Intraoperative Fluid Management of Liposuction , Cardiometry Versus Rohrich Formula
Condition: Lipodystrophy
MeSH terms: Lipodystrophy
Study type: Interventional

Summary: 
      The aim of the study is to compare the hemodynamic parameters of fluid resuscitation using
      Rohrich formula to cardiometry guided stroke volume variation in patients undergoing large
      volume liposuction surgery .
    

Detailed description: 
      The study will done on 50 patients divided equally into two groups. Group A Fluid
      administration in the form of lactated ringer will be managed by Rohrich formula and the
      intraoperative fluid ratio (subcutaneous infiltration fluid plus intravenous fluid divided by
      total aspirate volume) will be 1.2. Rohrich formula represents fluid maintenance,deficit and
      replacement fluid ( 0.25 ml crystalloid given for each 1 ml above 4 litre of lipoaspirate).

      Group B Patients will receive fluid maintenance of lactated ringer 2 ml/kg/h, cardiometry
      guided stroke volume variation will be measured before and after induction then every 30 min
      ,it ranges between 5-15%, fluid bolus of lactated ringer 4 ml /kg over 15 min will be
      administered if stroke volume variation ˃ 15% .

      Electrical cardiometry will be connected to the patient before induction,the skin will be
      clean and dry before placing the electrodes. Four electrodes will be applied, first one is at
      the upper part of the anterior aspect of the neck, second one is 5 cm below the first
      electrode at lower part of the neck, third one at the lower left thorax in line with xiphoid
      process at the level of anterior axillary line and the fourth one is 5 cm below the third
      electrode at the level of anterior axillary line.Electrical cardiometry will be connected to
      the sensor cable and the patient data will be applied as (gender - age - height - weight -
      blood pressure -heart rate - hemoglobin and oxygen saturation).

      Surgical Technique The wetting solution will be lactated ringer with epinephrine 1mg on 1
      litre so concentration is 1:1,000,000.10 ml lidocaine 2% will be added.Subcutaneous
      infiltration of the wetting solution will facillate dissection and removal of fat ,the
      technique that will be used is traditional liposuction , suction assisted liposuction with
      super wet technique ( the amount of infiltration solution is equal to the amount of fat
      aspirate).

      The liposuction cannula is a multihole blunt tip cannula with a diameter of 3 to 6 mm, 4-6 mm
      for deep liposuction,2-4 mm for superficial liposuction and a length ranging between 10 to 30
      cm. The surgeon will inject the wetting solution to the target area until it becomes tense
      then infiltrates the other side waiting 10 to 15 min after infiltration to begin suction .The
      aspirate will be collected in suction container, fat will separate from solution after
      approximately 1-2 h by gravity into upper yellowish part includes fat called supernatant and
      lower part includes blood tinged fluid called infranatant.

      Measurements

        -  Noninvasive blood pressure ,oxygen saturation, Heart rate before induction, 5 min and 15
           min after induction then every 30 min.

        -  Urine output, baseline and every hour.

        -  Venous blood sample for measurement of hemoglobin and hematocrit level after aspiration
           of 4 litre of fat and for every litre after.

        -  Measurement of blood volume in aspirate by taking a sample from infranatant part after
           its separation from fat for hemoglobin level calculation and by equation of multiplying
           this hemoglobin concentration to infranatant volume divided by preoperative hemoglobin
           concentration, the investigators can measure blood volume in aspirate .

        -  Amount of intravenous and infiltration fluids.

        -  Amount of fat and total aspirate.

        -  Stroke volume variation before and after induction then every 30 min.
    

Intervention name(s): Electrical Cardiometry (EC) ICON; Rohrich formula
Intervention type(s): Device; Other
Intervention description(s): Electrical Cardiometry (EC) ICON (Osypka Medical, Berlin, Germany) is an FDA approved device used for non-invasive measurement of some hemodynamic parameters as cardiac output,cardiac index, stroke volume,stroke volume variation, systemic vascular resistance, thoracic fluid content, ICON (index of contractility), variation of ICON,corrected flow time and systolic time ratio.The set data of EC are the height, weight,hemoglobin, Oxygen saturation(SPO2),age, gender ,blood pressure and heart rate(HR) of the patient; Rohrich formula and the intraoperative fluid ratio (subcutaneous infiltration fluid plus intravenous fluid divided by total aspirate volume) will be 1.2
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study will done on 50 patients divided equally into two groups. Group A Fluid administration in the form of lactated ringer will be managed by Rohrich formula and the intraoperative fluid ratio (subcutaneous infiltration fluid plus intravenous fluid divided by total aspirate volume) will be 1.2(10). Rohrich formula represents fluid maintinance,deficit and replacement fluid ( 0.25 ml crystalloid given for each 1 ml above 4 litre of lipoaspirate).
Group B Patients will receive fluid maintenance of lactated ringer 2 ml/kg/h, cardiometry guided SVV will be measured before and after induction then every 30 min ,it ranges between 5-15%, fluid bolus of lactated ringer 4 ml /kg over 15 min will be administered if SVV ˃ 15% .
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Lipodystrophy