Background and Goal of Study:
During laparoscopic cholecystectomy, CO2 pneumoperitoneum and surgical position (reverse-Trendelenburg and right-side-up position) can change intrathoracic pressure and systemic venous return. Consequently, dynamic fluid responsiveness index such as stroke volume variation (SVV) may be affected in laparoscopic cholecystectomy. In the present study, we investigated and the optimal threshold of SVV to predict fluid responsiveness in patients undergoing laparoscopic cholecystectomy.
Materials and Methods:
After induction of anesthesia, arterial cannulation was performed to monitor direct arterial pressure and connected to EV1000 via FloTrac system for monitoring stroke volume index, cardiac index, stroke volume variation. Hemodynamic parameters were measured at 4-time points (T1: after induction of anesthesia, T2: before fluid loading, T3: after fluid loading, T4: at the time of skin closure). Fluid loading was performed at 1 minute after application of CO2 pneumoperitoneum and surgical position. For a fluid challenge, crystalloid (plasmalyte solution) 250 ml was infused for 10 minutes. Patients were regarded as fluid responders according to whether they showed an increase of stroke volume index >15% after fluid challenge.
Results and Discussion:
In a total of 42 patients, 28 patients were fluid responders (67%). The mean of SVV was higher in fluid responder group (16 vs 9, P=0.0001). In receiver operating characteristic curve analysis, SVV showed an area under the curve of 0.871 (P<0.0001). The optimal cut-off value of SVV predicting a stroke volume index increase of >15% after the fluid challenge was 12.
Conclusion(s):
SVV can predict an increase in stroke volume index >15% after fluid challenge in laparoscopic cholecystectomy and its cut-off value was 12. It may provide a helpful information for fluid management in laparoscopic cholecystectomy

03 / The usefulness of stroke volume variation to predict the fluid responsiveness in patients undergoing laparoscopic cholecystectomy