Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

Abstract

Purpose Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery. Methods This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone. Results The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use. Conclusion Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period. Registration number of Clinical Trial The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018).

Prevalence and predictors of preoperative cardiac autonomic dysfunction among elective neurosurgical patients: A prospective observational study

“…Firstly, we assessed CAD by using a relatively novel device, ANSiscope™. Though this instrument has been used across diverse groups of patients,[ 5 6 7 8 9 ] its validation with conventional ANS assessment tools is needed before routine use in the perioperative setting. Secondly, we performed the ANS function assessments in the operating room’s preoperative holding area just before the induction of anaesthesia for surgery.…”

“…Real-time heart rate variability (HRV) assessment using the ANSiscope™ equipment informs about the sympathovagal balance. Previous studies have demonstrated this device’s validity[ 4 ] and utility in the perioperative period during electroconvulsive therapies,[ 5 ] cervical spine,[ 6 ] intracranial[ 7 ] cardiac,[ 8 ] and obstetric surgeries. [ 9 ]…”

Perioperative Autonomic Dysfunction in a Patient With Charcot-Marie-Tooth Disease: A Case Report

“…12 Also, a preanesthetic crystalloid fluid bolus may improve postinduction hypotension. 13 An arterial line should be considered when blood pressure lability is expected due to blood loss, hypovolemia, or specific risk factors. Additional monitoring devices can be considered depending on the patient’s comorbidities (Table 2).…”

Hemodynamic changes in the prone position according to fluid loading after anaesthesia induction in patients undergoing lumbar spine surgery: a randomized, assessor-blind, prospective study

“…To prevent and treat these hemodynamic deteriorations, studies related to prone positioners [ 4 , 10 , 11 ] or the adjustment of fluid preloading to compensate for the decrease in relative circulatory volume [ 8 , 12 , 13 ] have been conducted. In studies related to fluid administration, parameters such as stroke volume variation (SVV) and pulse pressure variation (PPV) are mainly used to determine fluid responsiveness [ 14–16 ].…”