A Preliminary Clinical Study Of Restrictive Transfusion Administration On Gynecological Laparoscopic Surgery

The concept of restrictive fluid administration has been proposed as a compromise strategy, which allows the restoration of blood circulation with minimal fluid requirements and a modest maintenance of blood pressure by controlling the fluid infusion speed and volume of infusion,to get less effect to internal environment,fewer complications and mortality.Research suggests that perioperative restrictive transfusion can reduce complications of uncontrolled hemorrhagic shock patients, to enhance the growth of healing, the stability of organ function, accelerate the recovery of gastrointestinal function, improve lung function and oxygenation of tissue, shorten the days of hospitalization after operation.At present, there is few Restrictive transfusion used in clinical gynecologic operation,whether the application of intravenous fluid restiction can also make patients get better effect still needs to be explored in the gynecologic operation.This study proposed by monitoring patients’ hemodynamics and blood gas index, quality of postoperative revival, postoperative time of hospital stay, discusses restrictive transfusion during anesthesia for elective laparoscopic assisted in hysterectomy patients. Materials and methods1.Patients and methodsThirty-two patients of American Society of Anesthesiologist(ASA)Ⅰ and Ⅱ physical status, undergoing laparoscopic radical resection of uterus and the preoperative state of critical organ including heart, lung, encephalon and kidney was normal.Patients were randomly allocated into two groups,Group A and B.The patients in Group A received restrictive fluid,15ml/Kg.The ones in Group B received liberal fluid,40ml/Kg.Aged31-60years old,weighing47-82kg,height144-165cm.2.Anesthesia and observation index2.1.Anesthesia method:Datex-Ohmeda monitor ECG monitoring, local anesthesia catheter on the right radial artery puncture. FloTrae/Vigileo monitor monitoring of arterial blood pressure and cardiac output.Anesthesia was induced with iv midazolam(0.04mg/kg),propofol (2mg/kg), sufentanil (0.3～0.4ug/kg) and rocuronium(0.9mg/kg).3minutes later, thacheal intubation,continuous inhalation of sevoflurane to maintain anesthesia. Datex-Ohmeda anesthesia machine maintenance of mechanical ventilation,tidal volume of8～10ml/kg,frequency12～20times/min,maintain end-tidal carbon dioxide (PetCO2)35～45mmHg during operation. After induction,the right internal jugular vein puncture,single lumen central venous catheter placement16G,depth of12cm,and the monitoring of central venous pressure.The use of bispectral index monitor monitoring of BIS,maintained at45～55,in order to maintain the stability of the depth of anesthesia,avoiding the depth of anesthesia on hemodynamics in different influence.Use of compound sodium chloride infusion pump uniform inputoperation,group A for15ml/kg,group B for40ml/kg.Intraoperative required additional sufentanil citrate and rocuronium.2.2Monitoring indicators and Record timeTheir Heart Rate, Central Venous Pressure, Cardiac Output, Mean Arterial Blood Pressure and Stroke Volume were monitored respectively before-anesthesia(T0) before the pneumoperitoneum(T1),5min(T2),10min(T3),20min(T4)30min(T5)after the pneumoperitoneum and5min(T6),10min(T7) after the deflation of abdomen. Before anesthesia (TO) and at the end of the operation (T7) extraction arterial blood for blood gas analysis, recording blood gas indexes:Lactic acid, hemoglobin and hematocrit. After the first day of operation, recording blood gas indexes:Lactic acid, hemoglobin and hematocrit. Record the PACU retention time,PACU stay and postoperative agitation (min),the hospitalization time after operation.3. Statistical analysis methodsStatistical analysis was performed using SPSS version13.0(SPSS Inc., Chicago, IL). To calculate sample size, we used the mean and standard deviation (SD) of the first six patients. All data are expressed as mean±SD. Changes in values with time were analyzed with repeated measures analysis of variance. Differences within the group were analyzed with a paired t-test with Bonferroni correction. A value of P<0.05was considered as statistically significant. The graphs were made using office2003.Results1. There was no significant differece in age,weight,height,BMI index,anesthesia time,operation time and blood loss with two groups(P>0.05).2. Comparison of two groups:Within the same group,there was no significant difference in Lac between the time of preoperative and the postoperative(P>0.05). There was significant difference in postoperative Hb and Hct compare with it of preoperative(P<0.05).In group A,compared with T1,SVV decreased on T6,T7(P<0.05).In group B,compared with T1,SVV decreased on T6,T7(P<0.05).Compared with T1,CVP of the two groups were increased on T2-T6(P<0.05).3. Comparison between two groups:There was no significant difference between the two groups of the preoperative Lac,Hb,Hct(P>0.05).Between the two groups, after the operation and postoperative Hb,Hct of Group B decreased (P<0.05).Between the two groups,there was no significant difference in HR,MAP,CO,SV in each time point.The overall trend of HR,MAP,CO,SV,CVP,SVV between the two groups is identical.There was no significant difference about cycle index at the same time point between the two groups.The HR,MAP,SV,CO of two groups were maintained in the normal range.The urine volume of restrictive transfusion was less than the unrestricted group,but it still maintained at0.5ml/Kg*h,do not affecting the renal perfusion. The the time of PACU stay and Hospital stay in group A was decreased (P<0.05).Conclusions1. The restrictive transfusion can maintain hemodynamic stability and guarantee the mean arterial pressure above70mmHg, guarantee the important viscera perfusion.Using it in gynecological laparoscopic total hysterectomy is safe and feasible.2. Restrictive transfusion was not increase lactic acid value, reduced the excessive hemodilution, enhance the capacity of oxygen-carrying hemoglobin, guarantee the viscera of oxygen supply.3. The restrictive transfusion can shorten the PACU residence time, improve the quality of awakening, shorten hospitalization time, save social resources.