Omar Jilani, MD1, Pamela Kim, MD1, Annika Dhawan1, Emily Brignone2, Kelly Shields, PhD2, Manish Dhawan, MD3
1Allegheny General Hospital, Pittsburgh, PA; 2Highmark Health, Pittsburgh, PA; 3Allegheny Health Network, Pittsburgh, PA
Introduction: Colonoscopy and esophagogastroduodenoscopy (EGD) are commonly performed under sedation with close hemodynamic monitoring. Given the risk of intra-procedural hypotension, it is common practice to start intravenous fluids (IVF) routinely during these procedures despite a lack of evidence for reduction in morbidity. This study aims to compare routine IVF administration versus on-demand IVF administration on patient outcomes after routine endoscopy in an ambulatory surgical center.
Methods: An IRB approved retrospective chart review of 100 patients was completed. Of the 100 patients, 50 patients received routine IVFs during endoscopy and the remaining 50 patients did not. Data collected included age, gender, body mass index, and American Society of Anesthesiologists (ASA) score, duration of the procedure, time spent in the recovery room post procedure, quantity of IVFs used and hemodynamics. Adverse patient effects such as dizziness, nausea, emesis, or shortness of breath were documented.
Results: The routine IVF group and the on-demand IVF group had similar demographics (table 1). About 75% of the patients in both groups met criteria for ASA class 2. About one-third of the patients in both groups had a BMI over 30. There was no significant difference in the preoperative, intraoperative and postoperative hemodynamics between the two groups. The average preoperative and postoperative blood pressure in both groups was 137/83 and 116/66, respectively. The on-demand group received an average 15 milliliters of fluids, likely as KVO (Keep Vein Open) while the routine IVF group received an average of 423 milliliters of fluid (table 2). Although 84% of patients in the routine IVF group received fluids postoperatively there was no reported change in hemodynamics to warrant this fluid. There was a significant difference in the post-procedure recovery time between the two groups, 49.9 minutes for the IVF group and 41.7 minutes for the on-demand IVF group (p < 0.002). Only one patient (from the IVF group) required vasopressor intraoperatively for hypotension.
Discussion: The lack of routine intravenous fluids did not result in adverse outcomes or any detrimental change in hemodynamics. Prospective studies can reveal more insight into the utility of routine IVF use during these procedures and any improvement in safety and quality to justify the increased cost.
Citation: Omar Jilani, MD; Pamela Kim, MD; Annika Dhawan; Emily Brignone; Kelly Shields, PhD; Manish Dhawan, MD. P1281 - CONTINUOUS INTRAVENOUS FLUID VERSUS ON-DEMAND FLUID THERAPY DURING ELECTIVE ENDOSCOPY. Program No. P1281. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.