Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery

• Published in: Acta anaesthesiologica Scandinavica 2012-07, Vol.56 (6), p.777-786
• Main Authors: HØISETH, L. Ø., HOFF, I. E., MYRE, K., LANDSVERK, S. A., KIRKEBØEN, K. A.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anesthesia - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Area Under Curve; Biological and medical sciences; Blood Pressure - physiology; Central Venous Pressure - physiology; Confidence intervals; Female; Fluid Therapy - methods; Head-Down Tilt; Hernias; Humans; Laparoscopy; Laparoscopy - methods; Male; Medical sciences; Middle Aged; Oximetry; Plethysmography; Pneumoperitoneum, Artificial - methods; Respiratory Mechanics - physiology; ROC Curve; Sample Size; Signal Processing, Computer-Assisted; Stroke; Stroke Volume - physiology; Surgery
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2011.02641.x

Background Few data exist on dynamic variables predicting fluid responsiveness during laparoscopic surgery. The aim of this study was to explore the effects of laparoscopy on four dynamic variables: respiratory variations in pulse pressure (ΔPP), stroke volume variation by Vigileo/FloTrac (SVV Vigileo), pleth variability index (PVI) and respiratory variations in pulse oximetry plethysmography waveform amplitude (ΔPOP), and their relation to fluid challenges during laparoscopic surgery. Methods ΔPP, SVV Vigileo, PVI and ΔPOP were studied in 20 adult patients before and during pneumoperitoneum (10–12 mmHg). During ongoing laparoscopic surgery, relations between the dynamic variables and changes in stroke volume oesophageal Doppler, (SVOD) after fluid challenges (250 ml colloid) were evaluated. Results Pneumoperitoneum changed the dynamic variables as follows {mean [95% confidence interval (CI)]}: ΔPP 0.5 (−1.3, 2.3)%, P = 0.53; SVV Vigileo 0.6 (−1.3, 2.5)%, P = 0.52; PVI 2.9 (0.4, 5.3)%, P = 0.025. For ΔPOP, median difference (95% CI) was 2.5 (−0.15, 6.7)%, P = 0.058. During laparoscopic surgery, areas under receiver operating characteristics curves (95% CI) were ΔPP 0.53 (0.31–0.75), SVV Vigileo 0.74 (0.51–0.90), PVI 0.61 (0.38–0.81), ΔPOP 0.63 (0.40–0.82). Correlation coefficients (P‐values) between changes in dynamic variables and changes in SVOD were ΔPP r = −0.65, P = 0.009; SVV Vigileo r = −0.73, P = 0.002; PVI r = −0.22, P = 0.44; ΔPOP r = −0.32, P = 0.24. Conclusion ΔPP and SVV Vigileo did not change as pneumoperitoneum was established, whereas PVI increased and ΔPOP tended to increase. All four dynamic variables predicted fluid responsiveness relatively poor during ongoing laparoscopic surgery. ΔPP and SVV Vigileo tracked changes in stroke volume induced by fluid challenges during ongoing laparascopic surgery, whereas ΔPOP and PVI did not.