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Perioperative fluid management: comparison of high, medium and low fluid volume on tissue oxygen pressure in the small bowel and colon

Published online by Cambridge University Press:  01 November 2007

L. B. Hiltebrand ,
G. Pestel ,
H. Hager ,
J. Ratnaraj ,
G. H. Sigurdsson  and
A. Kurz
L. B. Hiltebrand*
Affiliation:
Washington University, Department of Anesthesiology, St. Louis, MO, USA
G. Pestel
Affiliation:
University of Bern, Department of Anesthesiology, Inselspital, Bern, Switzerland
H. Hager
Affiliation:
Washington University, Department of Anesthesiology, St. Louis, MO, USA
J. Ratnaraj
Affiliation:
Washington University, Department of Anesthesiology, St. Louis, MO, USA
G. H. Sigurdsson
Affiliation:
Landspitali University Hospital and University of Iceland, Department of Anesthesia and Intensive care medicine, Reykjavik, Iceland
A. Kurz
Affiliation:
University of Louisville, Outcomes Research Institute, Louisville, KY, USA
*
Correspondence to. Luzius Hiltebrand, Department of Anaesthesiology, Inselspital, University of Bern, 3010 Bern, Switzerland. E-mail: [email protected]; Tel: +41 31 362 24 83; Fax: +41 31 632 05 54
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Summary

Background and objective

Insufficient blood flow and oxygenation in the intestinal tract is associated with increased incidence of postoperative complications after bowel surgery. High fluid volume administration may prevent occult regional hypoperfusion and intestinal tissue hypoxia. We tested the hypothesis that high intraoperative fluid volume administration increases intestinal wall tissue oxygen pressure during laparotomy.

Methods

In all, 27 pigs were anaesthetized, ventilated and randomly assigned to one of the three treatment groups (n = 9 in each) receiving low (3 mL kg−1 h−1), medium (7 mL kg−1 h−1) or high (20 mL kg−1 h−1) fluid volume treatment with lactated Ringer’s solution. All animals received 30% and 100% inspired oxygen in random order. Cardiac index was measured with thermodilution and tissue oxygen pressure with a micro-oximetry system in the jejunum and colon wall and subcutaneous tissue.

Results

Groups receiving low and medium fluid volume treatment had similar systemic haemodynamics. The high fluid volume group had significantly higher mean arterial pressure, cardiac index and subcutaneous tissue oxygenation. Tissue oxygen pressures in the jejunum and colon were comparable in all three groups.

Conclusions

The three different fluid volume regimens tested did not affect tissue oxygen pressure in the jejunum and colon, suggesting efficient autoregulation of intestinal blood flow in healthy subjects undergoing uncomplicated abdominal surgery.

