الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The goal of perioperative intravenous fluid therapy is to maintain or restore circulation with an adequate fluid and electrolyte balance, secure sufficient circulation and secure sufficient oxygen delivery to organs. There had been much debate about which intraoperative fluid regimen is best for patients undergoing major surgery, with many advocating restrictive, more liberal or goal directed fluid regimens with the aim of improving patient outcomes. Clinicians have traditionally administered generous amounts of intravenous fluids perioperatively to correct for preoperative fasting and other fluid deficits, anesthesia-induced vasodilation, hemorrhage, and accumulation of fluid in extravascular spaces and to enhance tissue oxygen delivery and maintain urine output. In neurosurgery patient management is based on maintaining homeostasis, focusing on hemodynamic stability and cerebral perfusion, maintaining CPP, cerebral blood flow and adequate oxygen supply. Therefore, it is essential to avoid hypovolemia and the depressant effects of anesthetics in order to prevent neurological damage. Additional risk includes patient positioning, especially sitting and prone positions, which may also promote hemodynamic changes due to venous pooling and diminished venous return to the heart. Postoperative pulmonary complications (PPCs) are common, serious, and often potentially preventable. The most common postoperative pulmonary complications (PPCs) are pneumonia, acute lung injury, pulmonary edema and acute respiratory distress syndrome. Endocrine changes and systemic inflammatory response caused by surgical trauma lead to an imbalance of sodium and water. There is also significant association between intraoperative fluid volume and PPCs. Goal‐directed therapy has been well‐established as a standard of care in anesthesia due to the strong body of evidence behind it and its benefits in reducing both morbidity and mortality. Electrical Cardiometry (EC) is an effective method to measure the CO. EC measures stroke volume determined by calculating beatto- beat changes in the electrical impedance of the chest and neck. This method can measure CO noninvasively and continuously at the bedside. The aim of this work was to compare the fluid management in sitting or prone neurosurgical patients with expected marked fluid shift guided by goal directed fluid therapy versus the use of the restrictive regimen. The primary outcome variable was lung ultrasound score (LUS), which has been evaluated preoperatively and postoperative in post anesthesia care unit (PACU). Secondary outcome variables were total intraoperative fluid requirements, number of fluid boluses, number of patients requiring vasopressors, postoperative pulmonary complications such as pneumonia or atelectasis and ICU length of stay. This randomized prospective study was carried out on 70 patients of both sex aged more than 21 years old with ASA physical status II or III scheduled for neurosurgical procedures in sitting or prone position with expected marked fluid shift at Tanta University hospitals. Our results revealed that there was no significant difference between the two groups regarding the demographic data and patient characteristics. There was statistically insignificant change in LUS between the two groups in the postoperative period. GDFT group as compared to restrictive fluid therapy group showed a significant decrease in length of I.C.U stay and length of hospital stay while, there was a significant decrease in the total volume of infused crystalloids in the restrictive fluid therapy group. There was a statistically insignificant difference in total amount of infused volume of colloid solutions and the number of patients who needed colloid solutions, blood component, vasopressors administration in the two groups. Moreover, there were statistically insignificant changes in HR, MAP between the two groups at all times of measurement. Also the incidence of post-operative brain edema, pulmonary embolism, sepsis, pneumonia, acute kidney injury, renal failure, arrhythmia and skin infection were insignificant among the two groups. Moreover, 3 patients (9%) in group A needed post-operative mechanical ventilation while 2 patient (6%) in group B needed mechanical ventilation.