Background The validation of inferior vena cava (IVC) respiratory variation for predicting volume responsiveness is still under debate, especially in spontaneously breathing patients. The present study aims to verify the effectiveness and accuracy of IVC variability for volume assessment in the patients after abdominal surgery under artificially or spontaneously breathing. Methods A total of fifty-six patients after abdominal surgeries in the anesthesia intensive care unit ward were included. All patients received ultrasonographic examination before and after the fluid challenge of 5 ml/kg crystalloid within 15 min. The same measurements were performed when the patients were extubated. The IVC diameter, blood flow velocity–time integral of the left ventricular outflow tract, and cardiac output (CO) were recorded. Responders were defined as an increment in CO of 15% or more from baseline. Results There were 33 (58.9%) mechanically ventilated patients and 22 (39.3%) spontaneously breathing patients responding to fluid resuscitation, respectively. The area under the curve was 0.80 (95% CI: 0.68–0.90) for the IVC dimeter variation (cIVC1) in mechanically ventilated patients, 0.87 (95% CI: 0.75–0.94) for the collapsibility of IVC (cIVC2), and 0.85 (95% CI: 0.73–0.93) for the minimum IVC diameter (IVCmin) in spontaneously breathing patients. The optimal cutoff value was 15.32% for cIVC1, 30.25% for cIVC2, and 1.14 cm for IVCmin. Furthermore, the gray zone for cIVC2 was 30.72 to 38.32% and included 23.2% of spontaneously breathing patients, while 17.01 to 25.93% for cIVC1 comprising 44.6% of mechanically ventilated patients. Multivariable logistic regression analysis indicated that cIVC was an independent predictor of volume assessment for patients after surgery irrespective of breathing modes. Conclusion IVC respiratory variation is validated in predicting patients' volume responsiveness after abdominal surgery irrespective of the respiratory modes. However, cIVC or IVCmin in spontaneously breathing patients was superior to cIVC in mechanically ventilated patients in terms of clinical utility, with few subjects in the gray zone for the volume responsiveness appraisal. Trial registration ChiCTR-INR-17013093. Initial registration date was 24/10/2017.

Background: After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU). Methods: This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy. Results: Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9–36.7] mg/L vs. 44.8 [95%CI: 26.9–63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D-lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups. Conclusion: Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR. Trial Registration: ChiCTR-INR-17013093.

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Objective The crash cesarean section (CS), which keeps extremely life-threatening to maternals or fetus, seems to be performed within adequate time horizon for the avoidance of negative feto-maternal denouement. The effective and vigilant technique of anesthesia remains vital for crash cesarean delivery. This study, hence, aims to validate the impact of various anesthesia tactics on the maternal as well as neonatal outcomes. Method This was a retrospective cohort study of parturient with the indication for crash CS with the assistance of general or neuraxial anesthesia during the period of January 2015 and July 2021 in our institution. The 1min Apgar score as primary outcome was documented. Secondary outcomes composing 5 min Apgar score, DDI, OAII, duration of operation, length of hospitalization, height and weight of newborn, use of vasopressors, blood loss were also measured. Results Of the total 536 subjects incorporated in the analysis, 337 crash CS were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSE), respectively. The Apgar score of 1 min and 5 min in newborn receiving general anesthesia were lower than those under intraspinal anesthesia and no difference was found between EA and CSEA. The decision-to-delivery interval (DDI) of parturients under GA, EA, and CSE was 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. DDI as well as decision to incision interval (DII) of GA and EA were shorter than CES, among which there was a similarity in DDI and DII between GA and EA. Compared to GA, the onset of anesthesia to incision interval (OAII) of intraspinal anesthesia was extended significantly. The birth height and weight of neonates from EA seem to be superior to GA. Conclusion Epidural anesthesia did not exploited negative impact on neonatal and maternal outcomes as compared to general anesthesia and could be utilized as an alternative to general anesthesia in crash cesarean section; in addition, the DDI of crash cesarean section could be achieved within 15 minutes under general or epidural anesthesia in our institution.

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