An interventional study of Protocol group 2 and Protocol group 1 in Perioperative/Postoperative Complications, Hypovolemia and Hypoxia, sponsored by Guangzhou First People's Hospital. Status unknown at 1 site in China. Open to participants aged 70 Years and older. Per ClinicalTrials.gov, last updated 2012-09-07.
Sponsored by Guangzhou First People's Hospital · Not applicable, Interventional, and Treatment
There is growing evidence that the risk of postoperative complications can be decreased by optimizing the amount and type of infusion fluids given during surgery, steered by goal-directed therapy based on flow-related hemodynamic parameters, particularly in high-risk patients. This study is undertaken subsequently to test the hypothesis that the intraoperative goal-directed strategy based on FloTrac/Vigileo, a minimally invasive monitor, can partially prevented postoperative complications and shorten hospital stay in the elderly high-risk patients undergoing total hip replacement with continuous spinal anaesthesia .
After sedated with IV 0.02 mg/kg midazolam, all patients will receive arterial, central venous, and L3-4 intrathecal catheterizations. A T12 sensory level block was attained with ropivacaine through the intrathecal catheter. Besides currently recommended monitoring during the intraoperative period, arterial blood pressure, stroke volume (Edwards Lifesciences, Irvine, Calif.), and central venous oxygen saturation (Edwards Lifesciences) will be measured and recorded. All Patients will receive intranasal oxygen 2 mL/min and be kept normothermic (body temperature > 36°C). Patients in both groups receive 8 mL/kg/hour of Ringer's lactate solution from 30 minutes prior to induction of anaesthesia through the end of surgery, when the rate will be decreased to 100 mL/hour. In addition, boluses of colloid will be given to different protocol group according to the study arm to which the patient allocated.Postoperative care and discharge criteria were predefined using the hospital care map and protocol.
1,231 studies on the registry are indexed under Hypoxia; 241 are open to participants now.
This study's planned enrollment of 72 is above the median of 45 across 853 interventional studies indexed under Hypoxia.
Browse Hypoxia studies →Guangzhou First People's Hospital is the lead sponsor of 25 studies on the registry; 5 are open to participants now.
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Exclusion Criteria:
Using standard hemodynamic therapy
Procedure: Protocol group 1
Using goal-directed therapy
Procedure: Protocol group 2
ensure SpO2≥ 92%, MAP 65-100 mmHg, HR \<100 bpm, Hb\> 8mg/dL and temperature ≥ 36℃, the patients were then administrated a 200 ml colloid as a fluid challenge. The fluid challenge repeat until the SV failed to increase by a factor of 10%. If at this stage the DO2I can not be greater than 600 mL/m2, then dobutamine will be started at a dose of 2.5 μg/kg/min and increased by the same increment every 20 minutes until the described target is reached or until a maximal dose of 20 μg/kg/min is given. Dobutamine is decreased in dose or discontinued if the heart rate is above 120 beats per minute or shows signs of cardiac ischemia. Blood transfusions will be used to maintain a hemoglobin concentration over 8mg/dL
Also known as: goal-directed therapy
The goal of this protocol is to ensure MAP\> 65 mmHg, CVP 8-12 cmH2O. If meet the above requirements, do nothing, re-evaluate after 5min. If CVP \<8 cmH2O, the patient will receive an additional 200ml colloid .If MAP beyond the scope of 65-100 mmHg, vasoactive agents will be administrated until achieve the goal. If 25mL/kg colloid given before goal is achieved, fluid challenges will then be performed with 200mL boluses of Ringer's lactate solution. Blood transfusions will be used to maintain a hemoglobin concentration over 8mg/dL
Also known as: conventional fluid management
length of postoperative hospital stay
days from end of surgery to hospital discharge.
Time frame: 28 days
postoperative complications and mortality
1. Major complications: Infection , Major cardiovascular complications , Pulmonary Embolism, Renal Failure, Anaemia requiring blood transfusion in the presence of shock. 2. Minor complications: Hypotension (systolic blood pressure \< 90 mmHg) requiring fluid boluses, Uncomplicated infections (not requiring intra-venous antibiotic therapy and with no signs of sepsis, i.e. uncomplicated urinary tract infections), Anemia requiring blood transfusions in the absence of shock. 3. PONV: Postoperative Nausea and Vomiting 4. delirium and postoperative cognitive dysfunction 5. mortality
Time frame: 28 days
information of hemodynamic and ScvO2 ,types and volumes of all fluids administered
Time frame: 24 hours after operation
This study is status unknown, as verified in Sep 2012. You cannot join it, but the record below documents what was studied.
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Guangzhou First People's Hospital