Norepinephrine in Goal-Directed Fluid Therapy during General Anesthesia in Elderly Patients Undergoing Spinal Operation: Determining Effective Infusion Rate to Enhance Postoperative Functions

2021 ◽  
Vol 22 ◽  
Author(s):  
Fan Wu ◽  
Tao Liang ◽  
Wei Xiao ◽  
Tianlong Wang
Keyword(s):  
Elderly Patients ◽  
General Anesthesia ◽  
Fluid Therapy ◽  
Infusion Rate ◽  
Anesthesia Induction ◽  
Rehabilitation Outcomes ◽  
Intraoperative Hypotension ◽  
Norepinephrine Infusion ◽  
Intraoperative Management ◽  
Goal Directed Fluid Therapy

Background and Objective: Intraoperative hypotension is a common complication in general anesthesia that could result in different serious complications particularly in elderly patients. This Randomized Clinical Trial (RCT) aims to determine effective continuous infusion rate of norepinephrine to prevent intraoperative hypotension during spinal surgery under general anesthesia in elderly patients. Methods: This RCT was conducted on elderly patients (n= 108) undergoing general anesthesia for posterior lumbar spinal fusion. The patients were randomly divided into 0.030, 0.060, and 0.090 μg.kg-1.min-1 groups of norepinephrine infusion rates. The outcomes were assessed at entrance to operation room (T0), 15 mins after anesthesia induction (T1), 60 mins following surgery (T2), and immediately after surgery (T3). The intraoperative and postoperative complications and rehabilitation outcomes were comparatively assessed. Results: All three groups significantly reduced the incidence of delayed wound healing (0.030 vs. 0.060 vs. 0.090 μg.kg-1.min-1; 33.3% vs. 10% vs. 10%, P=0.024) and wound infection (26.7% vs. 6.7% vs. 6.7%, P=0.031). Intraoperative total fluid volume and colloids volume in the 0.030 group were significantly higher than 0.060 and 0.090 groups (P=0.005, P=0.003, and P=0.01, respectively). The 0.060 and 0.090 groups significantly increased mean-arterial-pressure than the 0.030 group at T2 and T3. Both 0.060 and 0.090 infusion rates significantly reduced intraoperative hypotension than 0.030 dosage (P=0.01 and P=0.003, respectively). The bradycardia incidence in the 0.090 group was significantly higher than the 0.030 (P=0.026) and 0.060 groups (P=0.038). The 0.060 group decreased the first intake by 1.4 hours (P=0.008) and first flatus by 1.1 hours (P=0.004) and postoperative hospital stay by 1 day (P=0.066). Conclusion: The 0.060 µg·kg-1·min-1 norepinephrine infusion combined with goal-directed fluid therapy exhibited adequate intraoperative management and postoperative outcomes.

scholarly journals Adequate Dosage of Norepinephrine Infusion Combined with Goal-Directed Fluid Therapy During General Anesthesia May Improve Elderly Patients’ Postoperative Outcome Undergoing Lumbar Spinal Fusion

2020 ◽  
Author(s):  
Fan Wu ◽  
Tao Liang ◽  
Jie Wu ◽  
Wei Xiao ◽  
Long Fan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Elderly Patients ◽  
Fluid Therapy ◽  
Postoperative Outcome ◽  
Postoperative Hospital Stay ◽  
Lumbar Spinal Fusion ◽  
Norepinephrine Infusion ◽  
Goal Directed Fluid Therapy ◽  
Group 3 ◽  
Lumbar Spinal

