{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:07:55Z","timestamp":1790431675376,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,2]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n Anesthetics and neuraxial anesthesia commonly result in vasodilation\/hypotension. Norepinephrine counteracts this effect and thus allows for decreased intraoperative hydration. The authors investigated whether this approach could result in reduced postoperative complication rate.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n In this single-center, double-blind, randomized, superiority trial, 166 patients undergoing radical cystectomy and urinary diversion were equally allocated to receive 1 ml\u00b7kg\n \u22121<\/jats:sup>\n \u00b7h\n \u22121<\/jats:sup>\n of balanced Ringer\u2019s solution until the end of cystectomy and then 3 ml\u00b7kg\n \u22121<\/jats:sup>\n \u00b7h\n \u22121<\/jats:sup>\n until the end of surgery combined with preemptive norepinephrine infusion at an initial rate of 2 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7h\n \u22121<\/jats:sup>\n (low-volume group; n = 83) or 6 ml\u00b7kg\n \u22121<\/jats:sup>\n \u00b7h\n \u22121<\/jats:sup>\n of balanced Ringer\u2019s solution throughout surgery (control group; n = 83). Primary outcome was the in-hospital complication rate. Secondary outcomes were hospitalization time, and 90-day mortality.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n In-hospital complications occurred in 43 of 83 patients (52%) in the low-volume group and in 61 of 83 (73%) in the control group (relative risk, 0.70; 95% CI, 0.55\u20130.88;\n P<\/jats:italic>\n = 0.006). The rates of gastrointestinal and cardiac complications were lower in the low-volume group than in the control group (5 [6%]\n vs<\/jats:italic>\n . 31 [37%]; relative risk, 0.16; 95% CI, 0.07\u20130.39;\n P<\/jats:italic>\n < 0.0001 and 17 [20%]\n vs.<\/jats:italic>\n 39 [48%], relative risk, 0.43; 95% CI, 0.26\u20130.60;\n P<\/jats:italic>\n = 0.0003, respectively). The median hospitalization time was 15 days [range, 11, 27d] in the low-volume group and 17 days [11, 95d] in the control group (\n P<\/jats:italic>\n = 0.02). The 90-day mortality was 0% in the low-volume group and 4.8% in the control group (\n P<\/jats:italic>\n = 0.12).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n A restrictive-deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy and urinary diversion significantly reduced the postoperative complication rate and hospitalization time.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/aln.0b013e3182a44440","type":"journal-article","created":{"date-parts":[[2013,7,25]],"date-time":"2013-07-25T13:03:24Z","timestamp":1374757404000},"page":"365-377","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":154,"title":["Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time"],"prefix":"10.1097","volume":"120","author":[{"given":"Patrick Y.","family":"Wuethrich","sequence":"first","affiliation":[{"name":"From the Department of Anaesthesiology and Pain Therapy (P.Y.W., F.S.) and Department of Urology (F.C.B., G.N.T., U.E.S.), University Hospital Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona C.","family":"Burkhard","sequence":"additional","affiliation":[{"name":"From the Department of Anaesthesiology and Pain Therapy (P.Y.W., F.S.) and Department of Urology (F.C.B., G.N.T., U.E.S.), University Hospital Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George N.","family":"Thalmann","sequence":"additional","affiliation":[{"name":"From the Department of Anaesthesiology and Pain Therapy (P.Y.W., F.S.) and Department of Urology (F.C.B., G.N.T., U.E.S.), University Hospital Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Stueber","sequence":"additional","affiliation":[{"name":"From the Department of Anaesthesiology and Pain Therapy (P.Y.W., F.S.) and Department of Urology (F.C.B., G.N.T., U.E.S.), University Hospital Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs E.","family":"Studer","sequence":"additional","affiliation":[{"name":"From the Department of Anaesthesiology and Pain Therapy (P.Y.W., F.S.) and Department of Urology (F.C.B., G.N.T., U.E.S.), University Hospital Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20241219","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/01.sla.0000094387.50865.23","article-title":"Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens.","volume":"238","year":"2003","journal-title":"Ann Surg"},{"key":"R2-20241219","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1001\/archsurg.2010.275","article-title":"Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial.","volume":"145","year":"2010","journal-title":"Arch Surg"},{"key":"R3-20241219","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00000542-200507000-00008","article-title":"Effect of intraoperative fluid management on outcome after intraabdominal