Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program.

Détails

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Etat: Public
Version: Final published version
Licence: Non spécifiée
ID Serval
serval:BIB_ECDC7FA1AAA6
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program.
Périodique
Journal of Surgical Research
Auteur⸱e⸱s
Hübner M., Schäfer M., Demartines N., Müller S., Maurer K., Baulig W., Clavien P.A., Zalunardo M.P.
Collaborateur⸱rice⸱s
Zurich Fast Track Study Group
Contributeur⸱rice⸱s
Müller S., Hübner M., Demartines N., Clavien PA., Zalunardo MP., Maurer K., Werner B., Decurtins M., Eisner L., Castelli I., Keller HP., Langer I., Gelpke H., Grieder F., Carstensen T., Gehrz A., Spahr T., Paganoni R.
ISSN
1095-8673 (Electronic)
ISSN-L
0022-4804
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
173
Numéro
1
Pages
68-74
Langue
anglais
Notes
Publication types: Journal Article ; Randomized Controlled Trial
Publication Status: ppublish
Résumé
BACKGROUND AND OBJECTIVE: Key factors of Fast Track (FT) programs are fluid restriction and epidural analgesia (EDA). We aimed to challenge the preconception that the combination of fluid restriction and EDA might induce hypotension and renal dysfunction.
METHODS: A recent randomized trial (NCT00556790) showed reduced complications after colectomy in FT patients compared with standard care (SC). Patients with an effective EDA were compared with regard to hemodynamics and renal function.
RESULTS: 61/76 FT patients and 59/75 patients in the SC group had an effective EDA. Both groups were comparable regarding demographics and surgery-related characteristics. FT patients received significantly less i.v. fluids intraoperatively (1900 mL [range 1100-4100] versus 2900 mL [1600-5900], P < 0.0001) and postoperatively (700 mL [400-1500] versus 2300 mL [1800-3800], P < 0.0001). Intraoperatively, 30 FT compared with 19 SC patients needed colloids or vasopressors, but this was statistically not significant (P = 0.066). Postoperative requirements were low in both groups (3 versus 5 patients; P = 0.487). Pre- and postoperative values for creatinine, hematocrit, sodium, and potassium were similar, and no patient developed renal dysfunction in either group. Only one of 82 patients having an EDA without a bladder catheter had urinary retention. Overall, FT patients had fewer postoperative complications (6 versus 20 patients; P = 0.002) and a shorter median hospital stay (5 [2-30] versus 9 d [6-30]; P< 0.0001) compared with the SC group.
CONCLUSIONS: Fluid restriction and EDA in FT programs are not associated with clinically relevant hemodynamic instability or renal dysfunction.
Mots-clé
Adult, Aged, Aged, 80 and over, Analgesia, Epidural, Anesthetics, Combined, Colectomy, Female, Fluid Therapy/contraindications, Hemodynamics/physiology, Humans, Incidence, Infusions, Intravenous, Kidney/physiology, Length of Stay, Male, Middle Aged, Perioperative Care, Postoperative Complications/epidemiology, Prospective Studies, Water-Electrolyte Balance/physiology
Pubmed
Web of science
Open Access
Oui
Création de la notice
11/09/2011 13:28
Dernière modification de la notice
10/02/2022 7:12
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