaman, B. D. (2015) Role of intraoperative fluids on hospital length of stay in laparoscopic bariatric surgery: a retrospective study in 224 consecutive patients. Surg Endosc., 29(10), 2960–2969. doi: 10.1007/s00464-014-4029-1.

Matłok, M., Major, P., Małczak, P., Wysocki, M., Hynnekleiv, L., Nowak, M., et al. (2016) Reduction of the risk of rhabdomyolysis after bariatric surgery with lower fluid administration in the perioperative period: a cohort study. Pol Arch Med Wewn., 126(4), 237–242. doi: 10.20452/pamw.3368.

Nguyen, N. T., Nguyen, B., Shih, A., Smith, B., & Hohmann, S. (2013) Use of laparoscopy in general surgical operations at academic centers. Surgery for Obesity and Related Diseases, 9(1), 15–20.doi: 10.1016/j.soard.2012.07.002.

How to Cite

1.
Vorotyntsev SI. Goal-directed use of balanced solutions for laparoscopic surgery in obese patients. Zaporozhye medical journal [Internet]. 2018Jul.13 [cited 2024Mar.28];(4). Available from: http://zmj.zsmu.edu.ua/article/view/137102

Issue

Section

Original research