Professional Documents
Culture Documents
1
Assistant Professor, Department of Orthopedic Surgery, School of Medicine AND Shohada Educational Hospital, Tabriz University of
Medical Sciences, Tabriz, Iran
2
Associate Professor, Department of Orthopedic Surgery, School of Medicine AND Shohada Educational Hospital, Tabriz University of
Medical Sciences, Tabriz, Iran
3
Assistant Professor, Department of Orthopedic Surgery, School of Medicine AND Emam Khomeini Educational Hospital, Urmia University
of Medical Sciences, Urmia, Iran
Speaking about fluid therapy in surgery, transfusion before the operation, without
three points should be taken into account: systemic and metabolic disease, no solid
hypovolemia, hypervolemia, and tissue organ damage or multilevel fractures.
perfusion.6-10 The patients were randomly classified as
In hypovolemia, the patients encounter case and control groups (n = 50) and
decreases of tissue perfusion, and their compared. Patients of both groups were
different organs are damaged during or after matched considering age, gender, and kind
surgery.6-9 The increase of body fluids and of surgery. According to surgery protocol of
retention of fluids after surgery results in the hospital, both groups were fasting for 12
hypervolemia and it leads to the longer hours before surgery. The case group
intensive care unit (ICU) admission and more received 1.5 ml/kg crystalloid fluids (ringer)
post-operative mortality rate.10 There are while they were fasting. If patients had
more contradictions about pre-operative cardiac heart failure or end-stage renal
hydration, its quality, and clinical outcome of disease were excluded from the study.
the patients. Cardiac and pulmonary The patients of the control group were
function, tissue oxygenation, healing of fasting for 8 hours before surgery, according
wounds, post-operative ileus, renal function, to the protocol of the hospital, and did not
and coagulation conditions may be affected receive any intravenous fluid before surgery.
by pre-operative fluid therapy.11 According Finally, the patients of both groups were
to recent studies, pre-operative hydration followed up during and after surgery and
does not affect osmolality of the fasting compared considering intraoperative and
operated patients, and the prescribed post-operative complications.
crystalloid fluids are not successful in All patients were completely justified
preventing from hypotension during about the study, and they submitted a letter
anesthesia.12 However, other studies believe of satisfaction for participating in the study.
that prescribing appropriate volume of pre- They were assured that their information will
operative intravenous fluids may be helpful be kept confidentially, and their name and
in improving post-operative outcome.13 address will not be disclosed. There was not
This study assumes that pre-operative any extra intervention in this study, and the
crystalloid fluids may improve recovery patients did not pay any extra costs.
process of the patients and decrease the need to All understudy data were analyzed using
use blood products during surgery. Therefore, SPSS software (version 17, SPSS Inc.,
the present study evaluates effects of Chicago, IL, USA) and descriptive statistical
pre-operative hydration on clinical outcome of methods [frequency, percentage, mean, and
patients undergoing orthopedic surgery. standard deviation (SD)]. Chi-square and
Fischer’s exact (if required) statistical tests
were used to compare qualitative findings,
This case-control study was conducted on and quantitative variables were compared
100 patients underwent orthopedic surgeries using independent t-test. In this study,
in Shohada Hospital, affiliated by Tabriz P < 0.050 was considered meaningful.
University of Medical Sciences, Iran. Patients
with lower limb fractures (hip and femur
shaft) where there is not necessary to use a In this study, 100 patients underwent lower
tourniquet as well as patients without any limbs orthopedic surgery was classified in two
records of systemic disease such as diabetes, groups. Age average of the patients of the
cardiac, and renal diseases were qualified to intervention and control groups was 59.86 ±
enter the study. Patients were included with 18.46 and 63.00 ± 15.92 years, respectively.
long bone lower fractures need to surgical Statistically, there was not any significant
fixation, who were not need to blood difference between two groups
(P = 0.360). The intervention group was intravenous fluid and adversely affect the
consisted of 33 male (66%) and 17 female (34%) performance of the heart, lungs, digestive
patients. There were 35 (70%) male and 15 system, and kidneys. It even affects tissue
(30%) female patients in the control group. oxygenation and wound healing.9-11
There was not any significant difference However, high fluid therapy leads to some
between two groups considering gender complications such as pulmonary edema,
(P = 0.660). Table 1 compares intraoperative post-operative coagulopathy, and even
and other complications after surgery. compartment abdominal syndrome.14-16 In
According to table 1, mortality rate and needs spite of emphasize on pre-operative fluid
to ICU care were compared. Hemodynamic therapy, there are still challenges about the
disorders and hypotension in the intervention volume of the prescribed fluids.17,18 In
group were significantly less than that of the orthopedic surgeries, as one of the major
control one and 6 patients (12%) of the surgeries, appropriate fluid therapy may be
intervention, and 30 patients (60%) of the useful in achieving better post-operative
control group required blood transfusion (cell results. According to recent observations and
pack). As observed, need to blood transfusion studies, it was assumed that restrictive
in the intervention group was significantly less pre-operative fluid therapy may be associated
than the control one (P < 0.001). In addition, with satisfaction results. Therefore, the present
mean transfused blood was not statistically study classified the patients underwent lower
meaningful in the groups. There was higher limbs orthopedic surgery in two intervention
mean urine volume in the pre-operative fluid group (pre-operative fluid therapy, n = 50)
therapy group. Furthermore, ICU admission in and control group (no pre-operative fluid
the intervention group was significantly less therapy, n = 50). According to this study, pre-
than that of the control group. There was no operative fluid therapy is associated with
significant difference between the groups better results during and after surgery.
considering mortality rate. According to previous studies, pre-operative
hydration with appropriate volume of fluids
may lead to better results and less post-
The pre-operative fluid prescription is operative complications.19,20
required for surgical care. Severity of disease, The present study suggested that pre-
extent and duration of surgery, accompanying operative hydration is associated with less
diseases, quality of patients’ body response to hemodynamic disorder and hypotension as
pain all affect the need to intraoperative and well as less pack cell during surgery.
pre-operative hydration.12-15 However, high Contrary to findings of the above study,
and low fluid therapy is associated with Abraham-Nordling et al.21 observed that
some complications. Low fluid therapy may more vasopressors are used in the restrictive
lead to organ insufficiency due to decrease of fluid therapy group due to hypotension.
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