Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 8, November, p. 1189–1196

doi: 10.17219/acem/63140

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia

Edyta Kotlińska-Hasiec1,A,B,C,D,F, Rafał R. Rutyna1,A,B,C,F, Ziemowit Rzecki1,A,B,C,F, Katarzyna Czarko-Wicha1,A,B,C,F, Jacek Gagała2,B,C,E,F, Paulina Pawlik1,B,D,F, Alicja Załuska3,B,D,F, Andrzej Jaroszyński4,A,B,C,D,E,F, Wojciech Załuska5,C,E,F, Wojciech Dąbrowski1,A,B,C,D,F

1 Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland

2 Department of Orthopedic Surgery and Traumatology, Medical University of Lublin, Poland

3 Department of Physiotherapy, Medical University of Lublin, Poland

4 Department of Family Medicine, Medical University of Lublin, Poland

5 Department of Nephrology, Medical University of Lublin, Poland


Background. Crystalloids are frequently used for the correction of spinal anesthesia-induced hypotension, intraoperative bleeding, or vaporisation from surgical wounds.
Objectives. The aim of this study was to observe the effect of perioperative crystalloid infusion on intraabdominal pressure (IAP), volume excess (VE), total body water (TBW), and extracellular body water (ECW) in patients undergoing elective orthopedic surgery under spinal anesthesia.
Material and Methods. Adult patients undergoing hip or knee replacement were studied. Changes in VE, TBW, ECW, and IAP were observed in patients who received restrictive fluid therapy (group R) and in patients who received liberal fluid therapy (group L). IAP was measured in the urinary bladder. All parameters were measured at 4 points in time: just before anesthesia (baseline value, A); just after surgery (B); 3 h after surgery (C); and on the morning of postoperative day 1 (D). Additionally, IAP was measured after anesthesia, just before surgery (A1).
Results. The mean baseline values of IAP, ECW, TBW, and VE were comparable between groups L and R. The induction of anesthesia reduced IAP in both groups (p < 0.001). IAP and VE increased in both groups after surgery. Significantly higher values of IAP, however, were noted in group L at time points B, C, and D. TBW and ECW increased after surgery in group L. In group R, ECW slightly increased only at time point C. IAP strongly correlated with ECW in group L (p < 0.001, r = 0.62).
Conclusion. Spinal anesthesia reduces IAP. A perioperative increase in body water content and IAP mainly depends on the volume of the infused crystalloids.

Key words

fluid therapy, intra-abdominal pressure, extracellular water content, volume excess, liberal vs restricted

References (33)

