PREOPERATIVE SALINE LOADING IMPROVES OUTCOME AFTER ELECTIVE, NONCARDIAC SURGICAL-PROCEDURES

Patients with multiple system disease undergoing elective noncardiac s urgical procedures are at variable risk for developing postoperative c omplications and death. To determine whether preoperative expansion of plasma volume would improve outcome, 306 patients were admitted to th e Surgical Intensive Care Unit of the Veterans Administration Medical Center for Swan-Ganz catheter placement and measurement of hemodynamic responses to a 2 L infusion of normal saline over 2 hours. Intraopera tive stability and postoperative outcome were assessed by chart review and compared with similar operative groups of patients who did not re ceive saline infusion. Eighty-eight per cent of the patients had a pos itive expansion of blood volume with saline infusion. In patients unde rgoing aortic reconstructive procedures, there was a reduction in the incidence of postoperative complications (52% to 28%) primarily attrib uted to a reduction in pulmonary complications. In all patients there was an improvement in intraoperative cardiovascular stability (57% sal ine vs 38% control), a reduction in the need for pharmacologic support of blood pressure (19% saline vs 30% control), and reduction in the a mount of intraoperative fluid administration (hydration index: 5.12 sa line vs 8.61 control). We therefore conclude that preoperative saline loading is associated with improved outcome in high risk elderly patie nts undergoing elective, noncardiac surgical procedures.