Comparison of esophageal Doppler monitoring and conventional targeted fluid therapy in major orthopedic surgery cases

Comparison of fluid therapy in orthopedic surgeries

Abstract

Background/Aim: Conventional physiological parameters such as heart rate and mean blood pressure may not adequately detect hypovolemia. Esophageal Doppler monitoring (EDM) is a device that continuously measures blood flow in the descending aorta using a transesophageal Doppler transducer. In this study, we aim to compare Esophageal Doppler Monitoring (EDM) with conventional targeted fluid treatment in major orthopedic surgery cases.

Methods: Forty patients, aged between 18–65 years and falling within the American Society of Anesthesiologists (ASA) classifications I-III, who were slated for major orthopedic surgery were included in the study. Patients were escorted to the operating room and standard monitoring along with arterial monitoring was applied. Baseline systolic arterial pressure (SAP) and heart rate were recorded. The patients were then divided into two groups of 20 each, using a sealed method. For induction, 2–3 mg/kg propofol and remifentanil 1 μg/kg were administered to both groups and muscle relaxation was achieved with 0.6 mg/kg rocuronium before intubation. The first group, labeled as Group D, was monitored by EDM and fluid management followed using EDM. The second group, labeled as Group K, had its fluid management guided by conventional methods (pulse, blood pressure, urine output). For maintenance of anesthesia, both groups were administered 2–3% sevoflurane along with a 50% O₂ + 50% air mixture. In both groups, we recorded hemodynamic parameters, urine output, serum lactate level, the total given fluid and blood volume, inotropic or vasopressor requirement, anesthesia and surgery times, postoperative recovery time, hospital stay, oral diet starting time, and potential complications associated with postoperative nausea and vomiting.

Results: No difference was observed between the two groups in terms of demographic data. SAP in the control group was found to be statistically and significantly lower at the 10th, 20th, 25thh, 30th, and 90th minutes, compared to the Doppler group. Diastolic blood pressure was also noticeably lower in the control group at the 20th and 30th minutes than in the Doppler group. When comparing the lactate levels of the Doppler and control groups, the lactate level of the Doppler group was significantly lower at the 90th minute. Tachycardia was significantly lower in the postoperative Doppler group.

Conclusion: In major orthopedic surgery cases, we concluded that better results are obtained in perioperative vital signs with targeted fluid therapy, especially when accompanied by EDM. Specifically, the lactate level, which is considered important in terms of mortality and morbidity, is lower.