• Matija Belavić, Sotošek TokmadžićVlatkaVDepartment of Anesthesiology, Reanimatology, and Intensive Care, Faculty of Medicine, University of Rijeka, Rijeka, Croatia., Antonija Brozović Krijan, Ines Kvaternik, Kristina Matijaš, Nedjeljko Strikić, and Josip Žunić.
• Department of Anesthesiology, Reanimatology, and Intensive Medicine, Karlovac General Hospital, Karlovac, Croatia.
• Ther Clin Risk Manag. 2018 Jan 1; 14: 741-751.

PurposeThere are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate.Patients And MethodsIn this randomized, prospective study, patients were assigned to one of three groups based on the volume of fluid administered: the restrictive group received 1 mL/kg/hr, the low liberal group received 5 mL/kg/hr, and the high liberal group received 15 mL/kg/hr of Ringer's solution intraoperatively. There were 40 patients in each group. Each patient's hemodynamic parameters and laboratory values (arterial blood gas and lactate levels) were measured together with their consumption of crystalloids, volatile anesthetics, and analgesics.ResultsAnalysis of the hemodynamic and laboratory parameters revealed no signs of global hypoperfusion in any of the groups analyzed. There was no significant difference in the duration of surgery and anesthesia, but the consumption of crystalloids, volatile anesthetics, and opioids was significantly lower in the restrictive group, compared with the low and high liberal groups. Although there was no significant difference in the 1-year morbidity among the groups, heart failure was observed in one patient in the high liberal group in the early postoperative period.ConclusionRestrictive fluid therapy during laparoscopic cholecystectomy is justified, safe, and more cost-effective than other options.

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