Abstract Background: Norepinephrine is used to prevent anesthesia-related disorders in elderly patients. However, optimal dosage that improve the postoperative outcome undergone lumbar spinal fusion is unknown.Methods: A total of 108 elderly patients were randomized into three groups of norepinephrine infusion as 0.030 µg.kg− 1.min− 1, 0.060 µg.kg− 1.min− 1 and 0.090 µg.kg− 1.min− 1. The hemodynamics and related parameters were monitored at the entrance to the operation room (T0), 15 min following anesthesia induction (T1), 60 min after surgical incision (T2), and immediately after surgery (T3), respectively. The primary outcome was set as the incidence of postoperative complications and wound infections. The secondary outcomes were recorded by the incidence of nausea and vomiting, the time of first flatus, first ambulation, first intake and postoperative hospital stay.Results: Finally, 90 patients were recruited into the clinical trial, with 30 in each group. The incidence of delayed wound healing and infection were increase with the dose of 0.030 µg.kg− 1.min− 1 compared to others (0.030 µg.kg− 1.min− 1 vs. 0.060 µg.kg− 1.min− 1 vs. 0.090 µg.kg− 1.min− 1: 33.3% vs. 10% vs. 10%, P = 0.024; 26.7% vs. 6.7% vs. 6.7%, P = 0.031). Intraoperative total fluid volume and crystalloids, colloids volume in 0.030 µg.kg− 1.min− 1 group were significantly higher than 0.060 and 0.090µg·kg− 1·min− 1. The incidence of intraoperative hypotension effectively decreased in 0.060µg·kg− 1·min− 1 and 0.090µg·kg− 1·min− 1 compared to 0.030µg·kg− 1·min− 1(6.7%vs33.3%, P = 0.01, 3.3% vs. 33.3%, P = 0.003).The frequency of bradycardia in 0.090 µg.kg− 1.min− 1 group’s patients was significantly higher than that in the dosage 0.030 µg.kg− 1.min− 1 group (3%vs26%, P = 0.026) and 0.060 µg.kg− 1.min− 1 group (3% vs. 6.7%, P = 0.038). Patients with 0.060 µg.kg− 1.min− 1 had earlier first intaking by 1.4 hours and first flatus by 1.1 hours. Overall, Postoperative hospital stay was reduced by around 1 day in the 0.060 µg.kg− 1.min− 1 and 0.090 µg.kg− 1.min− 1 group among three groups (6.0 vs. 6.2 vs. 7.1days, P = 0.066).Conclusion: The 0.060 µg·kg− 1·min− 1 dosage of norepinephrine infusion combined with goal-directed fluid therapy can improve the elderly patients’ postoperative outcome and accelerate their rehabilitation process.Clinical Trial Registration: Identifier ChiCTR-1900021309, Registration date: September 19, 2018; www.chictr.org.cn.

scholarly journals Preoperative Carbohydrate Load and Intraoperative Goal-Directed Fluid Therapy for Elderly Patients Undergoing Open Gastrointestinal Operation: A Prospective Randomized Controlled Trial

2020 ◽  
Author(s):  
Xia Liu ◽  
Peng Zhang ◽  
MengXue Liu ◽  
JunLi Ma ◽  
XinChuan Wei ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Anesthesia Induction ◽  
Randomized Controlled ◽  
Goal Directed Fluid Therapy ◽  
Fluid Optimisation

Abstract Background: At present it remains uncertain as to whether carbohydrate (200 ml) loaded 2 hours before anesthesia induction combined with intraoperative goal-directed fluid therapy (GDFT) is beneficial to elderly patients undergoing gastrointestinal operations. As such, a randomized controlled trial was designed to evaluate the relative impact of perioperative fluid optimisation versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.Methods: A total of 120 elderly patients undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) load 2 hours before anesthesia induction. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic information, intraoperative parameters and postoperative outcomes were recorded.Results: Patients in the GDFT group were administered less crystalloid fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p = 0.000) and produced less urine output (200 ml [150-300] vs 400 ml [290-500]; p = 0.000) relative to patients in the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (55 ± 13.9 hours vs 65 ± 22.6 hours; p = 0.004) and oral intake (72 ± 17.4 hours vs 85 ± 27.5 hours; p = 0.002), as well as a reduction in the rate of postoperative complications (14 (25.5%) vs 27(47.4%) patients; p = 0.016). However, postoperative hospitalization or hospitalization expenses were similar between groups.Conclusions: Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration: ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=29899

scholarly journals Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xia Liu ◽  
Peng Zhang ◽  
Meng Xue Liu ◽  
Jun Li Ma ◽  
Xin Chuan Wei ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Randomized Controlled ◽  
Carbohydrate Loading ◽  
Prospective Randomized Controlled Trial ◽  
Preoperative Carbohydrate Loading ◽  
Goal Directed Fluid Therapy

Abstract Background The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery. Methods This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded. Results Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p < 0.001) and produced significantly less urine output (200 ml [150–300] vs 400 ml [290–500]; p < 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h; p = 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h; p = 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients; p = 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p > 0.05). Conclusions Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered.

scholarly journals Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jizheng Zhang ◽  
Xiaohua Sun ◽  
Wenjie Cheng ◽  
Wanlu Ren
Keyword(s):  
General Anesthesia ◽  
Adverse Reactions ◽  
Anesthesia Induction ◽  
Intraoperative Hypotension ◽  
Extubation Time ◽  
Group A ◽  
T1 And T2 ◽  
Group B ◽  
Group D ◽  
Different Doses