Keywords

PERIOPERATIVE CAREINFUSIONS INTRAVENOUSOXYGEN CONSUMPTION, gastrointestinal tract, subcutaneous
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 927 - 933
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Mythen, MG, Webb, AR. Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost. Intensive Care Med 1994; 20: 99–104.CrossRefGoogle ScholarPubMed
2.Wilson, J, Woods, I, Fawcett, J et al. . Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 1999; 318: 1099–1103.CrossRefGoogle ScholarPubMed
3.Shoemaker, WC, Appel, PL, Kram, HB, Waxman, K, Lee, TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94: 1176–1186.CrossRefGoogle ScholarPubMed
4.Boyd, O, Grounds, M, Bennett, E. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 1993; 270: 2699–2707.CrossRefGoogle ScholarPubMed
5.Wakeling, HG, McFall, MR, Jenkins, CS et al. . Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 2005; 95: 634–642.CrossRefGoogle ScholarPubMed
6.Mythen, MG, Webb, AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995; 130: 423–429.CrossRefGoogle ScholarPubMed
7.Conway, DH, Mayall, R, Abdul-Latif, MS, Gilligan, S, Tackaberry, C. Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 2002; 57: 845–849.CrossRefGoogle ScholarPubMed
8.Gan, TJ, Soppitt, A, Maroof, M et al. . Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002; 97: 820–826.CrossRefGoogle ScholarPubMed
9.Roumen, RM, van der Vliet, JA, Wevers, RA, Goris, RJ. Intestinal permeability is increased after major vascular surgery. J Vasc Surg 1993; 17: 734–737.CrossRefGoogle ScholarPubMed
10.Ohri, SK, Somasundaram, S, Koak, Y et al. . The effect of intestinal hypoperfusion on intestinal absorption and permeability during cardiopulmonary bypass. Gastroenterology 1994; 106: 318–323.CrossRefGoogle ScholarPubMed
11.Shandall, A, Lowndes, R, Young, HL. Colonic anastomotic healing and oxygen tension. Br J Surg 1985; 72: 606–609.CrossRefGoogle ScholarPubMed
12.Ratnaraj, J, Kabon, B, Talcott, MR, Sessler, DI, Kurz, A. Supplemental oxygen and carbon dioxide each increase subcutaneous and intestinal intramural oxygenation. Anesth Analg 2004; 99: 207–211.CrossRefGoogle ScholarPubMed
13.Greif, R, Akca, O, Horn, EP, Kurz, A, Sessler, DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 2000; 342: 161–167.CrossRefGoogle Scholar
14.Gottrup, F, Firmin, R, Rabkin, J, Halliday, BJ, Hunt, TK. Directly measured tissue oxygen tension and arterial oxygen tension assess tissue perfusion. Crit Care Med 1987; 15: 1030–1036.CrossRefGoogle ScholarPubMed
15.Michard, F, Teboul, JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002; 121: 2000–2008.CrossRefGoogle ScholarPubMed
16.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: 134–138.CrossRefGoogle ScholarPubMed
17.Krejci, V, Hiltebrand, L, Banic, A, Erni, D, Wheatley, AM, Sigurdsson, GH. Continuous measurements of microcirculatory blood flow in gastrointestinal organs during acute hemorrhage. Br J Anaesth 2000; 84: 468–475.CrossRefGoogle Scholar
18.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; 238: 641–648.CrossRefGoogle ScholarPubMed
19.Joshi, GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg 2005; 101: 601–605.CrossRefGoogle ScholarPubMed
20.Arkilic, CF, Taguchi, A, Sharma, N et al. . Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133: 49–55.CrossRefGoogle ScholarPubMed
21.Nisanevich, V, Felsenstein, I, Almogy, G, Weissman, C, Einav, S, Matot, I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005; 103: 25–32.CrossRefGoogle ScholarPubMed
22.Jonsson, K, Jensen, JA, 3rdGoodson, WH, West, JM, Hunt, TK. Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg 1987; 74: 263–267.CrossRefGoogle ScholarPubMed
23.Hwang, G, Marota, JA. Anesthesia for abdominal surgery. In: Hurford, WE, Bailin, MT, Davison, JK, Haspel, KL, Rosow, C, eds. Clinical Anesthesia Procedures of the Massachusetts General Hospital. Philadelphia, USA: Lippincott-Raven, 1997: 330–346.Google Scholar
24.Sendak, M. Monitoring and management of perioperative fluid and electrolyte therapy. In: Rogers, MC, Longnecker, DE, Tinker, JH, eds. Principles and Practice of Anesthesiology, 1st edn. New York, USA: Mosby-Year Book, 1993: 863–966.Google Scholar
25.Tonnesen, AS. Crystalloids and colloids. In: Miller, RD, ed. Anesthesia, 3rd edn. New York, USA: Churchill Livingstone, 1990: 1439–1465.Google Scholar
26.Campbell, IT, Baxter, JN, Tweedie, IE, Taylor, GT, Keens, SJ. IV fluids during surgery. Br J Anaesth 1990; 65: 726–729.CrossRefGoogle ScholarPubMed
27.Holte, K, Klarskov, B, Christensen, DS et al. . Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg 2004; 240: 892–899.CrossRefGoogle ScholarPubMed
28.Michard, F, Teboul, JL. Using heart–lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 2000; 4: 282–289.CrossRefGoogle ScholarPubMed