Effect of Restrictive Intraoperative Intravenous Fluids Combined with Prophylactic Noradrenaline on Postoperative Morbidity in Open Abdominal Procedures

Abstract
Background: Fluid regimens are variable and the choice of restrictive or liberal can have an impact on postoperative outcome especially during major procedures such as those of abdominal surgeries. The use of intraoperative noradrenaline infusion has been attributed to maintain perfusion alongside the restrictive regimen. The outcome is assessed both intra-and postoperatively using biomarkers and morbidity survey (Clavien Dindo classification).
Aim of the Study: Our goal was to evaluate the effect of restrictive hydration while infusing noradrenaline followed by postoperative assessment of complications and hospital stay as opposed to liberal hydration in open abdominal pro-cedures.
Patients and Methods: In this randomized double blinded study, 70 patients were split into two sections (restrictive and conventional hydration) scheduled for open abdominal pro-cedures namely radical cystectomy & hemi colectomy. They were then evaluated in the postoperative period for any morbidity or mortality.
- Restrictive group (n=35): A primary infusion of Ringer's solution (1ml/kg/h) till the accomplishment of tumor resec-tion, followed by a different dose of 4ml/kg/h before post-operative transfer. The dose of the prophylactic noradren-aline infusion perioperatively was 0.08ug/kg/min.
- Conventional group (n=35): An initial bolus of 5 ml/kg of Ringer's solution was infused intraoperatively in the early moments of surgery during anesthesia induction. It was then followed by the usual fluid administration in the form of maintenance, deficit and any other losses.
The primary outcome we targeted was postoperative morbidity by the Clavien-Dindo classification and length of hospital stay. Secondary outcome included intra and postop-erative biomarkers and hemodynamics.
Results: The restricted fluid regimen with prophylactic noradrenaline resulted in lower incidence of complications (whether medical or surgical) in contrast to liberal hydration.
Conclusion: Restricting intravenous fluid therapy plus prophylactic noradrenaline infusion is a safe and effective method of intraoperative hydration with better postoperative outcome.