Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial.


Autoria(s): Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George; Stüber, Frank; Studer, Urs
Data(s)

01/02/2014

Resumo

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.

Formato

application/pdf

Identificador

http://boris.unibe.ch/43758/2/Wuethrich_Anesthesiology_2014_120_365.pdf

Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George; Stüber, Frank; Studer, Urs (2014). Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology, 120(2), pp. 365-377. Lippincott Williams & Wilkins 10.1097/ALN.0b013e3182a44440 <http://dx.doi.org/10.1097/ALN.0b013e3182a44440>

doi:10.7892/boris.43758

info:doi:10.1097/ALN.0b013e3182a44440

info:pmid:23887199

urn:issn:0003-3022

Idioma(s)

eng

Publicador

Lippincott Williams & Wilkins

Relação

http://boris.unibe.ch/43758/

Direitos

info:eu-repo/semantics/openAccess

Fonte

Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George; Stüber, Frank; Studer, Urs (2014). Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology, 120(2), pp. 365-377. Lippincott Williams & Wilkins 10.1097/ALN.0b013e3182a44440 <http://dx.doi.org/10.1097/ALN.0b013e3182a44440>

Palavras-Chave #610 Medicine & health
Tipo

info:eu-repo/semantics/article

info:eu-repo/semantics/publishedVersion

PeerReviewed