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Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery

BACKGROUND AND AIMS: Minimally invasive and robotic surgeries need lesser fluid replacement but the role of restricted fluids in robotic surgeries other than prostatic surgeries has not been clearly defined. Our primary aim was to evaluate the effects of a restrictive fluid regimen versus a liberal...

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Autores principales: Kumar, Lakshmi, Kumar, Kalyan, Sandhya, Sai, Koshy, Deepa M, Ramamurthi, Kruthika P, Rajan, Sunil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413354/
https://www.ncbi.nlm.nih.gov/pubmed/32792736
http://dx.doi.org/10.4103/ija.IJA_401_20
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author Kumar, Lakshmi
Kumar, Kalyan
Sandhya, Sai
Koshy, Deepa M
Ramamurthi, Kruthika P
Rajan, Sunil
author_facet Kumar, Lakshmi
Kumar, Kalyan
Sandhya, Sai
Koshy, Deepa M
Ramamurthi, Kruthika P
Rajan, Sunil
author_sort Kumar, Lakshmi
collection PubMed
description BACKGROUND AND AIMS: Minimally invasive and robotic surgeries need lesser fluid replacement but the role of restricted fluids in robotic surgeries other than prostatic surgeries has not been clearly defined. Our primary aim was to evaluate the effects of a restrictive fluid regimen versus a liberal policy on intra-operative lactate in robotic colorectal surgery. Secondary outcomes were need for vasopressors, extubation on table, post-operative renal functions and length of ICU (LOICU) stay. METHODS: American society of anaesthesiologists (ASA) physical status I–II patients scheduled for robot-assisted colorectal surgery were randomised into one of two groups, receiving either 2 mL/kg/h (Group R) or 4mL/kg/h, (group L). Fluid boluses of 250 ml were administered if mean arterial pressure (MAP) <65 mmHg or urine output <0.5 ml/kg/h. Norepinephrine was added for the blood pressure after 2 fluid boluses. Surgical field was assessed by modified Boezaart's scale and surgeon satisfaction by Likert scale. RESULTS: Demographics and baseline renal functions were comparable. Adjusted intra-operative lactate at 2 h, 4 h, and 6 h and need for noradrenaline and post-operative creatinine were similar. One patient in the group L was ventilated due to hypothermia. The field was better at the 4 h in group R and comparable at other time points. The LOICU stay was longer in Group L. CONCLUSION: The use of restrictive fluid strategy of 2 mL/kg/h (group R) does not increase lactate levels or creatinine, improves surgical field at 4 h and shortens ICU stay in comparison to a liberal 4 mL/kg/h (group L) in robotic colorectal surgery.
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spelling pubmed-74133542020-08-12 Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery Kumar, Lakshmi Kumar, Kalyan Sandhya, Sai Koshy, Deepa M Ramamurthi, Kruthika P Rajan, Sunil Indian J Anaesth Original Article BACKGROUND AND AIMS: Minimally invasive and robotic surgeries need lesser fluid replacement but the role of restricted fluids in robotic surgeries other than prostatic surgeries has not been clearly defined. Our primary aim was to evaluate the effects of a restrictive fluid regimen versus a liberal policy on intra-operative lactate in robotic colorectal surgery. Secondary outcomes were need for vasopressors, extubation on table, post-operative renal functions and length of ICU (LOICU) stay. METHODS: American society of anaesthesiologists (ASA) physical status I–II patients scheduled for robot-assisted colorectal surgery were randomised into one of two groups, receiving either 2 mL/kg/h (Group R) or 4mL/kg/h, (group L). Fluid boluses of 250 ml were administered if mean arterial pressure (MAP) <65 mmHg or urine output <0.5 ml/kg/h. Norepinephrine was added for the blood pressure after 2 fluid boluses. Surgical field was assessed by modified Boezaart's scale and surgeon satisfaction by Likert scale. RESULTS: Demographics and baseline renal functions were comparable. Adjusted intra-operative lactate at 2 h, 4 h, and 6 h and need for noradrenaline and post-operative creatinine were similar. One patient in the group L was ventilated due to hypothermia. The field was better at the 4 h in group R and comparable at other time points. The LOICU stay was longer in Group L. CONCLUSION: The use of restrictive fluid strategy of 2 mL/kg/h (group R) does not increase lactate levels or creatinine, improves surgical field at 4 h and shortens ICU stay in comparison to a liberal 4 mL/kg/h (group L) in robotic colorectal surgery. Wolters Kluwer - Medknow 2020-07 2020-07-01 /pmc/articles/PMC7413354/ /pubmed/32792736 http://dx.doi.org/10.4103/ija.IJA_401_20 Text en Copyright: © 2020 Indian Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kumar, Lakshmi
Kumar, Kalyan
Sandhya, Sai
Koshy, Deepa M
Ramamurthi, Kruthika P
Rajan, Sunil
Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
title Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
title_full Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
title_fullStr Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
title_full_unstemmed Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
title_short Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
title_sort effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413354/
https://www.ncbi.nlm.nih.gov/pubmed/32792736
http://dx.doi.org/10.4103/ija.IJA_401_20
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