Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12254
Title: Fluid prescription practices of anesthesiologists managing patients undergoing elective colonoscopy: an observational study.
Authors: Weinberg, Laurence;Faulkner, Matthew;Tan, Chong O;Liu, Daniel H;Tay, Stanley;Nikfarjam, Mehrdad;Peyton, Philip J;Story, David A
Affiliation: Anesthesiologist, Department of Anesthesiology, Austin Hospital, Melbourne, Victoria, Australia. laurence.weinberg@austin.org.au.
Issue Date: 10-Jun-2014
Citation: Bmc Research Notes 2014; 7(): 356
Abstract: Routine fluid prescription is common practice amongst anesthesiologists caring for patients undergoing colonoscopy. However there is limited information about routine procedural fluid prescription practices of anesthesiologists in this setting. Routine fluid administration may also have important pharmaco-economic implications for the health care budget. Therefore we performed a prospective observational study assessing the fluid prescription practices of anesthesiologists caring for patients undergoing elective colonoscopy.With Institutional Review Board approval, adult patients receiving procedural fluid intervention during elective colonoscopy were included.size of intravenous cannula inserted, volumes of fluid administered, adverse events, procedure duration, and pharmaco-economic costs associated with fluid prescription. Anesthesiologists and gastroenterologists were blinded to the study.We collected data on 289 patients who received fluid prescription by their attending anesthesiologist. Median patient age: 48 yrs (range 18-83), gender: 174 (60%) female; median duration of procedure: 24 minutes (range 12-48). Cannula size: 181 (63%) patients received a 22G cannula or smaller. Median volume of fluid administered during the colonoscopy was 325 ml (range 0 to 1000 ml). Median duration of the procedure: 25 minutes (range 12 to 48 minutes). Median volume of fluid administered in the post anaesthesia recovery unit: 450 ml (range 0 to 1000 ml). Fifteen patients (5%) became hypotensive during the procedure and two patients (<1%) developed hypotension in the PACU. There was no difference in the median fluid requirements between patients with hypotension and those without. Fluid volumes were strongly associated with increasing cannula diameter (p = 0.0001), however there was no association between fluid volumes administered and vasopressor use, peri-procedural adverse events, or procedure duration. At our institution fluid therapy currently cost about AUD$4.90 per patient: 1 L crystalloid $1.18 and fluid delivery set $3.77 Our institution performs over 9000 endoscopic procedures annually with fluid therapy costing about $45,000/year.Routine fluid prescription by anesthesiologists managing patients undergoing colonoscopy was ineffective with low actual fluid volumes delivered during the procedure. There was no association between volumes of fluid delivered and procedural hypotension, adverse events, or procedure duration. Anesthesiologists should question the clinical and pharmaco-economic value of routine fluid administration for patients undergoing elective endoscopy.
Internal ID Number: 24916073
URI: http://ahro.austin.org.au/austinjspui/handle/1/12254
DOI: 10.1186/1756-0500-7-356
URL: http://www.ncbi.nlm.nih.gov/pubmed/24916073
Type: Journal Article
Subjects: Adolescent
Adult
Aged
Aged, 80 and over
Anesthesiology.methods
Colonoscopy.methods
Elective Surgical Procedures.methods
Female
Fluid Therapy.economics.methods.statistics & numerical data
Gastroenterology.methods
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Physician's Practice Patterns.statistics & numerical data
Prospective Studies
Single-Blind Method
Young Adult
Appears in Collections:Journal articles

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