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Background  The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.    Methods  This prospective randomized controlled trial with 120 patients over 65years undergoing gastrointestinal surgery were randomized into a CFT group ( n =60) with traditional methods of fasting and water-deprivation, and a GDFT group ( n =60) with carbohydrate (200ml) loading 2h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded.    Results  Patients in the GDFT group received significantly less crystalloids fluid (1111442.9ml vs 1411412.6ml;  p <0.001) and produced significantly less urine output (200ml [150300] vs 400ml [290500];  p <0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (5614.1h vs 6422.3h;  p =0.002) and oral intake (7216.9h vs 8526.8h;  p =0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients;  p =0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups ( p >0.05).    Conclusions  Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications.    Trial registration  ChiCTR,  ChiCTR1800018227 . Registered 6 September 2018 - Retrospectively registered.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12871-021-01377-8.

bmc anesthesiology

Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial