Influence of the Volemic Status of the Patient in the Preoperative Period on Indicators of Hemodynamics During Laparoscopic Surgery

The aim of the study was to study of the influence of targeted infusion therapy on changes in the main hemodynamic parameters at various stages of anesthesia benefits during laparoscopic interventions was conducted. Object and methods. 40 patients were examined during laparoscopic cholecystectomy, which were divided into three groups: Group 1 (control, n=20) – volemically stable patients whose infusion was carried out by crystalloids at a rate of 1 ml/kg/hour; Group 2 (responders, n=10), patients of this group underwent correction of the volemic status in the preoperative period according to the algorithm for constructing tactics of infusion therapy based on the dynamics of stroke volume indicators: 1) measurement of indicators of stroke volume (SV) in patients before anesthesia and surgical intervention; 2) the introduction of a bolus of 0.9 % NaCl solution in a volume of 200 ml; 3) repeated measurement of SV – if there is an increase in its level >10 % – the patient belongs to the category of responders, after which a repeated bolus of a 0.9 % NaCl solution in a volume of 200 ml is performed and if the increase in SV in response to a bolus does not exceed 10 %, then the patient is considered to be volemically stable and begin surgery; 4) during laparoscopic surgery, monitor the dynamics of SV, fix its decrease in the Fowler position, or increase in the Trendelenburg position, do not inject a bolus of crystalloids, continuing monitoring; 5) if during the surgery there is a decrease in SV, regardless of position, add a bolus of 0.9% NaCl solution in a volume of 200 ml; Group 3 (responders, n=10) – patients underwent infusion therapy without correction of the volemic status at the discretion of the anesthesiologist. The study was carried out at the stages: initially (on the operating table), induction phase, intubation, application of carboxyperitoneum, basic anesthesia, desufflation, extubation. Noninvasive hemodynamic monitoring (esCCO technology) was used to record stroke volume (SV) and cardiac output (CCO). Results. As a result of the study, the indicators of systemic hemodynamics in all groups had regular fluctuations during anesthesiological preparation of patients, during application of carboxyperitoneum, and at the stage of completion of surgery. Patients of the Group 3, who were responders and for whom no clinically latent hypovolemia was corrected, showed more pronounced fluctuations in hemodynamic parameters (systolic and mean blood pressure), which was due to fluctuations in preload, compared with the control patients and the group of responders with carrying out the target volumic correction. When studying the indicators of central hemodynamics, the value of the stroke volume in the Group 3 of patients at the induction stage was higher by 13.8 % and 15.8 %, and at the extubation stage, on the contrary, it was lower by 9.8 % and 5.3 % by compared with the Group 1 and Group 2 of the study, respectively (p<0.05). In a comparative analysis of the level of cardiac output at stage 2 in patients of the Group 3, it was significantly higher by 7.8 % and 9.5 % compared with the Group 1 and Group 2, respectively. At the anesthesia baseline stage, a decrease in cardiac output in the Group 3 was noted by 3.6 % (p=0.11) and 11.7 % (p=0.04) compared with patients of the Group 1 and Group 2 respectively. At the stage of extubation, a trend was revealed of a 5.6 % increase in cardiac output in the Group 2 of responders with correction of the volemic status compared to patients of the Group 3. Thus, the use of tests in the preoperative period allows predicting a subsequent increase in cardiac output per infusion load, which makes it possible to identify a group of potential responders requiring correction of the volemic status. The implemented protocol of targeted infusion therapy and the approach to correcting the volemic status allows the anesthesiological guide to be carried out most smoothly from the point of discrepancy between the blood volume and the vascular bed at the time of rapid redistribution of blood intraoperatively during laparoscopic surgery.