surgery.","volume":"103","year":"2005","journal-title":"Anesthesiology"},{"key":"R4-20241219","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.surg.2007.12.009","article-title":"Perioperative fluid restriction reduces complications after major gastrointestinal surgery.","volume":"143","year":"2008","journal-title":"Surgery"},{"key":"R5-20241219","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1213\/01.ANE.0000180217.57952.FE","article-title":"Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection.","volume":"101","year":"2005","journal-title":"Anesth Analg"},{"key":"R6-20241219","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1093\/bja\/aes163","article-title":"Which goal for fluid therapy during colorectal surgery is followed by the best outcome: Near-maximal stroke volume or zero fluid balance?","volume":"109","year":"2012","journal-title":"Br J Anaesth"},{"key":"R7-20241219","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1007\/s00268-004-7383-7","article-title":"Patterns and clinical outcomes associated with routine intravenous sodium and fluid administration after colorectal resection.","volume":"28","year":"2004","journal-title":"World J Surg"},{"key":"R8-20241219","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/ALN.0b013e31820bfc81","article-title":"Hypotension during fluid-restricted abdominal surgery: Effects of norepinephrine treatment on regional and microcirculatory blood flow in the intestinal tract.","volume":"114","year":"2011","journal-title":"Anesthesiology"},{"key":"R9-20241219","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.eururo.2009.05.008","article-title":"Complications following radical cystectomy for bladder cancer in the elderly.","volume":"56","year":"2009","journal-title":"Eur Urol"},{"key":"R10-20241219","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.eururo.2008.07.031","article-title":"Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.","volume":"55","year":"2009","journal-title":"Eur Urol"},{"key":"R11-20241219","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s11255-008-9351-x","article-title":"Gender and age differences in blood utilization and length of stay in radical cystectomy: A population-based study.","volume":"40","year":"2008","journal-title":"Int Urol Nephrol"},{"key":"R12-20241219","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S0302-2838(02)00581-X","article-title":"A study of the morbidity, mortality and long-term survival following radical cystectomy and radical radiotherapy in the treatment of invasive bladder cancer in Yorkshire.","volume":"43","year":"2003","journal-title":"Eur Urol"},{"key":"R13-20241219","article-title":"Results from three municipal hospitals regarding radical cystectomy on elderly patients.","volume":"33","year":"2007","journal-title":"Int Braz J Urol"},{"key":"R14-20241219","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/j.juro.2010.06.007","article-title":"Early and late perioperative outcomes following radical cystectomy: 90-day readmissions, morbidity and mortality in a contemporary series.","volume":"184","year":"2010","journal-title":"J Urol"},{"key":"R15-20241219","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.eururo.2007.02.048","article-title":"Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients.","volume":"52","year":"2007","journal-title":"Eur Urol"},{"key":"R16-20241219","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.critrevonc.2005.06.008","article-title":"Continent urinary diversion.","volume":"57","year":"2006","journal-title":"Crit Rev Oncol Hematol"},{"key":"R17-20241219","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.ucl.2011.07.011","article-title":"Lymphadenectomy for bladder cancer: Indications and controversies.","volume":"38","year":"2011","journal-title":"Urol Clin North Am"},{"key":"R18-20241219","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/00000542-200607000-00030","article-title":"Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies.","volume":"105","year":"2006","journal-title":"Anesthesiology"},{"key":"R19-20241219","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/S0140-6736(02)08711-1","article-title":"Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: A randomised controlled trial.","volume":"359","year":"2002","journal-title":"Lancet"},{"key":"R20-20241219","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/S0140-6736(07)61197-0","article-title":"Red blood cell transfusion in clinical practice.","volume":"370","year":"2007","journal-title":"Lancet"},{"key":"R21-20241219","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.urology.2007.07.048","article-title":"Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion.","volume":"70","year":"2007","journal-title":"Urology"},{"key":"R22-20241219","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1213\/00000539-199908000-00050","article-title":"The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery.","volume":"89","year":"1999","journal-title":"Anesth