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Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia.

Li Y, He R, Ying X, Hahn RG - Clinics (Sao Paulo) (2014)

Bottom Line: Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness.Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia.Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Shaoxing People's Hospital, People's Republic of China.

ABSTRACT

Objectives: Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins.

Methods: Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n=86) or Ringer's lactate (n=25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringer's lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples.

Results: Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringer's). The optimized stroke volume index was clustered around 35-40 ml/m2/beat. Additional fluid boluses increased the stroke volume by ≥10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringer's) times over the infused volume.

Conclusions: Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

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Related in: MedlinePlus

The relative change in stroke volume index (SVI) during fluid volume optimization with starch, which increased SVI by approximately 20% (top). The optimized SVI had a smaller variability than did SVI at baseline, i.e., before the induction of anesthesia (bottom).
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f3-cln_69p809: The relative change in stroke volume index (SVI) during fluid volume optimization with starch, which increased SVI by approximately 20% (top). The optimized SVI had a smaller variability than did SVI at baseline, i.e., before the induction of anesthesia (bottom).

Mentions: A high SVI at baseline was followed by a greater decrease in SVI in response to anesthesia. The relationship was reciprocal and persisted throughout the three bolus infusions (Figure 2A–D), which increased SVI by approximately 20% (Figure 3A) to reach the optimized SVI of 40 (9) ml/m2/beat (Figure 3B).


Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia.

Li Y, He R, Ying X, Hahn RG - Clinics (Sao Paulo) (2014)

The relative change in stroke volume index (SVI) during fluid volume optimization with starch, which increased SVI by approximately 20% (top). The optimized SVI had a smaller variability than did SVI at baseline, i.e., before the induction of anesthesia (bottom).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4286668&req=5

f3-cln_69p809: The relative change in stroke volume index (SVI) during fluid volume optimization with starch, which increased SVI by approximately 20% (top). The optimized SVI had a smaller variability than did SVI at baseline, i.e., before the induction of anesthesia (bottom).
Mentions: A high SVI at baseline was followed by a greater decrease in SVI in response to anesthesia. The relationship was reciprocal and persisted throughout the three bolus infusions (Figure 2A–D), which increased SVI by approximately 20% (Figure 3A) to reach the optimized SVI of 40 (9) ml/m2/beat (Figure 3B).

Bottom Line: Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness.Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia.Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Shaoxing People's Hospital, People's Republic of China.

ABSTRACT

Objectives: Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins.

Methods: Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n=86) or Ringer's lactate (n=25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringer's lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples.

Results: Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringer's). The optimized stroke volume index was clustered around 35-40 ml/m2/beat. Additional fluid boluses increased the stroke volume by ≥10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringer's) times over the infused volume.

Conclusions: Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

Show MeSH
Related in: MedlinePlus