Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2015.11.002
Brazilian Journal of Anesthesiology
Scientific Article

Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?

O jejum influencia a responsividade à pré-carga em voluntários ASA I e II?

Daniel Rodrigues Alves; Regina Ribeiras

http://dx.doi.org/10.1016/j.bjane.2015.11.002 Braz J Anesthesiol, vol.67, n2, p.172-179, 2017
PDF English
PDF Português
Downloads: 0
Views: 689

Abstract

Abstract Introduction: Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. Methods: We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6 hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. Results: Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. Conclusion: Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.

Keywords

Fasting, Echocardiography, Fluid therapy, Hemodynamics

Resumo

Resumo Introdução: O jejum no pré-operatório é há muito tempo considerado uma importante causa de depleção de líquidos, leva a instabilidade hemodinâmica durante a cirurgia, caso a reposição não seja prontamente instituída. Recentemente, esse ponto de vista tradicional tem sido progressivamente desafiado e um número crescente de autores agora propõe uma abordagem mais restritiva para o controle de líquidos, embora permaneçam dúvidas quanto à verdadeira influência hemodinâmica do jejum no pré-operatório. Métodos: Estudo observacional, analítico, prospectivo e longitudinal, no qual 31 voluntários ASA I e II foram submetidos a exame ecocardiográfico antes e após um período de jejum de no mínimo seis horas. Os dados dos índices de pré-carga tanto estáticos quanto dinâmicos foram obtidos em ambos os períodos e subsequentemente comparados. Resultados: Os índices estáticos de pré-carga mostraram um comportamento acentuadamente variável com o jejum. Os índices dinâmicos, entretanto, foram bem mais consistentes entre si, todos apontam na mesma direção; isto é, não evidenciam alteração estatisticamente significativa com o período de jejum. Analisamos também a confiabilidade dos índices dinâmicos para responder a alterações pré-carga intencionais conhecidas. A variação da integral de velocidade-temo (VTI) aórtica com a manobra de elevação passiva dos membros inferiores foi a única variável que mostrou sensibilidade suficiente para sinalizar de forma consistente a presença de variação na pré-carga. Conclusão: O jejum não pareceu causar uma alteração na pré-carga de voluntários conscientes nem alterou substancialmente a sua posição na curva de Frank-Starling, mesmo com tempos de jejum mais prolongados do que o normalmente recomendado. A variação do VTI transaórtico com a manobra de elevação passiva dos membros inferiores foi o índice dinâmico mais consistente (dos estudados) para avaliar a capacidade de resposta a variações da pré-carga em pacientes que respiram espontaneamente.

Palavras-chave

Jejum, Ecocardiografia, Fluidoterapia, Hemodinâmica

References

Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures. Anesthesiology. 2011;114:495-511.

Verma R, Wee MYK, Hartle A. AAGBI safety guideline: pre-operative assessment and patient preparation - the role of the anaesthetist. AAGBI. 2010:1-35.

Smith I, Kranke P, Murat I. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556-69.

Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration - does it improve outcome?. Acta Anaesthesiol Scand. 2002;46:1089-93.

Nygren J, Thorell A, Ljungqvist O. Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?. Curr Opin Anaesthesiol. 2007;20:540-4.

Morgan GEJ, Mikhail MS, Murray MJ. Chapter 29 - fluid management & transfusion. Clinical anesthesiology. 2006:690-707.

Magder S. Fluid status and fluid responsiveness. Curr Opin Crit Care. 2010;16:289-96.

Schmidt C, Hinder F, Van Aken H. Chapter 3 - global left ventricular systolic function. Transoesophageal echocardiography in anaesthesia and intensive care medicine. 2004:47-79.

Eaton DC, Pooler JP. Chapter 44 - basic renal processes for sodium, chloride and water; chapter 45 - regulation of sodium and water excretion. Medical physiology: a systems approach. 2011:437-48.

Kaye AD. Chapter 23 - fluid management. Basics of anesthesia. 2011:364-71.

Faber JE, Stouffer GA. Chapter 1 - introduction to basic hemodynamic principles. Cardiovascular hemodynamics for the clinician. 2008:3-15.

Sun LS, Schwarzenberger JC. Chapter 16 - cardiac physiology. Miller's anesthesia. 2010:393-410.

Monnet X, Teboul JL. Passive leg raising. Applied physiology in intensive care medicine. 2009:185-9.

Monnet X, Teboul JL. Volume responsiveness. Curr Opin Crit Care. 2007;13:549-53.

Sabatier C, Monge I, Maynar J, Ochagavia A. Assessment of cardiovascular preload and response to volume expansion. Med Intensiva. 2012;36:45-55.

Nolan JP. Chapter 9 - major trauma. Fundamentals of anaesthesia. 2009:156-72.

English WA, English RE, Wilson IH. Perioperative fluid balance. Update Anaesth. 2005;20:11-20.