Analg"},{"key":"R23-20241219","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey.","volume":"240","year":"2004","journal-title":"Ann Surg"},{"key":"R24-20241219","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.juro.2007.11.084","article-title":"Contemporary open radical cystectomy: Analysis of perioperative outcomes.","volume":"179","year":"2008","journal-title":"J Urol"},{"key":"R25-20241219","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1097\/00000542-200210000-00012","article-title":"Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery.","volume":"97","year":"2002","journal-title":"Anesthesiology"},{"key":"R26-20241219","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/ALN.0b013e3181863117","article-title":"A rational approach to perioperative fluid management.","volume":"109","year":"2008","journal-title":"Anesthesiology"},{"key":"R27-20241219","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.jamcollsurg.2012.01.046","article-title":"Serum brain naturietic peptide measurements reflect fluid balance after pancreatectomy.","volume":"214","year":"2012","journal-title":"J Am Coll Surg"},{"key":"R28-20241219","doi-asserted-by":"crossref","first-page":"521","DOI":"10.4070\/kcj.2012.42.8.521","article-title":"Postoperative B-type natriuretic Peptide levels associated with prolonged hospitalization in hypertensive patients after non-cardiac surgery.","volume":"42","year":"2012","journal-title":"Korean Circ J"},{"key":"R29-20241219","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/ALN.0b013e3181af59aa","article-title":"Role of central and mixed venous oxygen saturation measurement in perioperative care.","volume":"111","year":"2009","journal-title":"Anesthesiology"},{"key":"R30-20241219","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1186\/cc3888","article-title":"Changes in central venous saturation after major surgery, and association with outcome.","volume":"9","year":"2005","journal-title":"Crit Care"},{"key":"R31-20241219","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1213\/ANE.0b013e3181eb624f","article-title":"Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management.","volume":"111","year":"2010","journal-title":"Anesth Analg"},{"key":"R32-20241219","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.juro.2010.05.037","article-title":"Lessons learned from 1,000 neobladders: The 90-day complication rate.","volume":"184","year":"2010","journal-title":"J Urol"},{"key":"R33-20241219","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1093\/bja\/aei018","article-title":"Kidney dysfunction in the postoperative period.","volume":"95","year":"2005","journal-title":"Br J Anaesth"},{"key":"R34-20241219","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1001\/archsurg.2011.308","article-title":"Effect of the volume of fluids administered on intraoperative oliguria in laparoscopic bariatric surgery: A randomized controlled trial.","volume":"147","year":"2012","journal-title":"Arch Surg"},{"key":"R35-20241219","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1093\/bja\/aef220","article-title":"Pathophysiology and clinical implications of perioperative fluid excess.","volume":"89","year":"2002","journal-title":"Br J Anaesth"},{"key":"R36-20241219","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/ALN.0b013e3182054d06","article-title":"Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery.","volume":"114","year":"2011","journal-title":"Anesthesiology"},{"key":"R37-20241219","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1046\/j.1365-2044.2002.02708.x","article-title":"Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery.","volume":"57","year":"2002","journal-title":"Anaesthesia"},{"key":"R38-20241219","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1016\/j.juro.2011.07.093","article-title":"A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy.","volume":"186","year":"2011","journal-title":"J Urol"}],"container-title":["Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/pubs.asahq.org\/anesthesiology\/article-pdf\/120\/2\/365\/484830\/20140200_0-00023.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/anesthesiology.pubs.asahq.org\/article.aspx?volume=120&page=365","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T08:54:50Z","timestamp":1735894490000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/ALN.0b013e3182a44440"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":38,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014]]}},"URL":"https:\/\/doi.org\/10.1097\/aln.0b013e3182a44440","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.718047740.793482505","asserted-by":"object"}]},"ISSN":["0003-3022"],"issn-type":[{"value":"0003-3022","type":"print"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}