Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma

Study Objective: To investigate whether intraoperative fluid management contributes to Postoperative respiratory disturbances in esophagectomy for carcinoma. Design: Retrospective study. Setting: Operating room and postanesthetic rare unit of the cancer center. Patients: From 1997 to 2000, 112 ASA status I, II, and III patients with Primary carcinoma of the esophagus undergoing transthoraic esophagectomy. Interventions and Measurements: As of 1998, we altered fluid management (luring esophagectomy to save intraoperative fluid administration. Then, we investigate postoperative respiratory disturbances after esophagectomy in the period from 1998 to 2000 (late period) compared with the period from 1997 to 1998 (early period). We also investigated the relationship between perioperative risk factors and postoperative respiratory disturbances. The need far frequent (> 10) bronchoscopic suctioning of sputum during Postoperative Period. the need for tracheostomy, and failure in the removal of endotracheal tube (ETT) (extubation) on the first postoperative day (1 POD)) were investigated for respiratory disturbances after surgery. Main Results: Intraoperative volume balance decreased more so in the late period compared with early period (P < 0.0,001). The need for tracheostomy, bronchoscopic suctioning, and extubation failure on 1 POD were more frequent in the early period than in the late period (p = 0. 0083, p = 0.0319, anol p = 0. 002-1, respectively). The hospital recovery period after surgery was shortened during the late period (p = 0.032). Intraoperalive volume valance affected the need for tracheostomy and frequent bionchos-copy postoperatively Conclusions: Careful intraoperative fluid administration ma decrease postoperative respiratory disturbances. (C) 2002 by Elsevier Science Inc.