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

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. METHO...

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Autores principales: Li, Yuhong, He, Rui, Ying, Xiaojiang, Hahn, Robert G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286668/
https://www.ncbi.nlm.nih.gov/pubmed/25627992
http://dx.doi.org/10.6061/clinics/2014(12)04
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author Li, Yuhong
He, Rui
Ying, Xiaojiang
Hahn, Robert G
author_facet Li, Yuhong
He, Rui
Ying, Xiaojiang
Hahn, Robert G
author_sort Li, Yuhong
collection PubMed
description 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/m(2)/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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spelling pubmed-42866682015-01-15 Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia Li, Yuhong He, Rui Ying, Xiaojiang Hahn, Robert G Clinics (Sao Paulo) Clinical Science 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/m(2)/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. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2014-12 /pmc/articles/PMC4286668/ /pubmed/25627992 http://dx.doi.org/10.6061/clinics/2014(12)04 Text en Copyright © 2014 Hospital das Clínicas da FMUSP http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Science
Li, Yuhong
He, Rui
Ying, Xiaojiang
Hahn, Robert G
Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
title Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
title_full Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
title_fullStr Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
title_full_unstemmed Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
title_short Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
title_sort dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286668/
https://www.ncbi.nlm.nih.gov/pubmed/25627992
http://dx.doi.org/10.6061/clinics/2014(12)04
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