Comparison of Restrictive Fluid Therapy versus Conventional Fluid Therapy on Renal Indices in Patients undergoing Major Abdominal and Gynaecological Surgeries: A Tertiary centre experience

Restrictive Fluid Therapy versus Conventional Fluid Therapy

Abstract

Background: Perioperative fluid administration during major abdominal and gynaecological surgeries is done to ensure optimal oxygen supply and tissue perfusion. Restricted fluid therapy produces concentrated urine to reduce availability of water. Osmotic gradient is created and maintained by kidneys which become increasingly concentrated from the cortex to the medulla. Restrictive fluid therapy in abdominal surgery patients is associated with faster return of bowel function, fewer complications and shorter hospital stay. Subjects and Methods: The study groups were divided as Conventional (traditional practice) intravenous fluid group administered balanced salt solution as 10 mL/kg bolus followed by 8 mL/kg/hour as infusion until the end of surgery followed with maintenance infusion at 1.5 mL/kg/hour. The restrictive group fluid regimen administered intravenous fluid bolus limited to 5 mL/kg at induction and Balanced salt crystalloid at 5 mL/kg/hour as infusion was administered until the end of surgery, and bolus colloid/blood was used intraoperatively to replace blood loss (mL for mL); then a postoperative infusion rate of 0.8 mL/kg/hour until cessation of intravenous fluid therapy within 24 hours. Results: A significant increase in cystatin levels, a significant decline in serum potassium levels and in GFR (as per CKD-EPI formula based on combination of Cystatin C and Creatinine levels) was observed in both the groups. Conclusions: There was no significant difference between two groups for the primary renal function outcomes and electrolyte levels prior to surgery Post-operatively, mean serum urea, creatinine were comparable in both the groups in our study. Serum cystatin c levels were observed to be higher in restrictive group.