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A restrictive dose of crystalloids in patients during laparoscopic cholecystectomy is safe and cost-effective: prospective, two-arm parallel, randomized controlled trial

Authors Belavić M, Sotošek Tokmadžić V, Brozović Krijan A, Kvaternik I, Matijaš K, Strikić N, Žunić J

Received 25 December 2017

Accepted for publication 16 March 2018

Published 19 April 2018 Volume 2018:14 Pages 741—751


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh

Matija Belavić,1 Vlatka Sotošek Tokmadžić,2 Antonija Brozović Krijan,1 Ines Kvaternik,1 Kristina Matijaš,1 Nedjeljko Strikić,3,4 Josip Žunić1,4

1Department of Anesthesiology, Reanimatology, and Intensive Medicine, Karlovac General Hospital, Karlovac, Croatia; 2Department of Anesthesiology, Reanimatology, and Intensive Care, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; 3Department of Abdominal Surgery, Karlovac General Hospital, Karlovac, Croatia; 4Department of Nursing Science, Karlovac University of Applied Sciences, Karlovac, Croatia

Purpose: There 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 methods: In 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.
Results: Analysis 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.
Conclusion: Restrictive fluid therapy during laparoscopic cholecystectomy is justified, safe, and more cost-effective than other options.

Keywords: cholecystectomy, laparoscopic, crystalloid solutions, fluid therapy, hemodynamics, cost–benefit analysis, morbidity, mortality

Corrigendum for this paper has been published.

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