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Perioperative Fluid Guidance with Transthoracic Echocardiography and Pulse-Contour Device in Morbidly Obese Patients

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Abstract

Background

In bariatric surgery, non- or mini-invasive modalities for cardiovascular monitoring are addressed to meet individual variability in hydration needs. The aim of the study was to compare conventional monitoring to an individualized goal-directed therapy (IGDT) regarding the need of perioperative fluids and cardiovascular stability.

Methods

Fifty morbidly obese patients were consecutively scheduled for laparoscopic bariatric surgery (ClinicalTrials.gov Identifier: NCT01873183). The intervention group (IG, n = 30) was investigated preoperatively with transthoracic echocardiography (TTE) and rehydrated with colloid fluids if a low level of venous return was detected. During surgery, IGDT was continued with a pulse-contour device (FloTrac™). In the control group (CG, n = 20), conventional monitoring was conducted. The type and amount of perioperative fluids infused, vasoactive/inotropic drugs administered, and blood pressure levels were registered.

Results

In the IG, 213 ± 204 mL colloid fluids were administered as preoperative rehydration vs. no preoperative fluids in the CG (p < 0.001). During surgery, there was no difference in the fluids administered between the groups. Mean arterial blood pressures were higher in the IG vs. the CG both after induction of anesthesia and during surgery (p = 0.001 and p = 0.001).

Conclusions

In morbidly obese patients suspected of being hypovolemic, increased cardiovascular stability may be reached by preoperative rehydration. The management of rehydration should be individualized. Additional invasive monitoring does not appear to have any effect on outcomes in obesity surgery.

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Abbreviations

CI:

Cardiac index

CO:

Cardiac output

IAP:

Intra-abdominal pressure

IGDT:

Individualized goal-directed therapy

IBW:

Ideal body weight

LV:

Left ventricle of the heart

LOS:

Length of hospital stay

MO:

Morbidly obese patients

Nt-proBNP:

N-terminal prohormone of brain natriuretic peptide

OR:

Operating room

PEEP:

Positive end-expiratory pressure

PONV:

Postoperative nausea and vomiting

POP:

Postoperative recovery unit

RV:

Right ventricle of the heart

RAP:

Right atrial pressure

RWL:

Rapid weight loss

SV:

Stroke volume

SVV:

Stroke volume variation

TTE:

Transthoracic echocardiography

VAS:

Visual analog scale

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Acknowledgments

This research was supported by the Norrbotten County Council.

Conflict of Interest

The authors declare that there are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden

    Tomi Pösö, Ola Winsö, Roman Aroch & Doris Kesek

  2. Department of Cardiothoracic Anaesthesia, Heart Centre, Umeå University, 901 85, Umeå, Sweden

    Doris Kesek

Authors
  1. Tomi Pösö
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  2. Ola Winsö
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  3. Roman Aroch
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  4. Doris Kesek
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Correspondence to Tomi Pösö.

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Pösö, T., Winsö, O., Aroch, R. et al. Perioperative Fluid Guidance with Transthoracic Echocardiography and Pulse-Contour Device in Morbidly Obese Patients. OBES SURG 24, 2117–2125 (2014). https://doi.org/10.1007/s11695-014-1329-4

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  • DOI: https://doi.org/10.1007/s11695-014-1329-4

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