Intraoperative fluid management in pancreatic resections--the surgeon's view

• Published in: Zentralblatt für Chirurgie Vol. 133; no. 2; p. 168
• Main Authors: Lindenblatt, N, Park, S, Alsfasser, G, Gock, M, Klar, E
• Format: Journal Article
• Language: German
• Published: Germany 01.04.2008
• Subjects: Attitude of Health Personnel; Catecholamines - administration & dosage; Data Interpretation, Statistical; Female; Fluid Therapy - adverse effects; Fluid Therapy - methods; General Surgery; Humans; Intraoperative Care; Length of Stay; Male; Norepinephrine - administration & dosage; Pancreas - surgery; Pancreatic Fistula - epidemiology; Retrospective Studies; Surgical Wound Infection - epidemiology; Treatment Outcome; Wound Healing
• ISSN: 0044-409X
• DOI: 10.1055/s-2008-1004745

Even though intraoperative fluid management during major intraabdominal surgery has frequently been addressed in the past, there is a lack of evidence-based recommendations. This report elucidates the topic from the surgeon's view. For the surgeon, the influence of larger fluid amounts on wound and anastomotic healing, bleeding complications and postoperative outcome (time of extubation, postoperative gastrointestinal function, hospital stay, etc.) is of interest. To clarify the question as to what a perioperative fluid regime should be composed of from a surgical point of view, data from the literature and our own studies were evaluated. The retrospective analysis of 98 pancreas resections that had been performed in our hospital revealed no significant differences concerning the occurrence of postoperative bleeding (8.2 %), wound infection (4.1 %), pancreatic fistula (9.4 %) and mortality (2.0 %) based on the administered intraoperative fluid amount. These results were comparable to those of other authors. The average intraoperatively infused fluid amount was 13.9 +/- 0.9 mL / kg / h. Catecholamines were administered in 74 % of all operations, while noradrenaline was used in 54 % of all cases. Although other factors might play a role in this setting, we can deduce from these data that application of a volume of 10-15 mL / kg / h has no negative influence on the outcome following pancreas resections and that the intraoperative fluid therapy should be targeted at these values.