Intraoperative Intravascular Effect of Lactated Ringer's Solution and Hyperoncotic Albumin During Hemorrhage in Cystectomy Patients.

Published on Aug 1, 2021in Anesthesia & Analgesia5.178
· DOI :10.1213/ANE.0000000000005173
Lukas M. Löffel5
Estimated H-index: 5
(University of Bern),
Robert G. Hahn54
Estimated H-index: 54
(KI: Karolinska Institutet)
+ 1 AuthorsPatrick Y. Wuethrich13
Estimated H-index: 13
(University of Bern)
Background The intraoperative effect of 20% albumin on plasma volume during surgery involving major blood loss has not been explored extensively due to methodological difficulties. Crystalloids poorly expand the plasma volume, and using a colloid might then be a way to avoid fluid overload. As doubts have been raised about synthetic colloids, albumin solutions are currently used more extensively. This study presents a methodological development showing how plasma volume expansion can be studied in surgical settings with the coinfusion of 20% albumin and lactated Ringer's solution. Methods In this single-arm, single-center feasibility study, an intravenous (i.v.) infusion of 3 mL·kg·BW of 20% albumin was administered over 30 minutes to 23 cystectomy patients during the bleeding phase in addition to lactated Ringer's solution to correct blood loss. Blood samples were measured at regular intervals over a period of 300 minutes to estimate the blood volume expansion resulting from simultaneous infusions of lactated Ringer's and 20% albumin solutions, using a regression equation and the area under the volume-time curve method. Results Mean hemorrhage was 974 mL (standard deviation [SD] ± 381). The regression method showed strong correlation (r = 0.58) between blood loss minus blood volume expansion and the independent effects of the infused volume of lactated Ringer's and 20% albumin solutions. The mean plasma volume expansion attributable to the infusion of lactated Ringer's solution amounted to 0.38 (95% confidence interval [CI], 0 .31-0.49) of the infused volume; for the 20% albumin, it was 1.94 mL/mL (95% CI, 1.41-2.46 mL/mL) over 5 hours on average (regression method). The mean within-patient change was 0.20 mL/mL (± 0.06 mL/mL) for the lactated Ringer's solution and 2.20 mL/mL (±1.31 mL/mL) for the 20% albumin using the area under the volume-time curve method. Conclusions Blood volume expansion averaged 1.9-2.2 times the infused volume of 20% albumin during surgery associated with hemorrhage of around 1000 mL. This effect was long standing and approximately 5 times stronger than for the lactated Ringer's solution. Twenty percent albumin boosts the plasma volume expansion of lactated Ringer's solution to as high as 40% of the infused volume on the average, which is an effect that lasts at least 5 hours.
#1Emma Hasselgren (Karolinska University Hospital)H-Index: 3
#2Markus Zdolsek (Linköping University)H-Index: 5
Last. Robert G. HahnH-Index: 54
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BACKGROUND:Albumin may persist intravascularly for a shorter time in patients after major surgery than in healthy volunteers due to a surgery-induced breakdown (shedding) of the endothelial glycocalyx layer.METHODS:In this nonrandomized clinical trial, an IV infusion of 3 mL/kg of 20% albumin was gi
#1Markus Zdolsek (Linköping University)H-Index: 5
#2Robert G. Hahn (KI: Karolinska Institutet)H-Index: 54
Last. Joachim Zdolsek (Linköping University)H-Index: 12
view all 3 authors...
BackgroundAlthough hyperoncotic albumin may be used to recruit oedema, its effectiveness remains unclear. Therefore, this issue was studied during infusion experiments in healthy volunteers. Method ...
#1Kenneth J. Rothman (BU: Boston University)H-Index: 103
#2Sander Greenland (UCLA: University of California, Los Angeles)H-Index: 131
Study size has typically been planned based on statistical power and therefore has been heavily influenced by the philosophy of statistical hypothesis testing. A worthwhile alternative is to plan study size based on precision, for example by aiming to obtain a desired width of a confidence interval
#1Chiedozie UdehH-Index: 2
#2Jing YouH-Index: 26
Last. J. Steven HataH-Index: 9
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The use of hyperoncotic albumin (HA) for shock resuscitation is controversial given concerns about its cost, effectiveness, and potential for nephrotoxicity. We evaluated the association between early exposure to hyperoncotic albumin (within the first 48 h of onset of shock) and acute organ dysfunction in post-surgical patients with shock. This retrospective, cohort study included 11,512 perioperative patients with shock from 2009 to 2012. Shock was defined as requirement for vasopressors to mai...
