Obesity and Goal-directed Intraoperative Fluid Therapy
Study Details
Study Description
Brief Summary
The purpose of the study is to compare non-obese patients (BMI≤ 30 kg/m2)versus obese patients (BMI> 30 kg/m2) in regard of their respective needs for intraoperative fluid therapy during laparoscopic surgery.
Specifically the investigators will test the hypothesis that subcutaneous tissue oxygenation (PsqO2)is increased in obese patients when fluid management is optimized by means of esophageal Doppler monitoring compared to obese patients undergoing standard fluid management.
Furthermore the investigators will test the hypothesis that PsqO2 is decreased in obese patients undergoing conventional fluid therapy compared to non-obese patients when fluid management is optimized. Thus the investigators assume that PsqO2 is similar in obese and non-obese patients when fluid management is optimized in both groups.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Hemodynamic stability and normovolemia are critical determinants of tissue perfusion and oxygenation. Adequate tissue oxygenation is essential to maintain normal physiologic functions and to reduce complications, such as wound infections.
Fat tissue is relatively hypoperfused and, therefore, poorly oxygenated. Subcutaneous tissue oxygenation in the obese is thus critically low and even supplemental oxygen only slightly increases subcutaneous oxygenation.It is likely that poor subcutaneous oxygenation in the obese surgical patients results in part from inadequate intraoperative fluid replacement.
It remains unknown how to hydrate obese surgical patients best. The most physiologic approach for perioperative fluid replacement is now thought to be goal-directed management, using stroke volume as the treatment parameter.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: obese control
|
|
| Active Comparator: obese goal-directed
|
Other: Goal directed fluid therapy
Fluid will be administered to reach maximal stroke volume during the intraoperative period.
|
| Active Comparator: non-obese goal directed
|
Other: Goal directed fluid therapy
Fluid will be administered to reach maximal stroke volume during the intraoperative period.
|
Outcome Measures
Primary Outcome Measures
- Subcutaneous tissue oxygenation [intraoperative and 2 postoperative hours]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Non-obese (BMI≤ 30kg/m2) and obese patients (BMI > 30 kg/m2)
-
undergoing laparoscopic elective fundoplication or elective bariatric surgery
Exclusion Criteria:
-
decompensate heart failure
-
documented coronary artery disease
-
renal insufficiency
-
severe chronic obstructive pulmonary disease
-
symptoms of infection or sepsis
-
esophageal disease (excepting gastro-esophageal reflux without any other esophageal alteration).
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Department of Anesthesiology, Medical University of Vienna | Vienna | Austria | A-1070 |
Sponsors and Collaborators
- Medical University of Vienna
Investigators
- Principal Investigator: Barbara Kabon, MD, MUW
Study Documents (Full-Text)
None provided.More Information
Publications
- Fleischmann E, Kurz A, Niedermayr M, Schebesta K, Kimberger O, Sessler DI, Kabon B, Prager G. Tissue oxygenation in obese and non-obese patients during laparoscopy. Obes Surg. 2005 Jun-Jul;15(6):813-9.
- Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology. 2002 Oct;97(4):820-6.
- Kabon B, Nagele A, Reddy D, Eagon C, Fleshman JW, Sessler DI, Kurz A. Obesity decreases perioperative tissue oxygenation. Anesthesiology. 2004 Feb;100(2):274-80.
- 708/2009, local IRB