Abstract SNACC-50

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Stroke Volume Variation Guided Intra-Operative Fluid Individualization and Optimization for Neurosurgical Operations

1Zhou J, 2Aglio L, 3Kummerer L
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 2Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 3Brigham and Women's Hospital, Boston, MA, USA

Background: Fluid management for neurosurgical operations can be tedious due to the location and type of procedures. Fluid restriction techniques for brain tumor operations are typically not recommended for cerebrovascular procedures. We have demonstrated in the past that stroke volume variation (SVV), along with a number of other hemodynamic parameters, could be used to track patient volume status and fluid responsiveness. While debate still exists, clinical validity of SVV has been confirmed by most recent studies.

Methods and Results: With IRB approval, we retrospectively reviewed a series of neurosurgical cases. The average length of the operations, average fluid load including colloid and crystalloid, urine output, and estimated blood loss were calculated. Other medication usage including propofol, phenylephrine, diuretic and beta blocker agents were recorded. Laboratory data including hematocrit, BUN, base excess/deficit, lactic acid, and serum osmolarity were recorded. Final data will be reported at the SNACC meeting.

Discussion: With the advancement of surgical and anesthesia management, the outcome of neurosurgical operations has improved drastically over the past decades. Traditional neuroanesthetic fluid management scheme has become obsolete. We feel the SVV guided approach helps individualize and optimize the fluid management. In general, we identified the target range of SVV to be 15%-20% for brain tumor, and less than 10% for cerebrovascular operations as reasonable amounts. There was no cardiac, pulmonary or renal complication. SVV has been shown to be more sensitive to volume status when ventilation is maintained at relatively higher tidal volume. In light of potential lung injury in elderly, mechanical ventilation of the patient usually was maintained at 8 ml/kg. All of the above would have set the neurosurgical skull base cases into one of the best scenarios for clinical application of SVV. However, as other investigators have pointed out, clinical judgment and vigilance while using these parameters is absolutely critical since all of the values need to be interpreted with caution. Intra-operative neurophysiological monitoring could trigger significant interference to contour-based SVV monitoring devices. Additionally, the implementation of the SVV guided approach facilitates teaching, as it provides residents with clearer clinical indications for anesthetic management. The authors are calling for larger scale clinical trials and application in the field of neuroanesthesia, which are needed to guide clinical applications and determine the usability in such subspecialty cases.

References:
1. Zhou J. J Neurosurg Anesthesiol 2011;23(3):272
2. Tommasino C. Anesthesiology Clin N Am 2000;20:329-46.
3. Soriano SG, et al. Anesthesiology Clin N Am 2002;20(1):137-51.
4. Chen CM, et al. Neurosurg Rev 2011;34:281-96.
5. Liu N, et al. Anesth Analg 2011;112(3):546-57.


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