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Obesity Surgery

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01-11-2013 | Original Contributions

Morbid Obesity and Optimization of Preoperative Fluid Therapy

Authors: Tomi Pösö, Doris Kesek, Roman Aroch, Ola Winsö

Published in: Obesity Surgery | Issue 11/2013

Abstract

Background

Preoperative venous return (VR) optimization and adequate blood volume is essential in management of morbidly obese patients (MO) in order to avoid perioperative circulatory instability. In this study, all subjects underwent a preoperative 3-week preparation by rapid-weight-loss-diet (RWL) as part of their treatment program for bariatric surgery.

Methods

This is a prospective, observational study of 34 morbidly obese patients consecutively scheduled for bariatric surgery at Sunderby County Hospital, Luleå, Sweden. Preoperative transthoracic echocardiography (TTE) was performed in the awake state before and after intravascular volume challenge (VC) of 6 ml colloids/kg ideal body weight (IBW). Effects of standardized VC were evaluated by TTE. Dynamic and non-dynamic echocardiographic indices for VC were studied. Volume responsiveness and level of VR before and after VC were assessed by TTE. An increase of stroke volume ≥13 % was considered as a volume responder.

Results

Twenty-nine out of 34 patients were volume responders. After VC, a majority of patients (23/34) were euvolemic, and only 2/34 were hypovolemic. Post-VC hypervolemia was observed in 9/34 of patients.

Conclusions

The IBW-based volume challenge regime was found to be suitable for preoperative rehydration of RWL-prepared MO. Most of the patients were volume responders. Preoperative state of VR was not associated with volume responsiveness. IBW estimates and appropriate monitoring avoids potential hyperhydration in MO. For VC assessment, conventional Doppler indices were found to be more suitable compared to tissue Doppler, giving sufficient information on pressure–volume correlation of the left ventricle in morbidly obese.

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Title: Morbid Obesity and Optimization of Preoperative Fluid Therapy
Authors: Tomi Pösö
Doris Kesek
Roman Aroch
Ola Winsö
Publication date: 01-11-2013
Publisher: Springer US
Published in: Obesity Surgery / Issue 11/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-013-0987-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Morbid Obesity and Optimization of Preoperative Fluid Therapy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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