Anesth Analg 2006;103:1040
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000239026.60284.7f
LETTER TO THE EDITOR
Editor-in-Chief Steven L. Shafer
Supplemental Intravenous Crystalloid Administration and Risk of Surgical Wound Infection
Gonzalo Tornero-Campello, MD
Department of Anesthesiology and Reanimation; Hospital General Universitario de Elche (Spain); Elche (Alicante), Spain; gtorcam{at}hotmail.com
To the Editor:
Dr. Kabon et al. found no difference in rates of wound infection or days of hospitalization in patients undergoing open colon resection randomized to receive large-volume intravascular fluid management (10 mL/kg lactated Ringer's solution + 16–18 mL · kg–1 · h–1) or small-volume intravascular fluid management (8–10 mL · kg–1 · h–1) throughout surgery and for the first postoperative hour. The authors speculate that "the apparent lack of benefit from supplemental fluid may have resulted because the effect of hydration on intestinal oxygenation is modest." They temper this by observing that "the administration of 80% oxygen was not the standard of care at the time when we performed this study and, in fact, is still not as of the writing of this article."
In a recent publication, Nisanevich et al. (2) randomized patients to large- volume intravascular fluid management (10 mL/kg lactate Ringer's solution + 12 mL · kg–1 · h–1) or small-volume intravascular fluid management (4 mL · kg–1 · h–1) for elective abdominal surgery. They reported a higher rate of infectious complications (including surgical site infection) and a longer hospitalization period for the group receiving a large volume of fluids. This group also showed more hypoproteinemia and lower hematocrit.
The administration of large amounts of fluid might increase oxygen tension by increasing blood flow, but it might also lead to a reduced hematocrit, hypoproteinemia, and tissue swelling. These effects might decrease tissue oxygen tension. It is unclear whether the results reported by Dr. Kabon et al. have anything to do with tissue oxygenation, or whether the study design assesses the influence of tissue oxygenation on postoperative outcome.
REFERENCES
- Kabon B, Akça O, Taguchi A, et al. Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesth Analg 2005;101:1546–53.[Abstract/Free Full Text]
- Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005;103:25–32.[Web of Science][Medline]
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