The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

Abstract

SummarySurgical patients develop a fluid deficit during pre-operative starvation. This study examines the effects of pre-operative fluid administration on haemodynamic variables, oxygenation and splanchnic perfusion in patients undergoing elective coronary artery bypass grafting. Forty-eight patients were randomised to receive either a pre-operative crystalloid infusion (crystalloid group, n ¼ 24) or no infusion (control group, n ¼ 24). Patients in the crystalloid group received a continuous infusion of Ringer's solution at 1.5 ml.kg )1 .h )1 from 22:00 h until induction of anaesthesia the next morning. Immediately before induction of anaesthesia, all patients were given a colloid infusion to increase pulmonary capillary wedge pressure and central venous pressure to similar levels in both groups. Haemodynamic and oxygenation parameters were measured using invasive cardiovascular monitoring, and splanchnic perfusion was assessed by indocyanine green clearance. Patients in the crystalloid group received a mean (SD) of 1008 (140) ml of Ringer's solution overnight. Patients in the crystalloid group had a higher splanchnic blood flow than the control group before induction of anaesthesia [mean (SD) ¼ 1782 (573) ml.min )1 vs. 1391 (333) ml.min )1 , p < 0.05]. There were no significant differences in systemic haemodynamic data and global oxygenation parameters between the two groups. Pre-operative infusion of crystalloid appears to result in an improvement in pre-operative splanchnic perfusion.

Influence of pre‐operative fluid infusion on volume status during oesophageal resection – a prospective trial

“…In a randomised‐controlled trial, 24 patients undergoing coronary artery bypass grafting received a supplementary crystalloid infusion (1.5 ml/kg/h) pre‐operatively. In comparison with the control group, these patients had an improved pre‐operative hepatic bloodflow 17 . However, as in the present study, intraoperative cardiac function did not differ between the groups.…”

“…Klein et al 17 showed an increased splanchnic perfusion in a randomised trial in cardiovascular surgery after pre‐operative administration of 1.5 ml/kg crystalloid solution. In another study, a relevant improvement of intraoperative cardiac stability and decreased post‐operative morbidity was demonstrated after pre‐operative fluid loading with 2000 ml saline solution 18…”

Anesthesia and intraoperative support of homeostasis in fast‐track rehabilitation for elective colonic surgery

“…Based on the premise that patients develop a considerable preoperative fluid deficit because of bowel preparation, fasting and intraoperative fluid loss via the gut in prolonged abdominal surgery, volume and infusion therapies have traditionally been ‘generous’, meaning that patients often received five or more liters of fluid intraoperatively. This concept is supported by randomized investigations focused on intestinal perfusion enhancement of the mucosa and increased splanchnic perfusion during cardiac surgery 39 . Elevated intraoperative fluid regimes have been associated with a reduced incidence of mucosal hypoperfusion and severe complications.…”

Splanchnic Blood Flow in Low-Flow States

“…Although the administration of crystalloids may improve hepatosplanchnic perfusion in preoperative cardiac surgical patients (10,11), this seems not to be true for patients with other forms of circulatory failure (12). Moreover, the administration of crystalloid and colloid solutions based on saline can actually result in metabolic acidosis and impaired gastric mucosal perfusion (13).…”