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Abstract
Intra operative fluid management is one of the most important issues for the patient hemodynamic stability and affects the patient outcome. Different devices are used for intra-operative monitoring of the volume status of the patients. Pulse Co- oximeter (Masimo) is considered a safe non invasive device for intra operative fluid management. The principle objective of the current study is to detect the efficacy of Masimo as an alternative non-invasive device in fluid optimization in major abdominal surgery when compared with transoesophageal doppler. The second objective of the study is to compare the baseline hemodynamic parameters (SV, FTc, PVI, PI, MAP, HR) between responder group and non responder group. Sixty adult patients (ASA 1 - 2) undergoing major abdominal surgery were randomly allocated. Premedication was given in the form of midazolam (0.05 mg / kg) intravenously half an hour before operation. Anesthesia was induced with propofol (2 mg / kg), fentanyl (3 æg / kg), and atracurium (0.5 mg / kg). Then anesthesia was maintained by 1.2% MAC isoflurane with 100% oxygen in addition to supplemental doses of atracurium according to the nerve stimulator and fentanyl (1 æg / kg / hour). Mechanical ventilation was performed using a tidal volume of 6-8 ml/kg with the respiratory rate adjusted to maintain PaCO2 between 30 and 35 mm Hg. All patients were monitored for electrocardiogram, noninvasive arterial blood pressure, peripheral oxygen saturation, end-tidal carbon dioxide tension, temperature, hourly urinary output and bispectral index BIS for monitoring depth of anesthesia