Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Ann Med. 2024 Dec;56(1):2356645. doi: 10.1080/07853890.2024.2356645. Epub 2024 May 24.
A change from the supine to prone position causes hemodynamic alterations. We aimed to evaluate the effect of fluid preloading in the supine position, the subsequent hemodynamic changes in the prone position and postoperative outcomes.
This prospective, assessor-blind, randomized controlled trial was conducted between March and June 2023. Adults scheduled for elective orthopaedic lumbar surgery under general anaesthesia were enrolled. In total, 80 participants were randomly assigned to fluid maintenance (M) or loading (L) groups. Both groups were administered intravenous fluid at a rate of 2 ml/kg/h until surgical incision; Group L was loaded with an additional 5 ml/kg intravenous fluid for 10 min after anaesthesia induction. The primary outcome was incidence of hypotension before surgical incision. Secondary outcomes included differences in the mean blood pressure (mBP), heart rate, pleth variability index (PVi), stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index and cardiac index before surgical incision between the two groups. Additionally, postoperative complications until postoperative day 2 and postoperative hospital length of stay were investigated.
Hypotension was prevalent in Group M before surgical incision and could be predicted by a baseline PVi >16. The mBP was significantly higher in Group L immediately after fluid loading. The PVi, SVV and PPV were lower in Group L after fluid loading, with continued differences at 2-3 time points for SVV and PPV. Other outcomes did not differ between the two groups.
Fluid loading after inducing general anaesthesia could reduce the occurrence of hypotension until surgical incision in patients scheduled for surgery in the prone position. Additionally, hypotension could be predicted in patients with a baseline PVi >16. Therefore, intravenous fluid loading is strongly recommended in patients with high baseline PVi to prevent hypotension after anaesthesia induction and in the prone position.
KCT0008294 (date of registration: 16 March 2023).
从仰卧位转为俯卧位会引起血液动力学改变。我们旨在评估仰卧位时进行液体预负荷、随后俯卧位时的血液动力学变化以及术后结果。
这是一项前瞻性、评估者盲法、随机对照试验，于 2023 年 3 月至 6 月进行。纳入计划在全身麻醉下接受择期骨科腰椎手术的成年人。共有 80 名参与者被随机分配到液体维持（M）或液体负荷（L）组。两组均以 2ml/kg/h 的速度静脉输液，直到手术切口；L 组在麻醉诱导后 10 分钟内额外输注 5ml/kg 静脉液体。主要结局是手术切口前低血压的发生率。次要结局包括两组在手术切口前的平均血压（mBP）、心率、容积脉搏指数（PVi）、每搏量变异（SVV）、脉搏压变异（PPV）、每搏量指数和心指数的差异。此外，还调查了术后 2 天内的术后并发症和术后住院时间。
M 组在手术切口前存在低血压，且基线 PVi >16 可预测低血压的发生。液体负荷后，L 组 mBP 立即升高。液体负荷后，L 组 PVi、SVV 和 PPV 降低，SVV 和 PPV 在 2-3 个时间点仍有差异。两组其他结果无差异。
全身麻醉后进行液体负荷可降低俯卧位手术患者手术切口前低血压的发生率。此外，基线 PVi >16 的患者可预测低血压。因此，建议在基线 PVi 较高的患者中强烈推荐静脉液体负荷，以预防麻醉诱导后和俯卧位时的低血压。
KCT0008294（注册日期：2023 年 3 月 16 日）。