#1Robert G. Hahn (National Patient Safety Foundation)H-Index: 54
Excretion of crystalloid fluid is slow during general anesthesia. The distribution and elimination of buffered Ringer’s solution were analyzed to determine whether the rate of elimination correlates with a hemodynamic factor, consciousness, patient posture, or the type of general anesthesia. Data we
#1Lukas M. Löffel (University of Bern)H-Index: 5
#2Fiona C. BurkhardH-Index: 51
Last. Patrick Y. WuethrichH-Index: 13
view all 4 authors...
BACKGROUND Gastrointestinal (GI) complications often delay recovery after radical cystectomy with urinary diversion. The authors investigated if perioperative administration of a potassium-enriched, chloride-depleted 5% glucose solution (G5K) accelerates recovery of GI function. METHODS This randomized, parallel-group, single-center double-blind trial included 44 consecutive patients undergoing radical cystectomy and pelvic lymph node dissection with urinary diversion. Patients were randomized t...
#1Hyun Joo Ahn (Jeju National University)H-Index: 22
#2Jie Ae Kim (Jeju National University)H-Index: 21
Last. Burnyoung HeoH-Index: 2
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BACKGROUND: Fluid is restricted in thoracic surgery to reduce acute lung injury, and hydroxyethyl starches (HES) are often administered to reduce fluid amount. This strategy may contribute to the development of acute kidney injury (AKI). We evaluated the incidence, risk factors, and prognosis of AKI in thoracic surgery. We especially focused on whether fluid restriction/HES administration increased AKI. METHODS: This is a retrospective study of patients undergoing thoracic surgery in a tertiary ...
#2Urs E. StuderH-Index: 85
Last. Fiona C. BurkhardH-Index: 51
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Abstract Background Open radical cystectomy (ORC) is associated with substantial blood loss and a high incidence of perioperative blood transfusions. Strategies to reduce blood loss and blood transfusion are warranted. Objective To determine whether continuous norepinephrine administration combined with intraoperative restrictive hydration with Ringer's maleate solution can reduce blood loss and the need for blood transfusion. Design, setting, and participants This was a double-blind, randomised...
#1Lukas M. Löffel (University of Bern)H-Index: 5
#2Bettina Kleeb (University of Bern)H-Index: 2
Last. Patrick Y. Wuethrich (University of Bern)H-Index: 13
view all 4 authors...
Background The optimal crystalloid solution to use perioperatively in patients undergoing open radical cystectomy remains unclear. Many of the fluids used for intravenous hydration contain supraphysiologic concentrations of chloride, which can induce hyperchloremia and metabolic acidosis, resulting in renal vasoconstriction and decreased renal function. In addition, patients receiving less fluid and less sodium show faster recovery of gastrointestinal (GI) function after colonic surgery.
#1Kirsten C. Rasmussen (UCPH: University of Copenhagen)H-Index: 5
#2Pär I. JohanssonH-Index: 67
Last. Niels H. SecherH-Index: 100
view all 10 authors...
Objective:This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss.Background:Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi
Cited By3
#1Yoko Midorikawa (Hirosaki University)H-Index: 2
#2Junichi Saito (Hirosaki University)H-Index: 9
Last. Kazuyoshi Hirota (Hirosaki University)H-Index: 27
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BACKGROUND Acute normovolemic hemodilution (ANH) is used to reduce the risk of peri-operative allogeneic blood transfusion. Although crystalloid and/or colloid solutions have been used for volume replacement during ANH, no studies have examined the differences among solutions on the volume status, electrolytes, acid-base balance, and hemodynamic status during surgery with ANH. METHODS We retrospectively compared the effect of Ringer's lactate with 3% dextran-40 (Saviosol®, DEX group) and 6% hydr...
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