Perioperative Fluid Administration in Pancreatic Surgery: a Comparison of Three Regimens
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Optimization of perioperative fluid management is a controversial issue. Weight-adjusted, fixed fluid strategies do not take into account patient hemodynamic status, so that individualized strategies guided by relevant variables may be preferable. We studied this issue in patients undergoing pancreatic surgery within our institution.
All patients who underwent a laparotomy for pancreatic cancer during a 5-month period at our hospital (AOUI of Verona, Italy) were eligible to be included in this prospective, observational study. According to the responsible anesthesiologist’s free choice, patients received, during surgery, either liberal (12 ml/kg/h) or restricted (4 ml/kg/h) fixed-volume weight-guided replacement fluids or goal-directed (GD) fluid replacement using stroke volume variation (SVV) determined by the FloTrac Vigileo device.
Eighty-six patients were included: 29 in the liberal group, 23 in the restricted group, and 34 in the GD group. The mean duration of surgery was 6 [4–7] h. Patients in the liberal group received more perioperative fluid than those in the GD and restricted groups. Nearly one third of all patients had a major complication, including delayed enteral feeding, and presented a longer duration of hospital stay. Despite the biases related to our limited cohort, there were significantly fewer postoperative complications (such as postoperative fistula, abdominal collection, and hemorrhage) in the restricted and GD groups of patients than in the liberal one.
In patients undergoing pancreatic surgery, a restricted or individually guided GD strategy for management of perioperative fluids can result in fewer complications than a liberal fluid strategy. Larger and randomized investigations are warranted to confirm these data on this domain.
KeywordsFluid strategy Volume replacement Crystalloids Colloids Abdominal surgery Postoperative complications
LG, AM, NM, VS, and EP conceived and designed the study; NM, AM, KD, GM, and LP collected all sensitive data; AM, LG, and VS performed the statistical analysis; LG, AM, and NM first drafted the manuscript; all authors participated to manuscript preparation and finalization and agreed on its final version.
This study was not supported by any grant.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Approval from the Institutional Review Board was obtained (local committee acceptance number 884CESC) along with written informed consent from all patients.
- 4.De Schryver N, Wittebole X, Hubert C, Gigot JF, Laterre PF, Castanares-Zapatero D. Early hyperlactatemia predicts pancreatic fistula after surgery.BMCAnesthesiol. 2015 Jul 28;15:109.Google Scholar
- 5.Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K et al. Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Annals of surgery. 2003;238(5):641.Google Scholar
- 13.Claudio Bassi, Giovanni Marchegiani, Christos Dervenis, Micheal Sarr, Mohammad Abu Hilal, Mustapha Adham et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017 Mar;161(3):584–591.CrossRefGoogle Scholar
- 14.Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB (Oxford). 2010;12(9):610–8.CrossRefGoogle Scholar
- 17.ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526–33.Google Scholar
- 26.Forget P, Lois F, De Kock M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analgesia. 2010;111(4):910–4.Google Scholar
- 39.Boldt J. Volume therapy in the intensive care patient—we are still confused, but... Intensive Care Med. 2000;26(9):1181–92.Google Scholar
- 41.Senagore AJ, Emery T, Luchtefeld M, Kim D, Dujovny N, Hoedema R. Fluid management for laparoscopic colectomy: a prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarch coupled with an enhanced recovery program. Dis Colon Rectum.2009;52(12):1935–40.CrossRefGoogle Scholar