SVV guide to fluid administration in laparoscopic bariatric surgery

Patient Population
Laparoscopic bariatric surgery.

LiDCO Monitor
LiDCOrapid fluid optimisation.

Trial Design
Maintaining SVV% was the goal for fluid optimisation.

Outcome Impact
Using SVV% as the target physicians successfully maintained hemodynamic parameters (cardiac output, stroke volume and heart rate) within 10% of the preoperative level control level.

BACKGROUND
Perioperative fluid administration in morbidly obese patients is critical. There is scarcity of scientific information in literature on amount and rate of its application. Functional parameters (stroke volume variation (SVV), pulse pressure variation) are considered more accurate predictor of volume status of patients than blood pressure and central venous pressure.

METHODS
SVV was used as a guide for intra-operative fluid administration in 50 morbidly obese patients subjected to bariatric surgery. Pulse contour waveform analysis (LiDCO) was utilized to monitor SVV, and a value more than 10% was used as infusion trigger for intraoperative fluid management.

RESULTS
Mean amount of fluid infused was 1,989.90 ml (+/-468.70 SD) for mean 206.94 min (+/-50.30 SD) duration of surgery. All patients maintained hemodynamic parameters (cardiac output, cardiac index, stroke volume, noninvasive blood pressure, heart rate) within 10% of the baseline values. Central venous pressure and SVV showed no correlation, except for short period initially. Renal and metabolic indices remained within normal limits.

CONCLUSION
Obese patients coming for laparoscopic bariatric surgery may not require excessive fluid. Intra-operative fluid requirement is the same as for nonobese patients. SVV is a valuable guide for fluid application in obese patients undergoing bariatric surgery.

Jain A & Dutta A Stroke Volume Variation as a Guide to Fluid Administration in Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery. Obes Surg. 2010. DOI 10.1007/s11695-009-0070

Using SVV% as the target physicians successfully maintained hemodynamic parameters (cardiac output, stroke volume and heart rate) within 10% of the pre-operative level control level.

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