Article Data

  • Views 1220
  • Dowloads 175

Original Research

Open Access

Fluid optimisation in pancreas surgery


1University Medical Centre Ljubljana, Department of Anaesthesiology and Surgical Intensive Therapy, Zaloška 7, Ljubljana, Slovenia

2Department of Anesthesiology, Resuscitation and Intensive care, University Hospital Centre Zagreb, • Kišpatićeva ul. 12, Croatia

DOI: 10.22514/SV152.102019.7 Vol.15,Issue 2,September 2019 pp.45-51

Published: 20 September 2019

*Corresponding Author(s): SPINDLERVESEL ALENKA E-mail:


Background. Optimal intravascular blood volume, cardiac output and sufficient oxy-gen supply is a mainstay in major abdomi-nal surgery. Adequate haemodynamic management can improve a favourable outcome and shorten the duration of hos-pital stay.

Our study anticipated different fluid and vasoactive drug consumption and less complications during the pancreatic sur-gery in the group of patients where ex-tended haemodynamic monitoring was applied.

Materials and methods. 59 adult patients, ASA 2-3, undergoing elective pancreas surgery, were included in the study. In 29 patients in the study group (SG – extended haemodynamic monitoring), cardiac in-dex (CI), mean arterial pressure (MAP) and nominal stroke index (SI) were main-tained within 80% of baseline values with actions following study protocol. Patients’ groups were homogenous, even when di-vided into 4 subgroups (control group (CG) and without epidural catheter (EC), CG and with EC, SG and without EC, SG and with EC).

Intraoperative variables (amount of fluids, vasopressors, surgery duration) and hospi-talisation duration, wound healing, reop-eration, mortality and other complication were recorded on the postoperative days 3, 5, 8, 15 and on hospital discharge. Results. There was no difference in ASA health status, intraoperative management and duration of hospitalisation in 4 sub-groups. There is a significant difference in intraoperative use of vasopressor support between 4 subgroups (Fisher exact test, p=0,032). All patients in SG with EC re-quired vasopressors. Number of patients with major complications were not statisti-cally different between groups. Pulmonary embolism, postoperative food intolerance and myocardial infarction have occurred only in CG. 

Conclusion. In our study there was no dif-ference in overall fluid and vasoactive drug demand. Although in the studied subgroup of patients with additional epidural anaes-thesia there was significantly increased de-mand for vasoactive drugs. The incidence of complication was low in both groups, however, some of major complications oc-curred only in CG.


haemodynamic monitoring, fluid optimisation, postoperative outcome, pancreatic surgery

Cite and Share

JENKO MATEJ, POŽAR-LUKANOVIĆ NEVA,MLADEN PERIĆ,SPINDLERVESEL ALENKA. Fluid optimisation in pancreas surgery. Signa Vitae. 2019. 15(2);45-51.


1. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1988;94(6):1176-86

2. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a metaanalysis of randomised controlled trials. Br J Anaesth. 2009;103:637-46.

3. Drobin D, Hahn RG. Time course of increased haemodilution in hypotension induced by extradural anaesthesia. Br J Anaesth. 1996;77:223-6.

4. Buttenschoen K, Buttenschoen DC, Berger D, Vasilescu C, Schafheutle S, Goeltenboth B et al.Endotoxemia and acute-phase proteins in major abdominal surgery. Am J Surg. 2001;181:36-43.

5. Mijawaki T, Maeda S, Koyama Y, Fukuoka R, Shimada M. Elevation of plasma interleukin-6 level is involved in postoperative fever following major oral and maxillofacial surgery. Oral Med Oral Pathol Oral Radiol.1998;85:146-151.

6. Wortel CH, van Deventer SJH, Aarden LA, Lygidakis NJ, Buller HR, Hoek FJ et al. Interleukin-6 mediates host defence responses induced by abdominal surgery. Surgery 1993;114:564-569.

7. Foex BA, Lamb WR, Roberts TE, Brear SG, Macartney I, Hammer M et al. . Early cytokine response to multiple injury. Injury. 1993;24:373-376

8. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces com-plications and duration of hospital stay. A randomised, controlled trial (ISRCTN38797445). Crit Care. 2005;9:R687-93.

9. Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C et al. Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ. 1999,318:1099-103.

10. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003,348:5-14.

11. Walsh SR, Tang T, Bass S, Gaunt ME. Doppler-guided intra-operative fluid management during major abdominal surgery: systematic review and metaanalysis. Int J Clin Pract. 2008;62:466-70.

12. Abbas SM, Hill AG. Systematic review of the literature for the use of oesophageal Doppler monitor for fluid replacement in major abdominal surgery. Anaesthesia. 2008;63:44-51.

13. Gurgel ST, do Nascimento P Jr. Maintaining tissue perfusion in high-risk surgical patients: a systematic review of randomized clinical trials. Anesth Analg. 2011;112(6):1384-91.

14. Cecconi M, Fassano N, Langiano N, Divella M, Costa MG, Rhodes A et al.Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Crit Care. 2011;15(3):R132.

15. Ahlin Č, Stupica D, Strle F, Lusa L: A Web Application for Dynamic Summary and Analysis of Longitudinal Medical Data Based on

R. PLoS ONE 10(4):e0121760.

16. Habicher M, Balzer F, Mezger V, Niclas J, Müller M, Perka C et al.Implementation of goal-directed fluid therapy during hip revision arthroplasty: a matched cohort study. Perioper Med.2016;5:31.

17. Van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RM, Daams F et al.. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg. 2016; 36:183-200.

18. Gillies MA, Shah AS, Mullenheim J, Tricklebank S, Owen T, Antonelli J et al. Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial. Br J Anaesth. 2015;115:227-33.

19. Bundgaard-Nielsen M, Jans Ø, Müller RG, Korshin A, Ruhnau B, Bie Pet al. Does goal-directed fluid therapy affect postoperative orthostatic intolerance?: A randomized trial. Anesthesiology. 2013;119:813-23.

20. Phan TD, D'Souza B, Rattray MJ, Johnston MJ, Cowie BS. A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery pro-gram. Anaesth Intensive Care. 2014;42:752-60.

21. Sessler DI, Sigl JC, Kelley SD, Chamoun NG, Manberg PJ, Saager L et al.Hospital stay and mortality are increased in patients having a “triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. Anesthesiol-ogy. 2012;116:1195–203.

22. Scheeren TW, Wiesenack C, Gerlach H, Marx G. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput. 2013;27:225-33.

23. Forni LG. Fluid therapy and acute kidney injury: A question of balance? Signa Vitae. 2016;11(Suppl 2):17–21.

24. Žličar M. Current concepts in fluid therapy and non-invasive haemodynamic monitoring. Signa Vitae. 2017;13(21):53–5.

25. Colquhoun D. An investigation of the false discovery rate and the misinterpretation of P values. R Soc Open Sci. 2014;1–15.

26. Fritz CO, Morris PE, Richler JJ. Effect size estimates: Current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141(1):2–18.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time