  1. Onofriescu M, Hogas S, Voroneanu L, et al. Bioimpedance-guided fluid management in maintenance hemodialysis: A pilot randomized controlled trial. Am J Kidney Dis. 2014;64:111–118.
  2. Dąbrowski W, Kotlińska-Hasiec E, Schneditz D, et al. Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure. Clin Nephrol. 2014;82:41–50.
  3. Zaluska WT, Schneditz D, Kaufman AM, Morris AT, Levin NW. Relative underestimation of fluid removal during hemodialysis hypotension measured by whole body bioimpedance. ASAIO J. 1998;44:823–27.
  4. Malbrain MLNG, Huygh J, Dąbrowski W, De Waele JJ, Staelens A, Wauters J. The use of bio-electrical impedance analysis (BIA) to guide fluid management, resuscitation and deresuscitation in critically ill patients: A bench-to-bedside review. Anesthesiol Intensive Ther. 2014;46:381–91.
  5. Ernstbrunner M, Kostner L, Kimberger O, et al. Bioimpedance spectroscopy for assessment of volume status in patients before and after general anesthesia. PLoS One. 2014;9:e111139. doi: 10.1371/journal.pone.0111139.
  6. Silva JM Jr, de Oliveira AM, Nogueira FA, et al. The effect of excess fluid balance on the mortality rate of surgical patients: A multicenter prospective study. Crit Care. 2013;17:R288. doi: 10.1186/cc13151.
  7. Hahn RG. Must hypervolaemia be avoided? A critique of the evidence. Anaesthesiol Intensive Ther. 2015;47:449–456.
  8. Berger MM, Gradwohl I, Brunauer A, Ulmer H, Dünser MW. Targets of perioperative fluid therapy and their effects on postoperative outcome: A systematic review and meta-analysis. Minerva Anestesiol. 2015;81:794–807.
  9. Elvevoll B, Husby P, Øvrebø K, Haugen O. Acute elevation of intra-abdominal pressure contributes to extravascular shift of fluid and proteins in an experimental porcine model. BMC Research Notes. 2014;7:738.
  10. Kraemer M, Rode C, Wizemann V. Detection limit of methods to assess fluid status changes in dialysis patients. Kidney Int. 2006;69:1609–1620.
  11. Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. J Am Med Assoc. 1961;178:261–266.
  12. Holte K, Kristensen BB, Valentiner L, Foss NB, Husted H, Kehlet H. Liberal versus restrictive fluid management in knee arthroplasty: A randomized, double-blind study. Anesth Analg. 2007;105:465–474.
  13. Jiang L, Jiang S, Zhang M, Zheng Z, Ma Y. Albumin versus other fluids for fluid resuscitation in patients with sepsis: A meta-analysis. PLoS One. 2014;9(12):e114666. doi:10.1371/journal.pone.0114666
  14. Simon TP, Thiele C, Schuerholz T, et al. Molecular weight and molar substitution are more important in HES-induced renal impairment than concentration after hemorrhagic and septic shock. Minerva Anestesiol. 2015;81:608–618.
  15. Cohen R. Colloids versus crystalloids: The story continues. Minerva Anestesiol. 2013;79:3–4.
  16. Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: A stratified meta-analysis. Anesth Analg. 2012;114:640–651.
  17. Bruegger D, Jacob M, Rehm M, et al. Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts. Am J Physiol Heart Circ Physiol. 2005;289:H1993–1999.
  18. Dąbrowski W, Kotlińska-Hasiec E, Jaroszyński A, et al. Intra-abdominal pressure correlates with extracellular water content. PLoS One. 2015;10:e0122193. doi: 10.1371/journal.pone.0122193.
  19. Navarro LHC, Bloomstone JA, Auler JO Jr, et al. Perioperative fluid therapy: A statement from the International Fluid Optimization Group. Perioper Med. 2015;4:3. doi: 10.1186/s13741-015-0014-z.
  20. Ruttmann TG, Montoya-Pelaez LF, James MF. The coagulation changes induced by rapid in vivo crystalloid infusion are attenuated when magnesium is kept at the upper limit of normal. Anesth Analg. 2007;104:1475–1480.
  21. Ekseth K, Abildgaard L, Vegfors M, Berg-Johnsen J, Engdahl O. The in vitro effects of crystalloids and colloids on coagulation. Anesthesia. 2002;57:1102–1108.
  22. Darlington DN, Delgado AV, Kheirabadi BS, et al. Effect of hemodilution on coagulation and recombinant factor VIIa efficacy in human blood in vitro. J Trauma. 2011;71:1152–1163. doi: 10.1097/TA.0b013e318215178c.
  23. Janvrin SB, Davies G, Greenhalgh RM. Postoperative deep vein thrombosis caused by intravenous fluids during surgery. Br J Surg. 1980;67:690–693.
  24. Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: A systematic review and meta-analysis. Crit Care. 2013;17:R249. doi: 10.1186/cc13075.
  25. Huang SY, Feng CW, Hung HC, et al. A novel zebrafish model to provide mechanistic insights into the inflammatory events in carrageenan-induced abdominal edema. PLoS One. 2014;9:e104414. doi: 10.1371/journal.pone.0104414.
  26. Ohmi S, Takei T, Habuka K, Watanabe Y. Acute pulmonary leak syndrome during elective surgery under general anesthesia. J Anesth. 2008;22:77–80.
  27. Wakabayashi S, Yamaguchi K, Kumakura S, et al. Effects of anesthesia with sevoflurane and propofol on the cytokine/chemokine production at the airway epithelium during esophagectomy. Int J Mol Med. 2014;34:137–144.
  28. Rassias AJ, Procopio MA. Stress response and optimization of perioperative care. Dis Mon. 2003;49:522–554.
  29. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–117.
  30. Medrano G, Eitner F, Floege J, Leonhardt S. A novel bioimpedance technique to monitor fluid volume state during hemodialysis treatment. ASAIO J. 2010;56:215–220.
  31. Zhu F, Schneditz D, Wang E, Levin NW. Dynamics of segmental extracellular volumes during changes in body position by bioimpedance analysis. J Appl Physiol. 1998;85:497–504.
  32. Oshima Y, Shiga T. Within-day variability of whole-body and segmental bioelectrical impedance in a standing position. Eur J Clin Nutr. 2006;60:938–941.
  33. Sugano N, Yokoyama K, Kato N, et al. Monitoring of body water composition by the simultaneous use of bioelectrical impedance analysis and Crit-Line® during hemodialysis. Clin Exp Nephrol. 2014;18:944–951.