Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?

Abstract Introduction: Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number o...

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Main Authors: Daniel Rodrigues Alves, Regina Ribeiras
Format: Article
Language:English
Published: Sociedade Brasileira de Anestesiologia
Series:Revista Brasileira de Anestesiologia
Subjects:
Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000200172&lng=en&tlng=en
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spelling doaj-90ebdb64acfb4ec894f28a43c39869442020-11-24T21:00:28ZengSociedade Brasileira de AnestesiologiaRevista Brasileira de Anestesiologia1806-907X67217217910.1016/j.bjane.2015.11.002S0034-70942017000200172Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?Daniel Rodrigues AlvesRegina RibeirasAbstract Introduction: Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. Methods: We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6 hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. Results: Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. Conclusion: Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000200172&lng=en&tlng=enFastingEchocardiographyFluid therapyHemodynamics
collection DOAJ
language English
format Article
sources DOAJ
author Daniel Rodrigues Alves
Regina Ribeiras
spellingShingle Daniel Rodrigues Alves
Regina Ribeiras
Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?
Revista Brasileira de Anestesiologia
Fasting
Echocardiography
Fluid therapy
Hemodynamics
author_facet Daniel Rodrigues Alves
Regina Ribeiras
author_sort Daniel Rodrigues Alves
title Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?
title_short Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?
title_full Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?
title_fullStr Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?
title_full_unstemmed Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?
title_sort does fasting influence preload responsiveness in asa 1 and 2 volunteers?
publisher Sociedade Brasileira de Anestesiologia
series Revista Brasileira de Anestesiologia
issn 1806-907X
description Abstract Introduction: Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. Methods: We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6 hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. Results: Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. Conclusion: Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.
topic Fasting
Echocardiography
Fluid therapy
Hemodynamics
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000200172&lng=en&tlng=en
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