Faculty Opinions recommendation of Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery.

Abstract Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.

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Atypical Presentation of Severe Dengue in a Patient following a Major Abdominal Surgery

Case Reports in Infectious Diseases ◽

10.1155/2020/2916107 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Umesh Jayarajah ◽

Oshan Basnayake ◽

Kavinda Nagodavithane ◽

Jayan Jayasinghe ◽

Dharmabandhu N. Samarasekera

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Case Reports ◽

Clinical Manifestations ◽

Dengue Haemorrhagic Fever ◽

Major Abdominal Surgery ◽

Severe Dengue ◽

Organ Support ◽

Atypical Presentation ◽

Haemorrhagic Fever

Severe dengue infections in a postoperative patient may lead to significant derangement in the body’s homeostasis resulting in morbidity and sometimes even mortality. Reports on presentation and clinical manifestations of dengue in patients following major surgical procedures are scarce and restricted to few case reports. We describe a 26-year-old male with atypical presentation and late detection of dengue haemorrhagic fever following a major abdominal surgery. On postoperative day 6, he developed spontaneous bleeding from the drain site and moderate-to-massive bilateral pleural effusion with respiratory distress. His dengue IgM and IgG were positive. Therefore, a diagnosis of dengue haemorrhagic fever with bilateral lower zone pneumonia was made. A right-sided intercostal tube was inserted. Intensive care was given and was managed with intravenous antibiotics, targeted fluid therapy, and supportive care. He recovered from the infection and was discharged uneventfully. This case is unique because during the postoperative period, he went into critical phase with significant fluid leakage and developed bleeding manifestations without a clear febrile phase and deterioration in the haemodynamic parameters. High degree of suspicion and early detection are necessary to guide the fluid therapy and provide organ support in such patients.

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Parenteral fluid therapy for children undergoing major abdominal surgery: A study of 120 consecutive cases

British Journal of Surgery ◽

10.1002/bjs.18004720317 ◽

1959 ◽

Vol 47 (203) ◽

pp. 261-274 ◽

Cited By ~ 3

Author(s):

Winifred F. Young ◽

John McIntosh ◽

Valentine Swain ◽

B. Levin

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Major Abdominal Surgery

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Goal-directed fluid therapy during major abdominal surgery

10.3384/diss.diva-156263 ◽

2019 ◽

Author(s):

Hans Bahlmann

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Major Abdominal Surgery ◽

Goal Directed Fluid Therapy

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The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.173 ◽

2019 ◽

Vol 7 (8) ◽

pp. 1276-1281

Author(s):

Ahmed Hasanin ◽

Karim Hussein Mourad ◽

Inas Farouk ◽

Sherin Refaat ◽

Ahmed Nabih ◽

...

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Extravascular Lung Water ◽

Stroke Volume Variation ◽

Major Abdominal Surgery ◽

Control Group ◽

Lung Water ◽

Goal Directed Fluid Therapy ◽

Ultrasound Score ◽

The Impact

BACKGROUND: A growing interest had been paid to goal-directed fluid therapy (GDT) in abdominal surgery; however, its impact on the respiratory profile was not well investigated. AIM: We evaluated the impact of GDT on postoperative extravascular lung water and oxygenation after prolonged major abdominal surgery. METHODS: A randomised, controlled study was conducted in Kasr Alainy hospital from April 2016 till December 2017 including 120 adult patients scheduled for prolonged major abdominal surgery. Patients were randomised into either GDT group (n = 60) who received baseline restricted fluid therapy (2 mL/Kg/hour) which is guided by stroke volume variation, or control group (n = 60) who received standard care. Both study groups were compared according to hemodynamic data, fluid requirements, lung ultrasound score, and PaO2/fraction of inspired oxygen ratio (P/F ratio), RESULTS: Intraoperatively, GDT group received less volume of fluids and showed higher intraoperative mean arterial pressure compared to the control group. Postoperatively, lung ultrasound score was lower, and P/F ratio was higher in the GDT group compared to the control group. The number of patients who showed a significant postoperative increase in LUS was higher in the control group 44 (73%) patients versus 14 (23%) patients, P < 0.001). CONCLUSIONS: Using stroke volume variation for guiding fluid therapy in prolonged, major abdominal operations were associated with better hemodynamic profile, less intraoperative fluid administration, lower extravascular lung water and better oxygenation compared to standard care.

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