Anesth Pain Med.  2019 Apr;14(2):135-140. 10.17085/apm.2019.14.2.135.

Evaluation of suitability of fluid management using stroke volume variation in patients with prone position during lumbar spinal surgery

• Choi YJ
• Lee J
• Cha JR
• Lee KS
• Min TJ
• Lee YS
• Kim WY
• Kim JH

• KMID: 2447960
• DOI: http://doi.org/10.17085/apm.2019.14.2.135

Abstract

BACKGROUND
Static parameters such as central venous pressure and pulmonary artery occlusion pressure, have limitation in evaluation of patients' volume status. Dynamic parameters such as stroke volume variation (SVV), have been used to evaluate intraoperative hemodynamic volume status, in various operations. We examined if SVV is also effective for patients undergoing operation with prone position for fluid management.
METHODS
Eighteen patients that received spinal surgery under prone position November 2015 to May 2016, were enrolled. Patients were kept at an SVV value less than 14% during surgery. Changes of pre-, post-operative volume status were evaluated, using transthoracic echocardiography.
RESULTS
Mean fluid administered was 1,731.97 ± 792.38 ml. Left ventricular end-diastolic volume was 72.85 ± 13.50 ml before surgery, and 70.84 ± 15.00 ml after surgery (P value = 0.594). Right ventricular end-diastolic area was 15.56 ± 1.71 cm² before surgery, and 13.52 ± 2.65 cm² after surgery (P value = 0.110). Inferior vena cava diameter was 14.99 ± 1.74 mm before surgery, and 13.57 ± 2.83 mm after surgery (P value = 0.080).
CONCLUSIONS
We can confirm that fluid management based on SVV is effective, even in prone position surgery. So, SVV, that can be measured by continuous arterial pressure, can be considered a guideline for effective fluid management in spinal surgery.

Keyword

Fluid therapy; Prone position; Spinal surgery; Stroke volume

MeSH Terms

Arterial Pressure
Central Venous Pressure
Echocardiography
Fluid Therapy
Hemodynamics
Humans
Prone Position*
Pulmonary Artery
Stroke Volume*
Stroke*
Vena Cava, Inferior

Figure

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  Fig. 1 Flow diagram.

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  Fig. 2 Protocol of intraoperative fluid management. Vt: tidal volume, PEEP: positive end-expiratory pressure, SVV: stroke volume variation, CI: cardiac index, CVP: central venous pressure.

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  Fig. 3 Measurement of inferior vena cava (IVC). The IVC during expiration (A) and the IVC during inspiration (B) were measured 2 cm distal to the IVC-hepatic vein junction where the anterior and posterior walls of the IVC are well seen and parallel to each other.

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  Fig. 4 Intraoperative stroke volume variation (SVV) changes. MAP: mean arterial pressure.

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