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 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 a recent technology to measure the cardiac output. EC measures stroke volume determined by calculating beat - to-beat changes in the electrical impedance of the chest and neck. This method can measure cardiac output (CO) noninvasively and continuously at the bedside. The aim of this study was to compare the fluid management of intracranial surgeries guided by electrical cardiometry (EC) versus the guidance with the routine parameters. This prospective randomized double blinded controlled study was carried out in Tanta University Hospitals in Neurosurgery Department on 70 patients of both sex aged more than 21 years old with ASA physical status II or III with GCS 15 (fully conscious) and scheduled for elective craniotomy for brain tumor resection, brain abscess, or intracranial aneurysm. The patients were randomly allocated into two groups following the order of computer-generated software introduced into closed sealed envelopes to make the patients blinded to their own group: group (A) (n=35): The fluid management of patients in this group followed the routine management through 5 mL/kg/h of lactated ringer. Fluid management depended on the routine parameters as heart rate, mean arterial blood pressure, urine output and central venous pressure. group (B) (n=35): Four sensors of EC were applied. Corrected flow time (FTC) and stroke volume (SV) were measured continuously. Fluid maintenance was set at 3 mL/kg/h of lactated ringer solution with an infusion pump, and fluid boluses were allowed according to an FTc-based fluids algorithm protocol Demographic data included age, BMI, sex, ASA, duration of surgery and type of surgery were insignificant between the two studied groups. Our results revealed significant decrease in length of I.C.U stay and length of hospital stay in group B compared to group A. Also, we found that there was statistically significant decrease in total amount of infused volume of crystalloid solutions in group B compared to group A. In addition, we revealed that there was statistically significant difference in ONSD between both groups at all times of measurement. There was statistically insignificant change in total amount of infused volume of colloid solutions and the number of patients who needed colloid solutions, blood component, vasopressors administration and inotropes in group A compared to group B. Moreover, there were statistically insignificant changes in HR, MAP in group A compared to group B at all times of measurement. Also, there was statistically insignificant change in venous lactate in group A compared to group B at all times of measurement. The incidence of encephalodema was significantly increased in group A than group B. The incidence of post-operative ARDS, sepsis, pneumonia ,acute kidney injury, renal failure ,arrhythmia and skin infection were insignificant among the two groups. Moreover, 5 patients (14.3%) in group A needed post-operative mechanical ventilation while only 1 patient (2.9%) in group B needed mechanical ventilation.