ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 May;88(5):334-42

DOI: 10.23736/S0375-9393.22.15918-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

MEasuring the impact of Anesthetist-administered medications volumeS on intraoperative flUid balance duRing prolonged abdominal surgEry (MEASURE Study)

Laurence WEINBERG ^{1, 2, 3} ✉, Dong-Kyu LEE ⁴, Hannah BERGIN ¹, Anoop N. KOSHY ⁵, Patrick A. TULLY ¹, Joshua MEYEROV ¹, Maleck LOUIS ¹, Bobby Ou YANG ¹, Olivia GROVER-JOHNSON ¹, Nicholas SCURRAH ¹, Luka COSIC ¹, David STORY ^{1, 2}, Rinaldo BELLOMO ^{2, 6}

¹ Department of Anesthesia, Austin Health, Victoria, Australia; ² Department of Critical Care, University of Melbourne, Victoria, Australia; ³ Department of Surgery, University of Melbourne, Austin Health, Victoria, Australia; ⁴ Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; ⁵ Department of Cardiology, Austin Health, Victoria, Australia; ⁶ Department of Intensive Care, Austin Health, Victoria, Australia

BACKGROUND: The contribution of intraoperative anesthetist-administered medications (IAAMs) to the total volume of intraoperative intravenous (IV) fluid therapy and their association with postoperative outcomes has never been formally investigated.
METHODS: We performed a retrospective study of adult patients undergoing pancreaticoduodenectomy. The volume of IAAMs, crystalloids and colloids, blood and blood products, blood loss, urine output and intraoperative fluid balance were collected. The contribution of IAAMs to the total intraoperative IV fluid volume and postoperative complications was evaluated.
RESULTS: A total of 152 consecutive patients were included. The median volume of IAAMs was 363.8 mL (interquartile range [IQR], (241.0-492.5) delivered at a median rate of 0.61 mL kg hr^-1 (0.40-0.87) over a median duration of surgery of 489 minutes (416.3-605.3). This increased the total administered fluid volume by 5.2% (95% confidence intervals [CI]: 4.6, 5.9%) (Cohen’s d=1.33, P<0.001). The volume of IAAMs was comparable to the intraoperative colloid volume administered (median colloid volume, 400 mL). Overall, fluid volumes correlated significantly with the severity of complications (P=0.011), and the correlation strength increased when the IAAMs volume was included (P=0.005). On addition of IAAMs, the area under the receiver operator characteristic curve for prediction of postoperative complications increased from 0.580 (95%CI: 0.458, 0.701) to 0.603 (95%CI: 0.483, 0.723), P=0.041).
CONCLUSIONS: IAAMs significantly increased the total administered fluid volume during pancreaticoduodenectomy. Their inclusion increases the accuracy of postoperative complications predictions. These findings support their inclusion in fluid volumes and balances in future interventional studies.

KEY WORDS: Anesthesia; Pancreaticoduodenectomy; Surgical procedures, operative