Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study †

Holte, Kathrine; Foss, Nicolai Bang; Andersen, Jens T.; Valentiner, Lotte; Lund, Christian; Bie, Peter; Kehlet, Henrik

doi:10.1093/bja/aem211

Cited by 242 publications

(201 citation statements)

References 34 publications

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“…We enrolled 77 patients (24 women, 53 men) with a mean age of 62.6±16 years (range, 23-97), mean BMI of 24.6±3.9 (range, 18-34) kg/m 2 , mean operation time of 249±109 (range, 35-570) minutes, mean APACHE II score of 9.88±3.25 (range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Table 1 shows the distribution of patients according to type of surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Conflicting data exist regarding restrictive or liberal strategy of perioperative fluid replacement on postoperative complications and recovery of gastrointestinal tract (13,(14)(15)(16)(17). Liberal strategy of perioperative fluid administration includes replacement of preoperative fluid deficit, replacement of "third space" losses, preloading the patient before regional anesthesia, replacement of blood and insensible losses, maintaining an optimal central venous pressure, blood pressure and urine output, etc.…”

Section: Discussionmentioning

confidence: 99%

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The influence of fluid balance on intra-abdominal pressure after major abdominal surgery

Šerpytis

Ivaškevičius

2008

Medicina

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The influence of fluid balance on intra-abdominal pressure after major abdominal surgery

Šerpytis

Ivaškevičius

2008

Medicina

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“…Although this is in excess of maintenance requirements, some studies have considered this to be a 'standard' fluid regimen (27) . Some studies using 'restricted' fluid regimens have provided patients with appropriate maintenance requirements (27,28) , while others have used true restriction and given patients less than the desired amount (29,30) . In addition, there is often a discrepancy between the amount of fluid prescribed and that delivered.…”

Section: Definitionsmentioning

confidence: 99%

A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

2010

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The terminology used for describing intervention groups in randomised controlled trials (RCT) on the effect of intravenous fluid on outcome in abdominal surgery has been imprecise, and the lack of standardised definitions of the terms 'standard', 'restricted' and 'liberal' has led to some confusion and difficulty in interpreting the literature. The aims of this paper were to clarify these definitions and to use them to perform a meta-analysis of nine RCT on primarily crystalloid-based peri-operative intravenous fluid therapy in 801 patients undergoing elective open abdominal surgery. Patients who received more or less fluids than those who received a 'balanced' amount were considered to be in a state of 'fluid imbalance'. When 'restricted' fluid regimens were compared with 'standard or liberal' fluid regimens, there was no difference in post-operative complication rates (risk ratio 0 . 96 (95 % CI 0 . 56, 1 . 65), P = 0 . 89) or length of hospital stay (weighted mean difference (WMD) -1 . 77 (95% CI -4 . 36, 0 . 81) d, P = 0 . 18). However, when the fluid regimens were reclassified and patients were grouped into those who were managed in a state of fluid 'balance' or 'imbalance', the former group had significantly fewer complications (risk ratio 0 . 59 (95 % CI 0 . 44, 0 . 81), P = 0 . 0008) and a shorter length of stay (WMD -3 . 44 (95 % CI -6 . 33, -0 . 54) d, P = 0 . 02) than the latter. Using imprecise terminology, there was no apparent difference between the effects of fluid-restricted and standard or liberal fluid regimens on outcome in patients undergoing elective open abdominal surgery. However, patients managed in a state of fluid balance fared better than those managed in a state of fluid imbalance.

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“…Peri-operative analgesic protocols that include a combination of general and epidural analgesia have been introduced for a wide variety of surgical procedures to reduce stress response and allow immediate postoperative rehabilitation [1,2]. Epidural analgesia significantly reduces the incidence of cardiovascular events, acute respiratory failure, deep venous thrombosis and gastrointestinal paralysis after major abdominal surgery [3,4].…”

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confidence: 99%

Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery

et al. 2008

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SummaryIn a quality improvement audit on epidural analgesia in 300 patients after major abdominal surgery, we identified postoperative lower leg weakness and premature catheter dislodgement as the most frequent causes of premature discontinuation of postoperative epidural infusion. Lower limb motor weakness occurred in more than half of the patients with lumbar epidural analgesia. In a second period monitoring 177 patients, lumbar catheter insertion was abandoned in favour of exclusive thoracic placement for epidural catheters. Additionally, to prevent outward movement, the catheters were inserted deeper into the epidural space (mean (SD) 5.2 (1.5) cm in Period Two vs 4.6 (1.3) cm in Period One). Lower leg motor weakness declined from 14.7% to 5.1% (odds ratio 0.35; 95% confidence interval 0.16-0.74) between the two periods. Similarly, the frequency of premature catheter dislodgement was reduced from 14.5% to 5.7% (odds ratio 0.35; 95% confidence interval 0.17-0.72). With a stepwise logistic regression model we demonstrated that the odds of premature catheter dislodgement was reduced by 43% for each centimetre of additional catheter advancement in Period Two. We conclude that careful audit of specific complications can usefully guide changes in practice that improve success of epidural analgesia regimens.

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Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study †

Cited by 242 publications

References 34 publications

The influence of fluid balance on intra-abdominal pressure after major abdominal surgery

The influence of fluid balance on intra-abdominal pressure after major abdominal surgery

A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery

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