Hypovolemia after traditional preoperative care in patients undergoing colonic surgery is underrepresented in conventional hemodynamic monitoring

Junghans, T.; Neuß, H.; Strohauer, Michael; Raue, W.; Haase, Oliver; Schink, Tania; Schwenk, W.

doi:10.1007/s00384-005-0065-6

Cited by 41 publications

(21 citation statements)

References 20 publications

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“…The results of our study confi rmed the assumption that hypovolemia can be frequently found in patients undergoing major elective surgery (13,22). We also verifi ed high signifi cance of fl ow-related parameters for detection of hypoperfusion abnormalities (23,24,25) while using TED.…”

Section: Discussionsupporting

confidence: 82%

“…After introduction to general anesthesia, worsening of global hemodynamic parameters is observed, especially preload, which causes reduction of the CI and parallel elevation of systemic vascular resistance (13). However, traditional parameters such as heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) are often normal (14).…”

Section: Discussionmentioning

confidence: 99%

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Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

Szturz¹,

Kula²,

Tichy³

et al. 2014

BLL

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Background:The impact of different approaches to fl uid management during intraoperative volume resuscitation in patients undergoing major elective surgery is poorly defi ned. We compared volume effectiveness of crystalloid and colloid substitution aimed to maintain the cardiac index (CI) between 2.6 and 3.8 l/min/ m 2 as measured by transesophageal Doppler (TED). Methods: A total of 115 urological patients were enrolled in the prospective randomized trial and then randomized into 2 groups, one with volume therapy based on crystalloids (n = 57) and the other with colloids (n = 58). A TED probe was inserted and then hemodynamic optimization (therapy with Ringer's solution or hydroxyethyl starch 6 % 130/0.4 and administration of vasoactive drugs) was started according to TED variables to maintain the CI between 2.6 and 3.8 l/min/m 2 . Results: We observed high incidence of CI < 2.6 l/min/m 2 after induction of anesthesia (75 %) in both groups. There were no signifi cant differences in demographic characteristics, ASA classifi cation, length of surgery, estimated blood loss and the CI during surgery. To maintain the CI within the requested interval, signifi cantly different amounts of crystalloids were needed as compared to colloid (median: 5000 ml vs 1500 ml). In the CRY group, more patients were treated by vasodilatators (40.4 vs 20.7 %). Conclusions:The study confi rmed that crystalloids and colloids are effective in correcting fl ow-related perfusion abnormalities. The signifi cant difference between volumes of crystalloids and colloids proved their different characteristics such as unequal distribution between compartments. The expansion of therapeutic algorithm by using vasoactive drugs allows us to avoid adverse events resulting from fl uid overload (Tab. 1, Fig. 5, Ref. 35). Text in PDF www.elis.sk.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

Szturz¹,

Kula²,

Tichy³

et al. 2014

BLL

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“…Other studies on the PiCCO System were performed during neurosurgery [12], laparoscopic procedures [20] and major abdominal surgery [30 ] and in critically ill patients [13,31]. In all these studies, ITBV was confirmed as a better cardiac preload index when compared with conventional pressure-derived preload indicators (Table 1).…”

Section: Transpulmonary Double Indicator Dilution Techniquementioning

confidence: 90%

How to measure and interpret volumetric measures of preload

Rocca

Costa²,

Pietropaoli³

2007

Current Opinion in Critical Care

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“…Die Laparosko pie kommt aber zunehmend bei älteren Patienten mit kardiovaskulären Vorer krankungen zum Einsatz. So konnte auch bei Patienten der ASAKlassen III und IV gezeigt werden, dass eine laparoskopische Cholezystektomie ohne Verschlechte rung der Hämodynamik, der Oxygenati on sowie der Leber und Nierenfunktion durchführbar ist [15] [14]. An hand retrospektiv erhobener Daten wurde bei laparoskopischer Nierenlebendspende eine aggressive (>10 ml/kgKG) mit einer konservativen Flüssigkeitsgabe (<10 ml/ kgKG) verglichen: Bei gleicher Kompli kationsrate in beiden Gruppen fand sich eine signifikante Verkürzung der Kranken hausverweildauer (3 vs. 2 Tage) in der "konservativen" Gruppe.…”

Section: Hämodynamisches Managementunclassified

Pathophysiology of capnoperitoneum

Vogt

Eberle

2009

Anaesthesist

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Laparoscopic surgery was introduced into clinical practice in the early 1950s by gynaecologists. Technical improvements allowed its use for more complex and longer lasting procedures. Reduction of postoperative pain, more favourable cosmetic results, quicker recovery and reduced length of hospital stay proved to be advantageous when compared to open surgery. As a result progressively older patients with corresponding pulmonary and cardiovascular comorbidities and morbidly obese patients are now undergoing advanced laparoscopic surgery. Detailed knowledge of the respiratory and hemodynamic pathophysiology induced by capnoperitoneum is necessary to administer safe anaesthesia to such patients. This review addresses the most important effects of capnoperitoneum and recent research as well as the possible implications for clinical practice.

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Hypovolemia after traditional preoperative care in patients undergoing colonic surgery is underrepresented in conventional hemodynamic monitoring

Abstract: Combination of CP with 12 mmHg, head-down position, and infusion of 1,500 ml fluids compensated relative hypovolemia during colonic surgery. With conventional monitoring, intravascular volume status might be underestimated after traditional preoperative care.

Cited by 41 publications

References 20 publications

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

How to measure and interpret volumetric measures of preload

Pathophysiology of capnoperitoneum

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