Is the Use of Intraoperative Colloids Beneficial During Bariatric Surgery?
Dawes, Jerry J.; Gizoni, Joseph A.
2002-08-14
Abstract
Currently there is a lack of research to guide intra-operative fluid resuscitation for Roux-En-Y gastric bypass surgery. Inadequate fluid resuscitation can result in post-operative tachycardia, decreased urine output, and hypotension due to hypovolemia. However, these symptoms can also suggest bleeding or an anastamosis leak. The purpose of this study is to compare intraoperative fluid resuscitation using crystalloids only or crystalloids with colloids on post-operative intravascular fluid volume. We hypothesize that patients receiving crystalloids and colloids will have improved indices, reflecting increased post-operative intravascular volume. This was a prospective double-blinded study consisting of patients presenting for elective Roux-En-Y gastric bypass. Inclusion criteria included patients between the ages of 18 and 65 years, non-pregnant, and undergoing bariatric surgery. Exclusion criteria included renal failure, history of congestive heart failure, allergy to Hetastrarch, or coagulation abnormalities. Patients were randomly assigned to receive intraoperative crystalloid (20ml/kg/hr), or crystalloid (14 ml/kg/hr) and Hespan 6% (6ml/kg one dose time). Post-operative heart rate, blood pressure, respiratory rate, and urine output were measured every fifteen minutes until stable, then every hour for four hours, and then every four hours. Fluid boluses were also documented. Using 46 patients a power of 0.78 to detect one standard deviation. Data collected was divided into eight-hour increments, compared using the two-tailed unpaired students -t test and chi squared analysis. Forty-six ASA II and III patients were enrolled in the study. Twenty-four received crystalloids, and twenty-two received crystalloids with colloids. Demographic characteristics were similar in both groups, with the majority of patients being ASA III. Statistical differences in baseline mean arterial pressure were noted, with colloids baseline MAP=93 mmHg, and crystalloids baseline MAP=103.6 mmHg. Compared to the crystalloid only group, the mean arterial pressure in the colloid/crystalloid group was closer to baseline in all time periods with a statistically significant difference noted between groups in the 30-36 hour period (0.18mmHg in colloids vs. 13.5mmHg in crystalloids (p-value 0.004)). . There was no statistical difference in urine output or heart rate. Ninety-one percent of the colloids and crystalloids group had to be bolused post-operatively (20/22), compared to seventy-five percent in the crystalloids only group (18/24). The time to first bolus after surgery was prolonged in the colloids/crystalloids group, on average 2.2 hours. The colloids/ crystalloids group also had a reduced average total number of boluses and reduced average total bolus volume (colloids/crystalloids = 3.5boluses, crystalloids = 4.3 boluses, colloids/crystalloids = 2,727 cc, crystalloids = 3,438 cc). Our results suggest that the use of a combination of colloids and crystalloids slightly improves some postoperative indices, such as blood pressure and reduced frequency and total volume of fluid boluses compared to crystalloids only. Clinically, anesthesia providers should consider using 6% Hespan to decrease bolusing requirements post-operatively.Subjects
Roux-en-Y obesity hypovolemia crsystalloids colloids
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