Key result
Preanesthetic fluid loading cuts postinduction hypotension risk ~72% in cervical myelopathy surgery.
Why the study?
Patients with chronic compressive cervical myelopathy may have autonomic dysfunction that can aggravate intraoperative hemodynamic alterations, but the effect of fluid preloading remained to be determined.
Does preanesthetic fluid loading reduce postinduction hypotension and improve cardiac dynamic indices in patients with chronic compressive cervical myelopathy undergoing cervical spine surgery?
RCT (n=60)
Patient, anesthesiologist, outcome assessor, and data analyst blinded
Computer-generated random number table
No
Does preanesthetic fluid loading reduce postinduction hypotension and improve cardiac dynamic indices in patients with chronic compressive cervical myelopathy undergoing cervical spine surgery?
Odds Ratio: 0.28 (95% CI 0.17–0.44)
Absolute Event Rate: 26.7% vs 86.7%
p-value: p=<0.001
Preanesthetic fluid loading with Ringer's lactate significantly reduces postinduction hypotension and improves cardiac index during the early intraoperative period in patients undergoing cervical spine surgery.
Preanesthetic fluid loading reduces postinduction hypotension in cervical myelopathy surgery; extends low-certainty evidence from 2 prior trials.
Purpose Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery. Methods This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone. Results The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use. Conclusion Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period. Registration number of Clinical Trial The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018).
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Paul et al. (2022) conducted an RCT in Chronic compressive cervical myelopathy (n=60). Preanesthetic fluid loading (Ringer's lactate) vs. No preloading (Ringer's lactate at 2 mL/kg/h maintenance) was evaluated on Incidence of postinduction hypotension (OR 0.28, 95% CI 0.17-0.44, p=<0.001). Preanesthetic fluid loading with Ringer's lactate significantly reduced the incidence of postinduction hypotension compared to no preloading (26.7% vs 86.7%, OR 0.28) in patients with cervical myelopathy.
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