Präoperative Flüssigkeitssubstitution bei Nüchternheit im Rahmen elektiver Operationen – Einfluss auf die hämodynamische Stabilität während der Narkoseeinleitung und Operation
Loading...
Files
Date
Authors
Publisher
Philipps-Universität Marburg
Supervisors
Abstract
Hemodynamic instability is a common problem after introduction of general anaesthesia. It is mostly based on a certain lack of intravenous fluid after a prolonged fasting period the night before surgery. A clinical estimation of the actual lack is not that easy. We aimed to examine the influence of a pre-operative fluid loading on the hemodynamic situation after introduction of anaesthesia. We used a minimal-invasive monitoring system and transthoracic echocardiogram for our measurements. Patients who participated in this study underwent elective surgery without huge hemodynamic volume changes or blood loss.
This was a randomised clinical controlled trial. We sought to recruit 219 patients undergoing smaller elective surgery. Elective surgery meant operations on thyroid and parathyroid gland, gall bladder, ovaries and uterus. After informed consent was obtained patients were casted into a study or into a control group by envelope randomization. Control-group patients received no fluid load before introduction of anaesthesia whereas study-group patients received 8 ml/ kg of acetated Ringer´s solution. Primary outcome was the appearance of hemodynamic instability after introduction of general anaesthesia. In addition there existed 15 secondary outcome variables concerning the use of catecholamines, values in blood gas analysis, etc. For the evaluation, the software IBM SPSS Statistics Version 20 was used. Parametric data were evaluated with the student t-test and chi-squares-test. For non-parametric data Mann-Whitney u test and Wilcoxon-Test were used. Primary and secondary outcomes were calculated with logistic and linear regressions models.
Between March 2013 and September 2014 219 adult patients were recruited for this examination. The median pre- operative fluid loading volume in the study group was 550 ml (IQR 400 to 750) compared to 0 ml (IQR 0 to 0) in the control group. The fluid load group had significantly less hemodynamic instability after introduction of general anaesthesia (p<0,05). However, regarding the further secondary outcome points, there were no great differences between the two groups. Patients of the study group had a significantly higher systolic blood pressure, heart index, stroke volume variation and stroke volume index after introduction of anaesthesia. But at the end of operation, the two groups had the same consumption of catecholamines, the same values in blood gas analysis and an equally long stay in hospital.
Pre-operative intravenous fluid loading leads to a significant improvement in hemodynamic stability after introduction of general anaesthesia.
After the operation though the incidence of hemodynamic stability remains the same between the two groups and there are no further significant differences. The question how much fluid load exactly is necessary to archieve a hemodynamic stability remains to be responded.
Review
Metadata
Contributors
Supervisor:
Dates
Created: 2020Issued: 2020-02-04Updated: 2020-02-04
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
randomized clinical Trialhemodynamic stabilityfluid therapy
DFG-subjects
HämodynamikFlüssigkeitsgabeperioperativFall-Kontroll-StudieEchokardiografie
DDC-Numbers
610
show more
Hinterobermaier, Johanna: Präoperative Flüssigkeitssubstitution bei Nüchternheit im Rahmen elektiver Operationen – Einfluss auf die hämodynamische Stabilität während der Narkoseeinleitung und Operation. : Philipps-Universität Marburg 2020-02-04. DOI: https://doi.org/10.17192/z2020.0036.