• anesthesia
• goal-directed fluid treatment
• high-grade glioma
• postoperative brain edema

• Humans
• Brain Edema/prevention & control
• Brain Edema/etiology
• Female
• Male
• Glioma/surgery
• Glioma/pathology
• Middle Aged
• Fluid Therapy/methods
• Adult
• Postoperative Complications/prevention & control
• Brain Neoplasms/surgery
• Intraoperative Care/methods
• Aged
• Treatment Outcome
• Hydroxyethyl Starch Derivatives/administration & dosage

• brain tumour surgery
• fluid optimization
• haemodynamic management

Brain edema is the most frequent postoperative complication after brain tumor resection, especially in patients with high-grade glioma. However, the effect of SVV-based goal-directed fluid therapy (GDFT) on postoperative brain edema and the prognosis remain unclear.

This is a prospective, randomized, double-blinded, parallel-controlled trial aiming to observe whether stroke volume variation (SVV)-based GDFT could improve the postoperative brain edema in patients undergoing supratentorial high-grade gliomas compared with traditional fluid therapy. The patient will be given 3 ml/kg hydroxyethyl starch solution when the SVV is greater than 15% continuously for more than 5 min intraoperatively. The primary outcome will be postoperative cerebral edema volume on brain CT within 24 h.

This trial has been registered at ClinicalTrials.gov (NCT03323580) and approved by the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University (reference number: KY2017-067-02). The findings will be disseminated in peer-reviewed journals and presented at national or international conferences relevant to the subject fields.

ClinicalTrials.gov NCT03323580 (First posted: October 27, 2017; Last update posted: February 11, 2022).

The online version contains supplementary material available at 10.1186/s13063-022-06859-9.

This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection.

We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21–35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias.

Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21–35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching.

Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room.

The online version contains supplementary material available at 10.1186/s12871-022-01836-w.

• Children
• fluid responsiveness
• plethysmographic variability index
• pulse pressure variation
• stroke volume variation

• HES
• colloids
• hydroxyethyl starch
• perioperative
• renal failure
• trauma
• volume therapy

• Colloids/administration & dosage
• Colloids/adverse effects
• Critical Illness
• Crystalloid Solutions/administration & dosage
• Crystalloid Solutions/adverse effects
• Fluid Therapy/methods
• Humans
• Hydroxyethyl Starch Derivatives/administration & dosage
• Hydroxyethyl Starch Derivatives/adverse effects
• Length of Stay
• Perioperative Care/methods
• Randomized Controlled Trials as Topic

• acute kidney injury
• anaesthesia
• peri-operative

Goal-directed fluid therapy (GDFT) improved patient outcomes in various surgical procedures; however, its role during mass brain resection was not well investigated.

In this study, we evaluated a simple protocol based on intermittent evaluation of pulse pressure variation for guiding fluid therapy during brain tumour resection.

Sixty-one adult patients scheduled for supratentorial brain mass excision were randomized into either GDFT group (received intraoperative fluids guided by pulse pressure variation) and control group (received standard care). Both groups were compared according to the following: brain relaxation scale (BRS), mean arterial pressure, heart rate, urine output, intraoperative fluid intake, postoperative serum lactate, and length of hospital stay.

Demographic data, cardiovascular data (mean arterial pressure and heart rate), and BRS were comparable between both groups. GDFT group received more intraoperative fluids {3155 (452) mL vs 2790 (443) mL, P = 0.002}, had higher urine output {2019 (449) mL vs 1410 (382) mL, P < 0.001}, and had lower serum lactate {0.9 (1) mmol versus 2.5 (1.1) mmol, P = 0.03} compared to control group.

In conclusion, PPV-guided fluid therapy during supratentorial mass excision, increased intraoperative fluids, and improved peripheral perfusion without increasing brain swelling.

• Goal-directed fluid therapy
• Neurosurgical operations
• Pulse pressure variation
• Supratentorial mass excision

• FloTrac/Vigileo system
• Fluid responsiveness
• Goal-directed therapy
• Hemodynamics

The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomy which is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low central venous pressure (CVP) technique can still be effective, it may not be advantageous concerning the safety of healthy donors undergoing hepatectomy. Emerging evidence suggests that stroke volume variation (SVV), a simple and useful index for fluid responsiveness and preload status in various clinical situations, can be applied as a guide for fluid management to reduce blood loss during living donor hepatectomy. Synthetic colloid solutions are also associated with serious adverse events such as the use of renal replacement therapy and transfusion in critically ill or septic patients. However, it is uncertain whether the intra-operative use of colloid solution is associated with similarly adverse effects in patients undergoing living donor hepatectomy. In this review article we discuss the recent issues regarding the low CVP technique and the high SVV method, i.e., maintaining 10%-20% of SVV, for fluid management in order to reduce blood loss during living donor hepatectomy. In addition, we briefly discuss the effects of intra-operative colloid or crystalloid administration for surgical rather than septic or critically ill patients.

• Donor hepatectomy
• Central venous pressure
• Stroke volume variation
• Fluid
• Synthetic colloid

• Blood Loss, Surgical/prevention & control
• Crystalloid Solutions
• Fluid Therapy/adverse effects
• Fluid Therapy/methods
• Humans
• Isotonic Solutions/administration & dosage
• Isotonic Solutions/adverse effects
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Living Donors
• Monitoring, Intraoperative/methods
• Predictive Value of Tests
• Stroke Volume
• Treatment Outcome

• goal-directed fluid therapy
• goal-directed therapy
• hemodynamic optimization
• high risk
• perioperative