Obesity Surgery

, Volume 20, Issue 6, pp 709–715 | Cite as

Stroke Volume Variation as a Guide to Fluid Administration in Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery

  • Anil Kumar JainEmail author
  • Amitabh Dutta
Clinical Research



Perioperative fluid administration in morbidly obese patients is critical. There is scarcity of scientific information in literature on amount and rate of its application. Functional parameters (stroke volume variation (SVV), pulse pressure variation) are considered more accurate predictor of volume status of patients than blood pressure and central venous pressure.


SVV was used as a guide for intraoperative fluid administration in 50 morbidly obese patients subjected to bariatric surgery. Pulse contour waveform analysis (LiDCO Cardiac Sensor System, UK Company Regd. 2736561, VAT Regd. 672475708) was utilized to monitor SVV, and a value more than 10% was used as infusion trigger for intraoperative fluid management.


Mean amount of fluid infused was 1,989.90 ml (±468.70 SD) for mean 206.94 min (±50.30 SD) duration of surgery. All patients maintained hemodynamic parameters (cardiac output, cardiac index, stroke volume, noninvasive blood pressure, heart rate) within 10% of the baseline values. Central venous pressure and SVV showed no correlation, except for short period initially. Renal and metabolic indices remained within normal limits.


Obese patients coming for laparoscopic bariatric surgery may not require excessive fluid. Intraoperative fluid requirement is the same as for nonobese patients. SVV is a valuable guide for fluid application in obese patients undergoing bariatric surgery.


Anesthesia Morbid obesity Stroke volume variation Bariatric surgery Stroke volume Cardiac output 


