Hemodynamic complications related to intraoperative volume replacement in the immediate postoperative period

Abstract

Introduction: fluid administration during the transoperative period is aimed at maintaining an adequate intravascular volume to ensure appropriate hydroelectrolytic and acid-base balance and optimize oxygen transport and the function of coagulation factors. Objective: evaluate the relationship between the fluid administration regimen based on replacement solutions in the transoperative period and the appearance of hemodynamic complications in the immediate postoperative period. Method: a prospective cross-sectional descriptive study was conducted based on an exhaustive review of the medical records of patients undergoing surgical treatment at Hermanos Ameijeiras Clinical Surgical Hospital from January 2009 to January 2011. Additionally, the anesthesiologists involved were interviewed on the day after each operation. Results: in a sample of 42 patients, 15 showed hemodynamic behavior suggesting volume demand in the 24 hours following surgery. Volume demand was associated with abdominal and complex spinal surgery, colloidal volume replacement in blood losses or volemic losses under 100 %, and a surgical time greater than 5 hours. No influence was exerted by hematocrit values, weight or percentage of blood loss. Conclusions: the postoperative hemodynamic stability of patients undergoing surgical interventions with blood losses above 1 000 mL was influenced by the percentage of blood lost and its replacement. The best results were obtained when the expansion exceeded the losses and when the replacement was conducted with colloids. Surgical time had a significant influence on hemodynamic stability.

Keywords

• reposición de volumen, complicaciones hemodinámicas, administración intraoperatoria de fluidos