11 Jul 12

The volume of lactated Ringer’s solution required to maintain preload and cardiac index during open and laparoscopic surgery

Posted in Fluid management at 19:20 by Laci

By M Concha, V Mertz, L Cortínez, K González, J Butte, F Pinedo and A Zúñiga

Anesth Analg 2009;108:616-622

Recent studies have emphasized the importance of perioperative fluid restriction. However, fluid restriction regimens may increase the likelihood of insufficient perioperative fluid administration or may result in excess intravascular crystalloid replacement. We postulate that the use of transesophageal echocardiography may reduce the amount of crystalloid administered during open and laparoscopic colorectal surgery.

Methods
Fifteen ASA I and II patients scheduled for open colorectal surgery, and 15 patients scheduled for laparoscopic surgery were studied. Lactated Ringer’s solution was infused during the procedures. Left ventricular end diastolic volume index (LVEDVI) and cardiac index were assessed throughout surgery and used to guide the rate of lactated Ringer’s solution administration. Statistical analysis was performed with Student’s t-test for unpaired samples.

Results
The rate of crystalloid administration required to maintain baseline LVEDVI and cardiac index was 5.9 ± 2 mL · kg−1 · h−1 for open surgery and 3.4 ± 0.8 mL · kg−1 · h−1 for laparoscopic surgery (P < 0.01). This slower rate for laparoscopic surgery was offset by the longer surgical duration.

Conclusion
The rate of crystalloid solution to maintain baseline LVEDVI and cardiac index was greater in open surgery than laparoscopic surgery, and lower than commonly recommended for colorectal surgery.

Implications
Transesophageal echocardiography guidance suggests that crystalloid replacement therapy for colorectal surgery is approximately 6 mL · kg−1 · h−1 for open procedures and 3 mL · kg−1 · h−1 for laparoscopic procedures.

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