Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 8, November, p. 1189–1196

doi: 10.17219/acem/63140

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia

Edyta Kotlińska-Hasiec1,A,B,C,D,F, Rafał R. Rutyna1,A,B,C,F, Ziemowit Rzecki1,A,B,C,F, Katarzyna Czarko-Wicha1,A,B,C,F, Jacek Gagała2,B,C,E,F, Paulina Pawlik1,B,D,F, Alicja Załuska3,B,D,F, Andrzej Jaroszyński4,A,B,C,D,E,F, Wojciech Załuska5,C,E,F, Wojciech Dąbrowski1,A,B,C,D,F

1 Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland

2 Department of Orthopedic Surgery and Traumatology, Medical University of Lublin, Poland

3 Department of Physiotherapy, Medical University of Lublin, Poland

4 Department of Family Medicine, Medical University of Lublin, Poland

5 Department of Nephrology, Medical University of Lublin, Poland

Abstract

Background. Crystalloids are frequently used for the correction of spinal anesthesia-induced hypotension, intraoperative bleeding, or vaporisation from surgical wounds.
Objectives. The aim of this study was to observe the effect of perioperative crystalloid infusion on intraabdominal pressure (IAP), volume excess (VE), total body water (TBW), and extracellular body water (ECW) in patients undergoing elective orthopedic surgery under spinal anesthesia.
Material and Methods. Adult patients undergoing hip or knee replacement were studied. Changes in VE, TBW, ECW, and IAP were observed in patients who received restrictive fluid therapy (group R) and in patients who received liberal fluid therapy (group L). IAP was measured in the urinary bladder. All parameters were measured at 4 points in time: just before anesthesia (baseline value, A); just after surgery (B); 3 h after surgery (C); and on the morning of postoperative day 1 (D). Additionally, IAP was measured after anesthesia, just before surgery (A1).
Results. The mean baseline values of IAP, ECW, TBW, and VE were comparable between groups L and R. The induction of anesthesia reduced IAP in both groups (p < 0.001). IAP and VE increased in both groups after surgery. Significantly higher values of IAP, however, were noted in group L at time points B, C, and D. TBW and ECW increased after surgery in group L. In group R, ECW slightly increased only at time point C. IAP strongly correlated with ECW in group L (p < 0.001, r = 0.62).
Conclusion. Spinal anesthesia reduces IAP. A perioperative increase in body water content and IAP mainly depends on the volume of the infused crystalloids.

Key words

fluid therapy, intra-abdominal pressure, extracellular water content, volume excess, liberal vs restricted

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