Key result
A pre-operative fluid bolus of 8 mL/kg Ringer's acetate reduced the incidence of haemodynamic instability during anaesthetic induction compared to standard treatment (41.5% vs 56.6%, P=0.025).
Why the study?
Does a pre-operative fluid bolus of 8 mL/kg Ringer's acetate solution reduce haemodynamic instability during induction of general anaesthesia in healthy adults undergoing minor surgery?
RCT (n=219)
randomized
Does a pre-operative fluid bolus of 8 mL/kg Ringer's acetate solution reduce haemodynamic instability during induction of general anaesthesia in healthy adults undergoing minor surgery?
Absolute Event Rate: 41.5% vs 56.6%
p-value: p=0.025
Administering an 8 mL/kg fluid bolus of Ringer's acetate prior to general anaesthesia induction improves haemodynamic stability in patients undergoing minor surgery.
May warrant pre-operative fluid bolus for induction stability in minor surgery; extends RCT evidence on fluid optimization in anaesthesia.
BACKGROUND: Haemodynamic instability during the induction of anaesthesia and surgery is common and may be related to hypovolaemia caused by pre-operative fasting or chronic diuretic therapy. The aim of our prospective, controlled, randomized study was to test the hypothesis that a predefined fluid bolus given prior to general anaesthesia for minor surgery would increase haemodynamic stability during anaesthetic induction. METHODS: Two hundred and nineteen fairly healthy adult patients requiring minor surgery were enrolled. All received standard treatment, including a pulse contour analysing device for non-invasive measurement of cardiac index. Infusion therapy was started in all patients at induction. The intervention group (106 patients) was randomized to receive an additional fluid bolus of 8 mL/kg Ringer's acetate solution before the induction of anaesthesia. The primary endpoint was the incidence of haemodynamic instability, defined as a significant reduction of blood pressure or cardiac index during induction of anaesthesia. RESULTS: The interventional group had a lesser incidence of haemodynamic instability during induction (41.5% vs 56.6%, P = .025). This group also had higher cardiac index, stroke volume index, systolic and mean blood pressure and a greater left ventricular end-diastolic area. CONCLUSIONS: A fluid bolus prior to anaesthesia reduced the incidence of haemodynamic instability during induction of general anaesthesia. The total fluid volume was slightly greater in the intervention group compared to the control group (1370 ± 439 mL vs 1219 ± 483 mL, P = .007). We conclude that a defined fluid bolus can help stabilizing haemodynamics in patients undergoing general anaesthesia.
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Kratz et al. (2018) conducted an RCT in Minor surgery (n=219). Fluid bolus of Ringer's acetate solution vs. Standard treatment was evaluated on Incidence of haemodynamic instability, defined as a significant reduction of blood pressure or cardiac index during induction of anaesthesia (p=0.025). A pre-operative fluid bolus of 8 mL/kg Ringer's acetate reduced the incidence of haemodynamic instability during anaesthetic induction compared to standard treatment (41.5% vs 56.6%, P=0.025).
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