umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Perioperative fluid guidance with transthoracic echocardiography and pulse-contour device in morbidly obese patients
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
2014 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 24, no 12, 2117-2125 p.Article in journal (Refereed) Published
Abstract [en]

Background

In bariatric surgery, non-or mini-invasive modalities for cardiovascular monitoring are addressed to meet individual variability in hydration needs. The aim of the study was to compare conventional monitoring to an individualized goal-directed therapy (IGDT) regarding the need of perioperative fluids and cardiovascular stability. 

Methods

Fifty morbidly obese patients were consecutively scheduled for laparoscopic bariatric surgery (ClinicalTrials.gov Identifier: NCT01873183). The intervention group (IG, n=30) was investigated preoperatively with transthoracic echocardiography (TTE) and rehydrated with colloid fluids if a low level of venous return was detected. During surgery, IGDT was continued with a pulse-contour device (FloTrac (TM)). In the control group (CG, n=20), conventional monitoring was conducted. The type and amount of perioperative fluids infused, vasoactive/inotropic drugs administered, and blood pressure levels were registered. 

Results

In the IG, 213 +/- 204 mL colloid fluids were administered as preoperative rehydration vs. no preoperative fluids in the CG (p<0.001). During surgery, there was no difference in the fluids administered between the groups. Mean arterial blood pressures were higher in the IG vs. the CG both after induction of anesthesia and during surgery (p=0.001 and p=0.001). 

Conclusions

In morbidly obese patients suspected of being hypovolemic, increased cardiovascular stability may be reached by preoperative rehydration. The management of rehydration should be individualized. Additional invasive monitoring does not appear to have any effect on outcomes in obesity surgery.

Place, publisher, year, edition, pages
2014. Vol. 24, no 12, 2117-2125 p.
Keyword [en]
bariatric surgery, morbid obesity, rehydration, venous return, transthoracic echocardiography, perioperative monitoring, goal-directed therapy, stroke volume variation, preoperative assessment
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:umu:diva-87459DOI: 10.1007/s11695-014-1329-4ISI: 000346780400017PubMedID: 24902655OAI: oai:DiVA.org:umu-87459DiVA: diva2:709484
Available from: 2014-04-02 Created: 2014-04-01 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Assessment and management of bariatric surgery patients
Open this publication in new window or tab >>Assessment and management of bariatric surgery patients
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In morbidly obese individuals (MO) cardiorespiratory comorbidities and body habitus challenge the perioperative management of anesthesia. To implement safe and reproducible routines for anesthesia and fluid therapy is the cornerstone in order to minimize anesthesia-related complications and to meet individual variability in rehydration needs.

Methods: Paper I: Impact of rapid-weight-loss preparation prior to bariatric surgery was investigated. Prevalence of preoperative dehydration and cardiac function were assessed with transthoracic echocardiography (TTE). Paper II: The anesthetic technique for rapid sequence induction (RSI) in MO based on a combination of volatile and i.v. anesthetics was developed. Pre- and post-induction oxygenation, blood pressure levels and feasibility of the method was evaluated. Paper III: The preoperative ideal body weight based rehydration regime was evaluated by TTE. Paper IV: Need of rehydration during bariatric surgery was evaluated by comparing conventional monitoring to a more advanced approach (i.e. preoperative TTE and arterial pulse wave analysis).

Results: Rapid-weight-loss preparation prior to bariatric surgery may expose MO to dehydration. TTE was shown to be a robust modality for preoperative screening of the level of venous return, assessment of filling pressures and biventricular function of the heart in MO. The combination of sevoflurane, propofol, alfentanil and suxamethonium was demonstrated to be a safe method for RSI regardless of BMI. The preoperative rehydration regime implemented by colloids 6 ml/kg IBW was an adequate treatment to obtain euvolemia. In addition, preoperative rehydration seems to increase hemodynamic stability during intravenous induction of anesthesia and even intraoperatively.

Conclusion: This thesis describes a safe and comprehensive perioperative management of morbidly obese individuals scheduled for bariatric surgery. Hemodynamic and respiratory stability can be achieved by implementation of strict and proven methods of anesthesia and fluid therapy. Much focus should be placed on feasible monitoring and preoperative optimization in morbidly obese individuals for increased perioperative safety.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2014. 86 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1632
Keyword
Bariatric surgery, morbid obesity, anesthesia, echocardiography, fluid therapy, preoperative, perioperative, venous return, rehydration, volatile rapid sequence induction, spontaneous breathing, sevoflurane.
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-87546 (URN)978-91-7459-807-0 (ISBN)
Public defence
2014-05-16, Stora Aulan, Sunderby Sjukhus, 97180 Luleå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-04-11 Created: 2014-04-02 Last updated: 2014-04-14Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Pösö, TomiWinsö, OlaAroch, RomanKesek, Doris

Search in DiVA

By author/editor
Pösö, TomiWinsö, OlaAroch, RomanKesek, Doris
By organisation
Anaesthesiology
In the same journal
Obesity Surgery
Anesthesiology and Intensive Care

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 162 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf