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Colloid Infusion (colloid + infusion)
Selected AbstractsFunctional intravascular volume deficit in patients before surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010M. BUNDGAARD-NIELSEN Background: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. Methods: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a ,10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit. Results: Forty-two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200,600 ml), with no significant difference between the three groups of patients. The required volume was ,400 ml in nine patients (15%). Conclusion: The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal-directed fluid therapy. [source] Equal effects of gelatin and hydroxyethyl starch (6% HES 130/0.42) on modified thrombelastography in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009W. A. OSTHAUS Background: Artificial colloids are frequently used to prevent or treat circulatory failure due to hypovolaemia. Whereas gelatin has been shown not to affect coagulation besides its haemodilutional effect, hydroxyethyl starches (HES) have additional negative effects on haemostasis. The third-generation HES solutions have been developed to minimise these effects. We therefore conducted a prospective, randomised study, to verify the hypothesis that a 6% HES 130/0.42/6 : 1 and a 4% gelatin infusion influences modified thrombelastography (TEM) parameters in children in the same manner and to the same extent. Methods: A total of 50 paediatric patients aged 0,12 years scheduled for surgery were assigned to receive either 10 ml/kg HES 130/0.42 or gelatin. Blood gas analysis, haemodynamic parameters and TEM measurements were performed before and after colloid administration. Results: Patient characteristics, indications/surgical procedures and the main results obtained from blood gas analysis were comparable between the two groups. After administration of either gelatin or HES, all TEM parameters, except for clotting time, indicated impaired coagulation whereas the mean values of all TEM parameters remained within the normal ranges. Comparing the gelatin and HES 130/0.42/6 : 1 groups, none of the measured TEM parameters was found to show between-group differences at baseline or after colloid infusion. Conclusion: In conclusion, we could demonstrate that the investigational product, HES 130/0.42/6 : 1 solution, administered at a dosage of 10 ml/kg to children, had comparable effects on coagulation monitored with TEM as a gelatin solution. Perioperative administration of HES 130/0.42/6 : 1 does not alter coagulation to an extent above and beyond the effect of haemodilution. [source] Intra-operative colloid administration increases the clearance of a post-operative fluid loadACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009T. BORUP Background: It is unknown whether an intra-operative colloid infusion alters the dynamics of a crystalloid load administered post-operatively. Methods: Ten patients received 12.5 ml/kg of Ringer's lactate over 30 min 1,3 days before and 4 h after laparoscopic cholecystectomy, during which 10 ml/kg of a colloid solution, hydroxyethylstarch (HES 130/0.4), was infused. The total body clearance of the pre- and post-operative test infusions was taken as the ratio between the urinary excretion and the Hb-derived dilution of venous plasma over 150 min. The plasma clearance of the infused fluid was calculated using volume kinetics based on the plasma dilution alone. The pre-operative plasma clearance was compared with the post-operative plasma clearance and patients served as their own control. Results: The urinary excretion averaged 350 ml for the pre-operative infusion and 612 ml post-operatively, which corresponds to 46% and 68% of the pre- and post-operative infusions, respectively. The total body clearance of the crystalloid fluid was 30 ml/min before surgery and 124 ml/min after surgery (P<0.01). The plasma clearance, as obtained from the plasma dilution alone, was 28 and 412 ml/min, respectively. The maximal increase in plasma volume was 410 ml pre-operatively vs. 220 ml post-operatively. Conclusions: Infusion of a colloid solution in combination with a crystalloid during laparoscopic cholecystectomy increased the plasma clearance of a post-operative crystalloid infusion. [source] Administration of 5% human serum albumin in critically ill small animal patients with hypoalbuminemia: 418 dogs and 170 cats (1994,2008)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2010Fabio Viganó DVM, SCMPA Abstract Objectives , To describe the administration of 5% human serum albumin (HSA) in 588 critically ill hypoalbuminemic dogs and cats, and report outcome to discharge, changes in albumin concentration, and adverse effects during hospitalization. Design , Retrospective clinical study. Setting , Private emergency and general veterinary center. Animals , Client-owned dogs and cats. Interventions , None. Measurements and Main Results , The medical records of 588 critically ill hypoalbuminemic animals (418 dogs and 170 cats) were reviewed. All animals had hypoalbuminemia (serum albumin <20 g/L [2.0 mg/dL]) at admission, received an infusion of 5% HSA, and received no other colloid infusion. The HSA solution was administered through a peripheral vein at 2 mL/kg/h for 10 h/d (total volume 20 mL/kg/d) until albumin reached 20 g/L. The number of days of HSA infusion (median and range) was 4 days (2,11 d) for dogs and 3 days (2,7 d) for cats. Three hundred and sixteen dogs (75.6%) survived to discharge; 56 of 418 (13.4%) died in hospital. One hundred and twenty-three cats (72.3%) survived to discharge; 21 of 170 (12.4%) died in hospital. Severe hypersensitivity reactions such as anaphylaxis, angioedema, and urticaria were not noted. Interruption of albumin infusion and specific treatment of reactions were not required in any animal. Conclusions , In this study, administration of 5% HSA appeared to be safe in a large group of critically ill, hypoalbuminemic dogs and cats. The results should be interpreted with caution due to the retrospective, descriptive nature of the study, the absence of control groups and the lack of follow-up data, as well as the potentially life-threatening complications of HSA administration. [source] | ||||||||||