Bioelectrical Impedance Analysis in Patients Undergoing Major Head and Neck Surgery: A Prospective Observational Pilot Study

Background: Head and neck patients are prone to malnutrition. Perioperative fluids administration in this patient group may influence nutritional status. We aimed to investigate perioperative changes in patients undergoing major head and neck surgery and to examine the impact of perioperative fluid administration on body composition and metabolic changes using bioelectrical impedance. Furthermore, we sought to correlate these metabolic changes with postoperative complication rate. In this prospective observational pilot study, bioelectrical impedance analysis (BIA) was performed preoperatively and on postoperative days (POD) 2 and 10 on patients who underwent major head and neck surgeries. BIA was completed in 34/37 patients; mean total intraoperative and post-anesthesia fluid administration was 3682 ± 1910 mL and 1802 ± 1466 mL, respectively. Total perioperative fluid administration was associated with postoperative high extra-cellular water percentages (p = 0.038) and a low phase-angle score (p < 0.005), which indicates low nutritional status. Patients with phase angle below the 5th percentile at POD 2 had higher local complication rates (p = 0.035) and longer hospital length of stay (LOS) (p = 0.029). Multivariate analysis failed to demonstrate that high-volume fluid administration and phase angle are independent factors for postoperative complications. High-volume perioperative fluids administration impacts postoperative nutritional status with fluid shift toward the extra-cellular space and is associated with factors that increase the risk of postoperative complications and longer LOS. An adjusted, low-volume perioperative fluid regimen should be considered in patients with comorbidities in order to minimize postoperative morbidity.

Perioperative fluids and complications after pancreatoduodenectomy within an enhanced recovery pathway

Optimized fluid management is a key component of enhanced recovery (ERAS) pathways. Implementation is challenging for pancreatoduodenectomy (PD) and clear guidance is missing in the respective protocol. The aim of this retrospective study was to evaluate the influence of perioperative intravenous (IV) fluid administration on postoperative complications. 164 consecutive patients undergoing PD within ERAS between October 2012 and June 2017 were included. Perioperative IV fluid and morbidity (Clavien classification and comprehensive complication index (CCI)) were assessed. A threshold of more than 4400 ml IV fluid during the first 24 h could be identified to predict occurrence of complications (area under ROC curve 0.71), with a positive and negative predictive value of 93 and 23% respectively. More than 4400 ml intravenous fluids during the first 24 h was an independent predictor of overall postoperative complications (adjusted odds ratio 4.40, 95% CI 1.47–13.19; p value = 0.008). Patients receiving ≥ 4400 ml were associated with increased overall complications (94 vs 77%; p value < 0.001), especially pulmonary complications (31 vs 16%; p value = 0.037), as well as a higher median CCI (33.7 vs 26.2; p value 0.041). This threshold of 4400 ml intravenous fluid might be a useful indicator for the management following pancreatoduodenectomy.

Perioperative Fluid Management for Elective Major Surgery Patients at a Teaching Hospital in Rwanda

Background Every year, over 312 million surgical operations are performed globally. While perioperative goal-directed fluid strategy may reduce postoperative complications among patients undergoing major surgery, poor perioperative fluids management has been linked to adverse postoperative patients’ outcome. Methods This study used quantitative prospective design to assess the perioperative fluids management in 133 patients operated in the theatre of University Teaching Hospital of Butare (CHUB). The SPSS 21 was used to analyze the data, Chi-square test was performed to assess the association between fluid administered and patients’ hydration status with an acceptable cutoff at p<0.05. Results The findings showed that 108 (81.2%) and 25 (18.8%) participants were in dehydration class A and B before surgery and strongly associated with age, surgeries, type and amount of intraoperative fluids. Participants received RL and NS (67.7%), 2091.73 ml, +803.6 ml and lost 218.42+131.9 ml fluid in average. Postoperatively, 53.4% and 46.6% participants were in dehydration class A and B respectively, strongly associated with type and duration of surgery (P<0.05). All participants fasted more than 6 hours. Conclusion The dehydration rate increased intraoperatively in relation to type and duration of surgery and type and amount of fluid administered. Reduced fasting time and effective intraoperative fluid management would improve the patients’ hydration after surgery and postoperative patients’ outcome. Key words: Major Surgery, Elective Surgery, Perioperative care, Fluid management, patients

Mitochondrial Disease and Anesthesia

Mitochondrial disease is a genetically, biochemically, and clinically heterogeneous group of disorders that arise from defects in cellular oxidative phosphorylation, most commonly within the electron transport chain. All mitochondrial diseases involve disruption in energy production; clinical symptoms usually manifest in tissues with high energy demands although all organs may be affected. The extent of disease depends not only on the mitochondrial defect but on the numbers of dysfunctional mitochondria present in each tissue. Despite in vitro evidence that almost every anesthetic agent studied has been shown to decrease mitochondrial function, all anesthetic agents have been used safely. Discussion of the implications of mitochondrial disease for anesthetic management includes preoperative preparation, volatile and intravenous anesthetic agents, avoidance of succinylcholine, risk of malignant hyperthermia, perioperative fluids, and postoperative management.