Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 7/2015

01-07-2015 | Original Contributions

Reliability of Continuous Non-Invasive Assessment of Hemoglobin and Fluid Responsiveness: Impact of Obesity and Abdominal Insufflation Pressures

Authors: Mia DeBarros, Marlin W. Causey, Patrick Chesley, Matthew Martin

Published in: Obesity Surgery | Issue 7/2015

Login to get access

Abstract

Background

During surgery, proper fluid resuscitation and hemostatic control is critical. Pleth variability index (PVI) is advocated as a reliable way of optimizing intraoperative fluid resuscitation. PVI is a measure of dynamic change in perfusion index during a complete respiratory cycle. Non-invasive monitoring of total hemoglobin could provide a reliable means to determine need for transfusion. We analyzed the impact of insufflation and obesity on non-invasive measurements of hemoglobin and PVI in laparoscopic procedures to validate reliability of fluid responsiveness and hemoglobin levels.

Methods

A non-invasive hemoglobin and PVI monitoring device was prospectively analyzed in patients undergoing abdominal operations. Patients were stratified by open and laparoscopic approach and obesity (body mass index (BMI) ≥35). PVI and hemoglobin values were assessed before, during, and after insufflation and compared to control patients undergoing open surgery.

Results

Sixty-three patients were enrolled (mean age 42 years; 71 % male; mean BMI 36) with 24 patients laparoscopic non-obese (LNO), 20 laparoscopic obese (LO), and 19 undergoing open operations. There was no significant blood loss. Hemoglobin did not change significantly before or after insufflation. There was false elevation of PVI with insufflation and more pronounced in obese patients.

Conclusions

Insufflation or obesity was not associated with significant variations in hemoglobin. Non-invasive monitoring of hemoglobin is useful in laparoscopic procedures in obese and non-obese patients. PVI values should be used cautiously during laparoscopic procedures, particularly in obese patients.
Literature
1.
Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.PubMedCrossRef
2.
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.PubMedCrossRef
3.
Teboul JL, Monnet X. Detecting volume responsiveness and unresponsiveness in intensive care unit patients: two different problems, only one solution. Crit Care. 2009;13(4):175.PubMedCentralPubMedCrossRef
4.
Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294(13):1664–70.PubMedCrossRef
5.
6.
Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8.PubMedCrossRef
7.
Jefferson P, Ball DR. Central venous access in morbidly obese patients. Anesth Analg. 2002;95(3):782.PubMed
8.
Trick WE, Miranda J, Evans AT, et al. Prospective cohort study of central venous catheters among internal medicine ward patients. Am J Infect Control. 2006;34(10):636–41.PubMedCrossRef
9.
Brusasco C, Corradi F, Zattoni PL, et al. Ultrasound-guided central venous cannulation in bariatric patients. Obes Surg. 2009;19(10):1365–70.PubMedCrossRef
10.
Cotter G, Moshkovitz Y, Kaluski E, et al. Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest. 2004;125(4):1431–40.PubMedCrossRef
11.
Bodo M, Settle T, Royal J, et al. Multimodal noninvasive monitoring of soft tissue wound healing. J Clin Monit Comput. 2013;27(6):677–88.PubMedCrossRef
12.
Muller JC, Kennard JW, Browne JS, et al. Hemodynamic monitoring in the intensive care unit. Nutr Clin Pract. 2012;27(3):340–51.PubMedCrossRef
13.
Lipcsey M, Woinarski NC, Bellomo R. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Ann Intensive Care. 2012;2(1):11.PubMedCentralPubMedCrossRef
14.
Mohan VK, Chanderlekha, Kashyap L. Cardiac output monitoring based on thoracic electrical bioimpedance. J Postgrad Med. 2002;48(4):329–30.PubMed
15.
Cannesson M, Desebbe O, Rosamel P, et al. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth. 2008;101(2):200–6.PubMedCrossRef
16.
Feissel M, Teboul JL, Merlani P, et al. Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med. 2007;33(6):993–9.PubMedCrossRef
17.
Loupec T, Nanadoumgar H, Frasca D, et al. Pleth variability index predicts fluid responsiveness in critically ill patients. Crit Care Med. 2011;39(2):294–9.PubMedCrossRef
18.
Causey MW, Miller S, Foster A, et al. Validation of noninvasive hemoglobin measurements using the masimo radical-7 SpHb station. Am J Surg. 2011;201(5):592–8.PubMedCrossRef
19.
Henny CP, Hofland J. Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surg Endosc. 2005;19(9):1163–71.PubMedCrossRef
20.
Jafari MD, Jafari F, Young MT, et al. Volume and outcome relationship in bariatric surgery in the laparoscopic era. Surg Endosc. 2013;27(12):4539–46.PubMedCrossRef
21.
Nguyen NT, Nguyen B, Gebhart A, et al. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216(2):252–7.PubMedCrossRef
22.
Brandt S, Regueira T, Bracht H, et al. Effect of fluid resuscitation on mortality and organ function in experimental sepsis models. Crit Care. 2009;13(6):R186.PubMedCentralPubMedCrossRef
23.
Verdant C, De Backer D. How monitoring of the microcirculation may help us at the bedside. Curr Opin Crit Care. 2005;11(3):240–4.PubMedCrossRef
24.
Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27(12):1549–54.PubMedCrossRef
25.
Hoiseth LO, Hoff IE, Myre K, et al. Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiol Scand. 2012;56(6):777–86.PubMedCrossRef
26.
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(5):R249.PubMedCentralPubMedCrossRef
27.
Robinson BR, Cotton BA, Pritts TA, et al. Application of the Berlin definition in PROMMTT patients: the impact of resuscitation on the incidence of hypoxemia. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S61–7.PubMedCentralPubMedCrossRef
28.
Kulemann B, Timme S, Seifert G, et al. Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomoses—a histomorphological analysis. Surgery. 2013;154(3):596–603.PubMedCrossRef
Metadata
Title
Reliability of Continuous Non-Invasive Assessment of Hemoglobin and Fluid Responsiveness: Impact of Obesity and Abdominal Insufflation Pressures
Authors
Mia DeBarros
Marlin W. Causey
Patrick Chesley
Matthew Martin
Publication date
01-07-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 7/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1505-6

Other articles of this Issue 7/2015

Obesity Surgery 7/2015 Go to the issue

Original Contributions

Type 2 Diabetes Remission After Gastric Bypass: What Is the Best Prediction Tool for Clinicians?

Letter to the Editor

Outcome of Leaks After Sleeve Gastrectomy Based on a New Algorithm Addressing Leak Size and Gastric Stenosis

Original Contributions

Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients

Letter to the Editor

A Simple Trick to Prevent VOMIT After Sleeve Gastrectomy

Original Contributions

Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopy: Lessons We Learned After 100 Consecutive Patients

Brief Communication

Gastric Band Slippage: The Impact of a Change in Education and Band Filling