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[Effect of individualized goal directed therapy on outcome after major sugery]
Hidemasa Takahashi1, Kyouko Tagawa, Takeo Suzuki
1Department of Anesthesiology, Metropolitan Bokutoh Hospital, Tokyo 130-8575.
Background:
Goal directed therapy (GDT) is applied during the initial resuscitation of sepsis, known as early goal directed therapy (EGDT). Recent studies in major abdominal surgery suggested that anesthetic management with GDT may decrease morbidity and hospital stay. We have utilized GDT in major invasive surgery such as pancreatoduodenectomy in November 2009.
Methods:
In the anesthetic management of pancreatoduodenectomy, 11 patients managed by GDT were compared concerning postoperative hospital stay with 11 patients managed by conventional methods retrospectively. In our GDT protocol, we have set targets in mean blood pressure, oxygen saturation, and stroke volume variation, which is more individualized for each one. With falls below the target, fluid infusion, blood transfusions, and circulatory agonists were administered. In the conventional protocol, anesthesiologist managed the use of anesthetic agents, fluid infusion, blood transfusion, and circulatory agonist, through the observation of the operative field, blood pressure, heart rate and urine output.
Results:
Patients utilizing the GDT showed shorter postoperative hospital stay (group GDT; 21.8 days vs conventional group; 32.6 days. P<0.05).
Conclusions:
Anesthetic management with goal-directed therapy, may have contributed to shorter postoperative hospital stay.
