Preoperative Carbohydrate Loading And Intraoperative Goal-directed Fluid Therapy For Elderly Patients Undergoing Gastrointestinal Surgery

Objective:A randomized controlled trial was designed to evaluate the relative impact of perioperative optimal fluid therapy versus conventional fluid therapy on clinical outcomes for elderly patients undergoing gastrointestinal surgery.The aim of this study was to ascertain whether optimal fluid therapy was beneficial to elderly patients undergoing gastrointestinal operation and to provide guidance for clinical practice.Methods:This prospective randomized controlled study included 120 patients who underwent elective open gastrointestinal surgery in Sichuan Provincial People’s Hospital from May 2018 to December 2019.After the screening test,the elderly patients meeting the inclusion criteria were randomly assigned to the following two groups according to 1:1 ratio:(1)the experimental group(optimal fluid treatment group)of 60 patients;(2)The control group(traditional fluid treatment group)of 60 patients.The experimental group with carbohydrate(200 ml)loading 2 hours before surgery was conducted by a Vigileo/FloTrac monitor with cardiac index(CI),stroke volume variation(SVV),and mean arterial pressure(MAP)and maintained CI≥2.5 L/min/m2.The control group with traditional methods of fasting and water-deprivation underwent routine monitoring during surgery,such as MAP and heart rate,and maintained heart rate<100 bpm,MAP>65 mmHg,urine output>0.5 ml/kg/h.For all patients,demographic information,intraoperative hemodynamic data,blood lactate concentrations,duration of surgery,duration of anesthesia,crystalloid infusion,colloid infusion,estimated blood loss,time of gastrointestinal recovery,the incidence of postoperative complications,postoperative hospitalization and hospital expense were recorded.Results:There were no significant differences between groups with respect to demographic characteristics,surgical category,or ASA classification(p>0.05).Patients in the experimental group were significantly administered less crystalloid fluid(1111±442.9 ml vs 1411 ± 412.6 ml;p=0.000)and produced less urine output(1.40±0.9 ml/kg/h vs 2.25±1.4 ml/kg/h;p=0.000)relative to patients in the control group.Moreover,the experimental group was associated with a shorter average time to first flatus(55±13.9 hours vs 65±22.6 hours;p=0.004)and oral intake(72±17.4 hours vs 85±27.5 hours;p=0.002),as well as a reduction in the rate of postoperative complications(14(25.5%)vs 27(47.4%)patients;p=0.016).However,postoperative hospitalization or hospitalization expenses were similar between groups(p>0.05).Conclusions:Focused on elderly patients undergoing open gastrointestinal surgery,we found a combination of a goal-directed fluid protocol and preoperative carbohydrate loading 2 hours before surgery may be associated with improvement of bowel function and a lower incidence of postoperative complications.