Blood and Fluid Management During Scoliosis Surgery
关键词
抽象
描述
At investigators institution, neither anesthetic approaches to replacement of blood or fluid losses were standardized before 2014 for scoliosis surgery. Before 2014, fluid therapy was liberal and according to general principles of good clinical practice and ephedrine boluses of 5 mg were given when fluid boluses failed to maintain a systolic arterial pressure >90 mm Hg. Blood was replaced with crystalloid at a 3:1 ratio and colloid at a 1:1 ratio. Regarding blood product transfusion anesthesiologists were generally initiated when hemoglobin levels were less than 8 g/dl or less than 10 g/dl in patients with coronary diseases and predonated autologous or allogeneic RBCs were administered.
A protocol of management for scoliosis surgery was implemented in 2014 and included: a) fluid therapy according to SVV monitor, b) intraoperative permissive hypotension to reduce active bleeding (goal mean arterial pressure 60 mmHg), c) prophylactic tranexamic acid infusion (30 mg/kg bolus, 1mg/kg/hr during surgery), d) restrictive RBC trigger according to national standardized protocols (Hb<7.0 g/dL or <9g/dL in patients with coronary diseases) and e) use of perioperative cell savage.
In patients of Group Pro, basal crystalloid infusion was started at 4 ml/kg/h right after general anesthesia induction and intubation. ClearSight System (Edwards Lifesciences Cop, Irvine, CA, USA) was used to measure stroke volume variation and cardiac output, continuously and noninvasively through finger- cuffed technology. If SVV was >15% rapid crystalloid bolus of 10ml/kg or 4ml/kg colloid bolus were administered until it reached a value of ≤15%. After two consecutive fluid boluses SVV remained >15%, administration of noradrenaline infusion was considered.
Data will be collected from anesthesia records and included: age, gender, height, weight, body mass index and ASA score. Additional variables included infused crystalloid volume, infused colloid volume and the number of allogeneic transfused units of RBC. Serum Hb levels were measured preoperatively and after the end of surgery. Moreover, diuresis and use of vasopressors use were recorded.
日期
| 最后验证: | 12/31/2018 |
| 首次提交: | 01/19/2019 |
| 提交的预估入学人数: | 01/21/2019 |
| 首次发布: | 01/22/2019 |
| 上次提交的更新: | 02/05/2019 |
| 最近更新发布: | 02/07/2019 |
| 实际学习开始日期: | 10/29/2011 |
| 预计主要完成日期: | 11/19/2016 |
| 预计完成日期: | 12/31/2018 |
状况或疾病
干预/治疗
Other: protocol
相
手臂组
| 臂 | 干预/治疗 |
|---|---|
| no protocol liberal fluid therapy | |
| protocol fluid therapy according to stroke volume variation (SVV) monitor, tranexamic acid administration, use of cell saver | Other: protocol In patients of Group Protocol , basal crystalloid infusion was started at 4 ml/kg/h right after general anesthesia induction and intubation. ClearSight System (Edwards Lifesciences Cop, Irvine, CA, USA) was used to measure stroke volume variation and cardiac output, continuously and noninvasively through finger- cuffed technology. If SVV was >15% rapid crystalloid bolus of 10ml/kg or 4ml/kg colloid bolus were administered until it reached a value of ≤15%. After two consecutive fluid boluses SVV remained >15%, administration of noradrenaline infusion was considered. |
资格标准
| 有资格学习的性别 | All |
| 取样方式 | Non-Probability Sample |
| 接受健康志愿者 | 是 |
| 标准 | Inclusion Criteria: 1. severe curve (Cobb Angle > 70-degree) 2. same surgeon in all procedures Exclusion Criteria: 1. Patients with coagulopathy, 2. morbid obesity 3. severe cardiopulmonary disease 4. liver dysfunction 5. renal disease |
结果
主要结果指标
1. units of red blood cells transfused [intraoperative]
次要成果指标
1. volume of crystalloids infused [intraoperative]
2. volume of colloids infused [intraoperative]
3. infused vasopressors [intraoperative]
4. diuresis [intraoperative]
