Application of the goal-directed fluid therapy in supratentorial tumor resection

Objective To explore the application of the goal-directed fluid therapy (GDFT) in supratentorial tumor resection with central venous pressure(CVP), mean arterial pressure (MAP) and regional cerebral oxygen saturation(rSO2) as monitoring indicators. Methods A total of 60 patients undergoing supratentorial brain tumor resection under general anesthesia were selected and divided into two groups according to the random number table method(n=30): GDFT group(group G) and routine infusion group(group C). Group C was infused according to the routine rehydration protocol in Miller′s Anesthesia, 6 th edition. Meanwhile, group G received half of a cumulative lossfor 60 min after establishment of intravenous channels, with an infusion rate of 4 ml·kg-1·h-1, where CVP was measured every 15 min to maintain at 5-7 cmH2O(1 cmH2O=0.098 kPa), MAP≥65 mmHg (1 mmHg=0.133 kPa), rSO2 55%-75%, urine output>0.5 ml·kg-1·h-1. The volumes of crystal solution, colloidal solution, total infusion, blood loss, and urine and vasoactive agent doses were recorded. The values of heart rate, MAP, CVP, rSO2 and lactic acid(Lac) were recorded before anesthesia induction (T1), at the moment of intubation (T2), at the moment of opening the dura mater (T3), 1 h after opening the dura mater (T4), and at the end of surgery (T5). The concentration of hemoglobin (Hb) and laboratory parameters were recorded before and 24 h after the surgery. The first exhaust time, hospitalization stay and postoperative complications were recorded. Results Compared with group C, remarkably decreased volumes of infusion and urine and increased use of vasoactive agents were found in group G(P 0.05). Compared with group C, group G showed remarkable increases in 24 h Hb after surgery and serum albumin, and decreases in exhaust time and hospitalization stay(P 0.05). Conclusions The application of GDFT in supratentorial tumor resection can maintain effective circulation blood volume, maintain the balance of cerebral oxygen supply and demand, improve prognosis, and meet the requirements of accelerated rehabilitation surgery. Key words: Supratentorial neoplassm; Goal-directed fluid therapy; Regional cerebral oxygen saturation; Accelerated rehabilitation surgery