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Quality Improvement in Vitreoretinal Surgery: Single-Center Report on Utility of Routine Intravenous Fluids in Pars

Joseph R Abraham1, Andrea Arline1, Suraj Bala1,2

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Forgoing intravenous fluids during pars plana vitrectomy (PPV) surgery did not increase adverse events. Routine IV fluids may offer unclear clinical benefit for patients under monitored anesthesia care during PPV.

Keywords:
general anesthesiaintravenous fluidsmonitored anesthesia carepars plana vitrectomyperioperative managementretinal surgery

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Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Nephrology

Background:

  • Pars plana vitrectomy (PPV) is a common ophthalmic surgical procedure.
  • Intravenous (IV) fluid administration during PPV is a standard practice for some anesthesiologists.
  • The necessity and impact of IV fluids during PPV on systemic outcomes remain debated.

Purpose of the Study:

  • To evaluate the clinical outcomes of patients undergoing PPV with or without intraoperative IV fluids.
  • To determine if withholding IV fluids impacts systemic adverse events or perioperative decompensation.

Main Methods:

  • Retrospective observational study of 361 patients undergoing PPV.
  • Analysis of intraoperative IV fluid administration, anesthesia type, and systemic comorbidities.
  • Assessment of pre- and postoperative blood glucose and creatinine clearance.
  • Evaluation of intraoperative vasopressor use and perioperative decompensation episodes.

Main Results:

  • 212 patients (59%) did not receive IV fluids; 149 (41%) did.
  • No significant difference in systemic adverse events or perioperative decompensation between groups.
  • Only 1 patient (receiving general anesthesia with IV fluids) required hypoglycemia treatment.
  • No acute kidney injury observed at 1 month post-PPV; 8% of patients receiving IV fluids required vasopressors (all under general anesthesia).

Conclusions:

  • Withholding intraoperative IV fluids during PPV is not associated with increased systemic adverse events.
  • Routine IV fluid administration may not be necessary for patients undergoing PPV under monitored anesthesia care.
  • Further research is warranted to clarify the precise role of IV fluids in PPV outcomes.