Reves JG, Glass PSA, Lubarsky DA. Chapter 26 - intravenous anesthetics. Miller's anesthesia. 2010:719-68.

White PF, Eng MR. Chapter 18 - intravenous anesthetics. Clinical anesthesia. 2009:444-64.

Rosow C, Dershwitz M. Chapter 42 - pharmacology of opioid analgesics. Anesthesiology. 2012:703-24.

Power I, Paleologos M. Chapter 7 - analgesic drugs. Fundamentals of anaesthesia. 2009:584-608.

Fukuda K. Chapter 27 - opioids. Miller's anesthesia. 2010:769-824.

Smith TC. Chapter 6 - hypnotics and intravenous anaesthetic agents. Fundamentals of anaesthesia. 2009:569-83.

Dershwitz M, Rosow CE. Chapter 41 - pharmacology of intravenous anesthetics. Anesthesiology. 2012:687-702.

Eilers H. Chapter 9 - intravenous anesthetics. Basics of anesthesia. 2011:99-114.

Neto GFD. Capítulo 35 - Anestésicos venosos. Anestesiologia: princípios e técnicas. 2004:560-97.

Cooper N, Cramp P. Chapter 5 - fluid balance and volume resuscitation. Essential guide to acute care. 2003:74-102.

Chappell D, Jacob M, Hofmann-Kiefer K. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723-40.

Raghunathan K, McGee WT, Higgins T. Importance of intravenous fluid dose and composition in surgical ICU patients. Curr Opin Crit Care. 2012;18:350-7.

Kirov MY, Kuzkov VV, Molnar Z. Perioperative haemodynamic therapy. Curr Opin Crit Care. 2010;16:384-92.

Bamboat ZM, Bordeianou L. Perioperative fluid management. Clin Colon Rectal Surg. 2009;22:28-33.

Lowell JA, Schifferdecker C, Driscoll DF. Postoperative fluid overload: not a benign problem. Crit Care Med. 1990;18:728-33.

Jacob M, Chappell D, Conzen P. Blood volume is normal after pre-operative overnight fasting. Acta Anaesthesiol Scand. 2008;52:522-9.

Morley AP, Nalla BP, Vamadevan S. The influence of duration of fluid abstinence on hypotension during propofol induction. Anesth Analg. 2010;111:1373-7.

Osugi T, Tatara T, Yada S. Hydration status after overnight fasting as measured by urine osmolality does not alter the magnitude of hypotension during general anesthesia in low risk patients. Anesth Analg. 2011;112:1307-13.

Geisen M, Rhodes A, Cecconi M. Less-invasive approaches to perioperative haemodynamic optimization. Curr Opin Crit Care. 2012;18:377-84.

Pinsky MR. Goal-directed therapy: optimizing fluid management in your patient. Initiat Safe Patient Care. 2010:1-12.

Bar-Yosef S, Schroeder RA, Mark JB. Chapter 30 - hemodynamic monitoring. Miller's anesthesia. 2010:406-29.

Miller TE, Gan TJ. Chapter 11 - goal-directed fluid therapy. Clinical fluid therapy in the perioperative setting. 2011:91-102.

Rhodes A, Cecconi M, Hamilton M. Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study. Intensive Care Med. 2010;36:1327-32.

Gil Cano A, Monge Garcia MI, Baigorri Gonzalez F. [Evidence on the utility of hemodynamic monitorization in the critical patient]. Med Intensiva. 2012;36:650-5.

Benington S, Ferris P, Nirmalan M. Emerging trends in minimally invasive haemodynamic monitoring and optimization of fluid therapy. Eur J Anaesthesiol. 2009;26:893-905.

Slama M, Maizel J, Mayo PH. Chapter 10 - echocardiographic evaluation of preload responsiveness. Critical care ultrasonography. 2009:115-24.

Kitakule MM, Mayo P. Use of ultrasound to assess fluid responsiveness in the intensive care unit. Open Crit Care Med J. 2010;3:33-7.

Levitov A, Marik PE. Echocardiographic assessment of preload responsiveness in critically ill patients. Cardiol Res Pract. 2012;2012:819696.

Skoyles J. Section 2, Chapter 2 - body fluids. Fundamentals of anaesthesia. 2009:221-31.

Woodcock TE, Woodcock TM. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012;108:384-94.

Slama M, Maizel J. Chapter 6 - assessment of fluid requirements: fluid responsiveness. Hemodynamic monitoring using echocardiography in the critically ill. 2011:61-9.

Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity. Curr Opin Crit Care. 2008;14:334-9.

Dipti A, Soucy Z, Surana A. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med. 2012;30:1414.e1-9.e1.

Backer D. Chapter 7 - assessment of fluid requirements: the fluid challenge. Hemodynamic monitoring using echocardiography in the critically ill. 2011:71-7.

5dcd920e0e8825392bbf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections