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Perioperative Fluid Administration in Pancreatic Surgery: a Comparison of Three Regimens

  • Leonardo Gottin
  • Alvise Martini
  • Nicola Menestrina
  • Vittorio Schweiger
  • Giuseppe Malleo
  • Katia DonadelloEmail author
  • Enrico Polati
Original Article
  • 94 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Fluid strategy Volume replacement Crystalloids Colloids Abdominal surgery Postoperative complications 

Notes

Author Contributions

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.

Funding

This study was not supported by any grant.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Statement

Approval from the Institutional Review Board was obtained (local committee acceptance number 884CESC) along with written informed consent from all patients.

Supplementary material

11605_2019_4166_MOESM1_ESM.pdf (115 kb)
ESM 1 (PDF 114 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Unit of Cardio-Thoracic Anesthesia and Intensive Care; Department of Surgery, Dentistry, Paediatrics and GynaecologyUniversity of Verona, AOUI—University Hospital Integrated Trust of VeronaVeronaItaly
  2. 2.Unit of Anesthesia and Intensive Care B; Department of Surgery, Dentistry, Paediatrics and GynaecologyUniversity of Verona, AOUI—University Hospital Integrated Trust of VeronaVeronaItaly
  3. 3.General and Pancreatic Surgery Department; Pancreas InstituteAOUI—University Hospital Integrated Trust of VeronaVeronaItaly

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