Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial
Pré-carga de fluido antes do posicionamento da cadeira de praia para procedimentos artroscópicos do ombro: um estudo controlado randomizado
Huru Ceren Gokduman, Elif Aygun, Nur Canbolat, Mert Canbaz, Taner Abdullah, Ali Ersen, Mehmet I. Buget
Abstract
Background and objectives
The Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability.
Methods
This randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10 mL.kg-1 of ideal body weight was administered intravenously 30 min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid.
Results
The MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p = 0.001, p = 0.016, p = 0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p = 0.016, p = 0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p = 0.003, p = 0.018, p = 0.019, respectively).
Conclusion
Consequently, preloading can be favorable approach to preserve hemodynamic stability.
Keywords
Resumo
Justificativa e objetivos: O posicionamento da cadeira de praia (PCP) apresenta muitas vantagens, como menor lesão neurovascular e melhor visualização intra-articular, mas também traz consequências negativas, incluindo instabilidade hemodinâmica. Embora a manutenção da pressão arterial média (PAM) normal seja importante, o gerenciamento de fluidos também é um conceito crucial para a estabilidade hemodinâmica. O principal objetivo deste estudo é se a pré-carga antes do posicionamento seria eficaz para menor instabilidade hemodinâmica. Métodos: Este estudo randomizado e controlado foi realizado em um único centro da Universidade de Istambul, Faculdade de Medicina de Istambul. Quarenta e nove pacientes submetidos à cirurgia artroscópica eletiva no BCP foram recrutados. No grupo de estudo, fluido cristaloide a 10 ml/kg-1 de peso corporal ideal foi administrado por via intravenosa 30 min antes do BCP para pré-carga. As medidas de desfecho primário foram diferenças de variáveis hemodinâmicas como PAM, volume sistólico (VS), frequência cardíaca (FC) e débito cardíaco (DC). Os desfechos secundários foram as taxas de náuseas e vômitos pós-operatórios (NVPO) no primeiro dia de pós-operatório, escala de satisfação cirúrgica, dose total de efedrina usada durante a cirurgia e quantidade total de líquido. Resultados: As medidas de PAM, DC e VS do grupo estudo foram maiores do que as do grupo controle no 5º minuto após o BCP (respectivamente, p = 0,001, p = 0,016, p = 0,01). A quantidade total de escalas de satisfação cristaloide e cirúrgica foi maior no grupo de estudo (respectivamente, p = 0,016, p = 0,001). A quantidade total de coloide e a dose de efedrina utilizada no intraoperatório e as taxas de NVPO foram menores no grupo de estudo (p = 0,003, p = 0,018, p = 0,019, respectivamente). Conclusão: Consequentemente, a pré-carga pode ser uma abordagem favorável para preservar a estabilidade hemodinâmica.
Palavras-chave
References
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