Objective. To explore the application of different doses of dexmedetomidine combined with general anesthesia in patients with traumatic tibiofibular fractures. Methods. A total of 120 patients with traumatic tibiofibular fractures treated in our hospital (January 2018–January 2021) were selected as the research subjects and equally grouped into group A, group B, group C, and group D according to the dosage of dexmedetomidine. Group B, group C, and group D were pumped with 0.3 μg/kg, 0.5 μg/kg, and 0.8 μg/kg load doses of dexmedetomidine before anesthesia induction, with the same doses for maintenance during surgery. Group A was intravenously pumped with the same amount of normal saline and received tracheal intubation after anesthesia induction, with propofol and remifentanil to maintain general anesthesia during surgery. Results. No notable differences in general data were observed among the groups ( P  > 0.05). Ramsay sedation scores of all groups showed a downward trend after drug withdrawal. At 10 min, 30 min, and 60 min, the scores of groups C and D were markedly higher than those of groups A and B ( P  < 0.05), and the scores were higher in group D than those in group C ( P  < 0.05). The HR changes at each period were close between groups A and B ( P  > 0.05). The HRs at T1 and T2 in group C were slightly lower than those in group D ( P  > 0.05), and the HRs at T1 in groups A and B were remarkably higher than those in groups C and D, and were higher than those at T0 and T2 ( P  < 0.05). The SBP levels of all groups began to rise at T0, peaked at T1, and decreased to a lower level at T2 than that at T0. Moreover, the SBP levels of groups C and D at T1 and T2 were notably lower compared with groups A and B ( P  < 0.05). With a lower DBP level in group C than the other three groups at T1, the DBP levels were notably lower in groups C and D than those in groups A and B at T2 ( P  < 0.05). With no statistical difference in the MAP levels at T0 among the four groups ( P  > 0.05), the MAP levels in group A at T1 and T2 were obviously higher compared with groups C and D ( P  < 0.05). The extubation time in group A was notably longer than that that in groups B, C, and D ( P  < 0.05), with longer extubation time in group B than that in groups C and D ( P  < 0.05). The orientation recovery time in group D was markedly shorter than that in groups A, B, and C ( P  < 0.05). The incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B ( P  < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C ( P  < 0.05). Conclusion. Dexmedetomidine at doses of 0.5 μg/kg and 0.8 μg/kg has a better effect in the maintenance of general anesthesia for patients with traumatic tibiofibular fractures, with faster orientation recovery, better recovery of postoperative cognitive function, and a lower incidence of adverse reactions. Dexmedetomidine at 0.5 μg/kg is recommended in view of the increased risk of excessive sedation, chills, restlessness, and intraoperative hypotension in patients at 0.8 μg/kg.

scholarly journals Clinical research of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer

2018 ◽  
Vol 14 (8) ◽  
pp. 173 ◽  
Author(s):  
Shu-Bo Zhang ◽  
Tie-Jun Liu ◽  
Jin-Cun Zhang ◽  
Xiao-Zeng Gao ◽  
Zhi-Bin Tan ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Elderly Patients ◽  
Clinical Research ◽  
Fluid Therapy ◽  
Radical Resection ◽  
Goal Directed Fluid Therapy

scholarly journals Goal-directed Fluid Therapy in Elderly Patients Undergoing Lumbar decompression surgery in the Prone Position: A Randomized Controlled Clinical Trial

2019 ◽  
Author(s):  
DI XIA ◽  
Xu Li ◽  
Li Xu ◽  
Yuguang Huang
Keyword(s):  
Elderly Patients ◽  
Prone Position ◽  
Fluid Therapy ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Decompression Surgery ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Goal Directed Fluid Therapy ◽  
Lumbar Decompression Surgery

Abstract Background Major lumber spine surgeries in the prone position have high mortality and morbidity, especially in elderly patients. Intraoperative goal-directed fluid therapy (GDT) has improved outcomes in abdominal and thoracic surgical procedures. However the utility of intraoperative GDT in spine surgery has not been present. In this study, we investigated whether GDT would reduce the postoperative complications in elderly patients undergoing lumbar stenosis decompression in the prone position. Methods In this single-center, randomized controlled clinical trial, we randomly assigned 84 patients aged > 60 undergoing lumbar decompression surgery to either a GDT group or a control group, who received conventional anesthesiologist-directed fluid therapy. Perioperative lactic acid concentrations with 7 different time point, intraoperative fluid balance and postoperative complications from admittance to 30 days after surgery were recorded. Results Lactic acid concentrations were higher in the control group than in the GTD group from the start of operation to 24 h after the operation, reaching maximum concentrations at exit from the post-anesthesia care unit (2.50 ± 1.22 mmol/l compared with 1.32 ± 0.42 mmol/l in controls; p<0.001). More total fluid volume was infused in GDT patients than in control patients (2416 ± 539 ml vs. 2036 ± 424ml, p<0.001). GDT patients had fewer infectious complications that did control patients (4.7% vs. 19.5%, P<0.001) after the surgery. Conclusion GDT during lumbar decompressive surgery under general anesthesia in elderly patients results in significantly better postoperative outcomes, which may be due to optimal fluid management and better perfusion of tissues and organs. Trial registration NCT02470221. Initial registration date was 06/09/2015.

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