The Impact of Restrictive Versus Conservative Intraoperative Fluid Strategies upon the Renal Outcome in Colorectal Surgeries. A Randomized Controlled Trial

Abstract

Background: intraoperative fluid handling has a lot of concerns upon the postoperative organ function. One of the most sensitive organs which could be affected is the kidney. Objectives: We conducted this trial to address the impact of restrictive vs. conservative fluid approaches on postoperative renal complications, hemodynamics and hospital stay. Patients and methods: Prospective, randomized, double-blind placebo-controlled trial at Assiut University Hospitals. The study included 60 adult patients with American Society of Anesthesiologists (ASA) grade II-III undergoing elective colorectal surgery with an expected operative duration of at least two hours. Grouping was based upon the intraoperative fluid management Group (R): 6 mL/kg/h. of lactated ringer (LR), Group (C): 12 mL/kg/h. of LR. The preoperative serum Neutrophil gelatinase-associated lipocalin (NGAL) level (basal value) then by the 2nd and 24th postoperative hours, KDIGO (Kidney Disease: Improving Global Outcomes), serum urea and creatinine were documented by the end of 1st and 2nd postoperative days. Intraoperative hypovolemia events were noted as well. Results: serum NGAL has increased >149 ng/mlin three patients within group C, and two patients within group R; however, the difference was statistically insignificant p= 0.5. KDIGO showed significant difference between the two groups, with higher number of patients in the group R with p= 0.043. Serum urea and creatinine, intraoperative hypovolemic episodes showed insignificant differences between groups. Conclusion: no evident difference between restrictive and conservative intraoperative fluid strategies was noticed upon the early postoperative serum NGAL and other systems complications in patients undergoing major colorectal surgeries.

Keywords

• intraoperative
• fluid strategies
• renal outcome