Restrictive deferred hydration combined with preemptive norepinephrine infusion
during radical cystectomy reduces postoperative complications and hospitalization
time: a randomized clinical trial.
Author(s): Wuethrich PY(1), Burkhard FC, Thalmann GN, Stueber F, Studer UE.
Affiliation(s): Author information:
(1)From the Department of Anaesthesiology and Pain Therapy (P.Y.W., F.S.) and
Department of Urology (F.C.B., G.N.T., U.E.S.), University Hospital Bern, Bern,
Switzerland.
Publication date & source: 2014, Anesthesiology. , 120(2):365-77
BACKGROUND: Anesthetics and neuraxial anesthesia commonly result in
vasodilation/hypotension. Norepinephrine counteracts this effect and thus allows
for decreased intraoperative hydration. The authors investigated whether this
approach could result in reduced postoperative complication rate.
METHODS: In this single-center, double-blind, randomized, superiority trial, 166
patients undergoing radical cystectomy and urinary diversion were equally
allocated to receive 1 ml·kg·h of balanced Ringer's solution until the end of
cystectomy and then 3 ml·kg·h until the end of surgery combined with preemptive
norepinephrine infusion at an initial rate of 2 µg·kg·h (low-volume group; n =
83) or 6 ml·kg·h of balanced Ringer's solution throughout surgery (control group;
n = 83). Primary outcome was the in-hospital complication rate. Secondary
outcomes were hospitalization time, and 90-day mortality.
RESULTS: In-hospital complications occurred in 43 of 83 patients (52%) in the
low-volume group and in 61 of 83 (73%) in the control group (relative risk, 0.70;
95% CI, 0.55-0.88; P = 0.006). The rates of gastrointestinal and cardiac
complications were lower in the low-volume group than in the control group (5
[6%] vs. 31 [37%]; relative risk, 0.16; 95% CI, 0.07-0.39; P < 0.0001 and 17
[20%] vs. 39 [48%], relative risk, 0.43; 95% CI, 0.26-0.60; P = 0.0003,
respectively). The median hospitalization time was 15 days [range, 11, 27d] in
the low-volume group and 17 days [11, 95d] in the control group (P = 0.02). The
90-day mortality was 0% in the low-volume group and 4.8% in the control group (P
= 0.12).
CONCLUSION: A restrictive-deferred hydration combined with preemptive
norepinephrine infusion during radical cystectomy and urinary diversion
significantly reduced the postoperative complication rate and hospitalization
time.
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