Hypertonic saline for goal-directed therapy guided by Capstesia in gastrointestinal surgery: a randomized controlled study

Background: Goal-directed fluid therapy (GDT) aims to increase stroke volume and cardiac output and improve gut perfusion. Hypertonic saline (HS) can restore the macroand micro-circulation, increase myocardial contractility, and reduce tissue edema. Therefore, we aimed to investigate the efficacy of intraoperative HS administration in GDT during gastrointestinal (GI) surgery. Methods: Forty patients who underwent GI surgery under general anesthesia were enrolled in this randomized controlled study. Patients received boluses of either lactated Ringer's (LR) solution, or 3% HS solution guided by an algorithm dependent on a smartphone application for estimations of pulse pressure variation (PPV). The primary outcome was the total amount of administered intraoperative crystalloid fluids in both groups. Serum sodium and time to first bowel movement after surgery were also recorded. Results: In the HS group, patients received 1262.50 +/- 318.25 mL of crystalloids compared to 2667.50 +/- 670.29 mL received by patients in the LR group (P < 0.001).The mean time of first bowel movement in hours was 44.40 (+/- 14.09) in the HS group compared to 55.80 (+/- 18.38) in the LR group, but the P-value was > 0.05. Conclusions: The use of HS solution for GDT in GI surgery resulted in a beneficial reduction in positive fluid balance and possibly earlier resumption of bowel movements.