Financial Disclosure

Purely institutional

Conflict of Interest



  1. 1.
    Ogunnaike BO, Jones SB, Jones DB, et al. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95:1793–805.CrossRefPubMedGoogle Scholar
  2. 2.
    Chappell D, Jecob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007;35:64–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Beaussier M, Coriat P, Perel A, et al. Determinants of systolic pressure variation in patients ventilated after vascular surgery. J Cardiothorac Vasc Anesth. 1995;9(5):547–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92:984–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Reuter DA, Felbinger TW, Schmidt C, et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med. 2002;28:392–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients. Chest. 2002;121:2000–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Marik PE, Baram M. Non invasive hemodynamic monitoring in the intensive care unit. Crit Care Clin. 2007;23:383–400.CrossRefPubMedGoogle Scholar
  9. 9.
    Vincet JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53.CrossRefGoogle Scholar
  10. 10.
    Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor blinded multicenter trial. Ann Surg. 2003;230:641–8.CrossRefGoogle Scholar
  11. 11.
    Cohn JN. Central venous pressure as a guide to volume expansion. Ann Int Med. 1967;66:1283–7.PubMedGoogle Scholar
  12. 12.
    Baek S-M, Makabali GG, Bryan-Brown CW, et al. Plasma expansion in surgical patients with high central venous pressure (CVP): the relationship of blood volume to hematocrit, CVP, pulmonary wedge pressure, and cardiorespiratory changes. Surgery. 1975;78:304–15.PubMedGoogle Scholar
  13. 13.
    Pinsky MR, Teboul JL. Assessment of indices of preload and volume responsiveness. Curr Opin Crit Care. 2005;11:235–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of Seven Mares. Chest. 2008;134:172–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Gelman S. Venous function and central venous pressure. Anesthesiology. 2008;108:735–48.CrossRefPubMedGoogle Scholar
  16. 16.
    Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med. 2003;29:352–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Wagner JG, Leatherman JW. Right ventricular end-diastolic volume as a predictor of the hemodynamic response to a fluid challenge. Chest. 1998;113:1048–54.CrossRefPubMedGoogle Scholar
  18. 18.
    Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med. 2000;162:134–8.PubMedGoogle Scholar
  19. 19.
    Kumar A, Anel R, Bunnell E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32:691–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Magder S, Scharf SM. In: Scharf SM, Pinsky MR, Magder S, editors. Venous return, respiratory–circulatory interactions in health and disease. New York: Marcel Dekker; 2001. p. 93–112.Google Scholar
  21. 21.
    Massumi RA, Mason DT, Vera Z, et al. Reversed pulsus paradoxus. N Engl J Med. 1973;289:1272–5.PubMedGoogle Scholar
  22. 22.
    Perel A, Pizov R, Cotev S. Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology. 1987;67:498–502.CrossRefPubMedGoogle Scholar
  23. 23.
    Michard F, Chemla D, Richard C, et al. Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med. 1999;159:935–9.PubMedGoogle Scholar
  24. 24.
    Rick JJ, Burke SS. Respiratory paradox. South Med J. 1978;71:1376–8.PubMedGoogle Scholar
  25. 25.
    Pizov R, Ya’ari Y, Perel A. Systolic pressure variation is greater during hemorrhage than during sodium nitroprusside-induced hypotension in ventilated dogs. Anesth Analg. 1988;67:170–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Szold A, Pizov R, Segal E, et al. The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs. Intensive Care Med. 1989;15:368–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Connors AF Jr, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276:889–97.CrossRefPubMedGoogle Scholar
  28. 28.
    Polanczyk CA, Rohde LE, Goldman L, et al. Right heart catheterization and cardiac complications in patient undergoing noncardiac surgery: an observational study. JAMA. 2001;286:309–14.CrossRefPubMedGoogle Scholar
  29. 29.
    Sandham JD, Hull RD, Brant RF, et al. Canadian Critical Care Clinical Trials Group: a randomized, controlled trial of the use of pulmonary artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5–14.CrossRefPubMedGoogle Scholar
  30. 30.
    Coriat P, Vrillon M, Perel A, et al. A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg. 1994;78:46–53.CrossRefPubMedGoogle Scholar
  31. 31.
    Tavernier B, Makhotine O, Lebuffe G, et al. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology. 1998;89:1313–21.CrossRefPubMedGoogle Scholar
  32. 32.
    Reuter DA, Kirchner A, Felbinger TW, et al. Optimising fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations: a comparison to aortic systolic pressure variations. Br J Anesth. 2002;88:124–6.CrossRefGoogle Scholar
  33. 33.
    Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med. 2003;31:1399–404.CrossRefPubMedGoogle Scholar
  34. 34.
    Bendjelid K, Suter PM, Romand JA. The respiratory change in preejection period: a new method to predict fluid responsiveness. J Appl Physiol. 2004;96:337–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Vieillard-Baron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med. 2004;30:1734–9.PubMedGoogle Scholar
  36. 36.
    Godje O, Hoeke K, Lichtwarck-Aschoff M, et al. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med. 1999;27:2407–12.CrossRefGoogle Scholar
  37. 37.
    Godje O, Hoeke K, Lamm P, et al. Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac Cardiovasc Surg. 1998;46:242–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Beckett RC, Gray BA. Effect of atelectasis and embolization on extravascular thermal volume of the lung. J Appl Physiol. 1982;53:1614–9.PubMedGoogle Scholar
  39. 39.
    Combes A, Berneau JB, Luyt CE, et al. Estimation of left ventricular systolic function by single transpulmonary thermodilution. Intensive Care Med. 2004;30:1377–83.PubMedGoogle Scholar
  40. 40.
    Della Rocca G, Costa GM, Coccia C, et al. Preload index: pulmonary artery occlusion pressure versus intrathoracic blood volume monitoring during lung transplantation. Anesth Analg. 2002;95:835–43.CrossRefPubMedGoogle Scholar
  41. 41.
    Della RG, Costa MG, Coccia C, et al. Preload and haemodynamic assessment during liver transplantation: a comparison between the pulmonary artery catheter and transpulmonary indicator dilution techniques. Eur J Anaesthesiol. 2002;19:868–75.CrossRefGoogle Scholar
  42. 42.
    Hofer CK, Ganter MT, Matter ES, et al. Volumetric assessment of left heart preload by thermodilution: comparing the PiCCO-VoLEF system with transoesophageal echocardiography. Anaesthesia. 2006;61:316–21.CrossRefPubMedGoogle Scholar
  43. 43.
    Michard F, Alaya S, Zarka V, et al. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest. 2003;124:1900–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Side C, Gosling R. Non-surgical assessment of cardiac function. Nature. 1971;232:335–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Singer M, Clarke J, Bennett ED. Continuous hemodynamic monitoring by esophageal Doppler. Crit Care Med. 1989;17:447–52.PubMedCrossRefGoogle Scholar
  46. 46.
    Chinard FP, Enns T. Transcapillary pulmonary exchange of water in the dog. Am J Physiol. 1954;178:197–202.PubMedGoogle Scholar
  47. 47.
    Conway D, Mayall R, Abdul-Latif M, et al. Randomized controlled trial investigating the influence of intravenous fluid titration using esophageal Doppler monitoring during bowel surgery. Anaesth Intensive Care. 2002;57:845–9.Google Scholar
  48. 48.
    Feldman LS, Anidjar M, Metrakos P, et al. Optimization of cardiac preload during laparoscopic donor nephrectomy: a preliminary study of central venous pressure versus esophageal Doppler monitoring. Surg Endosc. 2004;18:412–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Monnet X, Rienzo M, Osman D, et al. Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients. Intensive Care Med. 2005;31:1195–2001.CrossRefPubMedGoogle Scholar
  50. 50.
    Mythen M, Webb A. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995;130:423–9.PubMedGoogle Scholar
  51. 51.
    Leykin Y, Pellis T, Mestro ED, et al. Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: hospital course and outcomes. Obes Surg. 2006;16:1563–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Jones K. Bariatric surgery and the prevention of postoperative respiratory complication. Anesth Analg. 2004;98:1810–1.Google Scholar
  53. 53.
    Astiz ME. Pathophysiology and classification of shock state. In: Fink PM, Abraham E, Vincent JL, et al., editors. Text book of critical care. 5th ed. Philadelphia: Saunders; 2005. p. 901–2.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Anaesthesiology, Pain, and Perioperative MedicineSir Ganga Ram Hospital, Sir Ganga Ram Hospital MargNew DelhiIndia

Personalised recommendations