Fluid optimisation in pancreas surgery

Background. Optimal intravascular blood volume, cardiac output and sufficient oxy-gen supply is a mainstay in major abdomi-nal surgery. Adequate haemodynamic management can improve a favourable outcome and shorten the duration of hos-pital stay.

Our study anticipated different fluid and vasoactive drug consumption and less complications during the pancreatic sur-gery in the group of patients where ex-tended haemodynamic monitoring was applied.

Materials and methods. 59 adult patients, ASA 2-3, undergoing elective pancreas surgery, were included in the study. In 29 patients in the study group (SG – extended haemodynamic monitoring), cardiac in-dex (CI), mean arterial pressure (MAP) and nominal stroke index (SI) were main-tained within 80% of baseline values with actions following study protocol. Patients’ groups were homogenous, even when di-vided into 4 subgroups (control group (CG) and without epidural catheter (EC), CG and with EC, SG and without EC, SG and with EC).

Intraoperative variables (amount of fluids, vasopressors, surgery duration) and hospi-talisation duration, wound healing, reop-eration, mortality and other complication were recorded on the postoperative days 3, 5, 8, 15 and on hospital discharge. Results. There was no difference in ASA health status, intraoperative management and duration of hospitalisation in 4 sub-groups. There is a significant difference in intraoperative use of vasopressor support between 4 subgroups (Fisher exact test, p=0,032). All patients in SG with EC re-quired vasopressors. Number of patients with major complications were not statisti-cally different between groups. Pulmonary embolism, postoperative food intolerance and myocardial infarction have occurred only in CG. 

Conclusion. In our study there was no dif-ference in overall fluid and vasoactive drug demand. Although in the studied subgroup of patients with additional epidural anaes-thesia there was significantly increased de-mand for vasoactive drugs. The incidence of complication was low in both groups, however, some of major complications oc-curred only in CG.

haemodynamic monitoring, fluid optimisation, postoperative outcome, pancreatic surgery

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