The Effect of Conventional Versus Pleth Variability Index-Guided Goal-Directed Intraoperative Fluid Management on Renal Function in Patients Undergoing Elective Total Abdominal Hysterectomy

Introduction: Intraoperative fluid management is a critical component of anesthetic practice, aiming to maintain tissue perfusion and electrolyte balance.Inadequate or excessive fluid administration may cause complications, thereby affecting postoperative outcomes.This study aimed to assess the impact of pleth variability index (PVI)-based goal-directed fluid therapy (GDFT), compared with a conventional fluid strategy, on renal function during elective total abdominal hysterectomy (TAH).Methods: This prospective, non-randomized, comparative study included 68 participants (American Society of Anesthesiologists I-II) who underwent TAH.Patients were followed in two parallel clinical cohorts according to the fluid management strategy applied: Group P (GDFT monitored via PVI) and Group G (conventional fluid therapy).Heart rate (HR), mean arterial pressure (MAP), urine output, blood loss, and fluid volumes were recorded every 30 minutes for up to 150 minutes post-intubation.Blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), urine specific gravity, and calculated osmolarity were evaluated preoperatively, postoperatively, and on postoperative day 3. Results: No statistically significant differences were observed between the groups in HR, MAP, or urine output.Group G received more fluids and experienced greater intraoperative blood loss than Group P. Postoperatively, BUN levels and calculated osmolarity decreased in both groups, while eGFR and creatinine remained unchanged from baseline.Urine specific gravity increased significantly only in Group P. Conclusion: Conventional and PVI-guided GDFT protocols exert similar effects on postoperative renal function after elective TAH.PVI-guided GDFT achieves robust hemodynamic stabilization with a significant reduction in intraoperative fluid volumes compared to conventional management, representing a reliable fluid-sparing approach for routine clinical practice.