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

Löffel, Lukas; Hahn, Robert G.; Engel, Dominique; Wüthrich, Patrick (2021). Intraoperative Intravascular Effect of Lactated Ringer's Solution and Hyperoncotic Albumin During Hemorrhage in Cystectomy Patients. Anesthesia and analgesia, 133(2), pp. 413-422. International Anesthesia Research Society 10.1213/ANE.0000000000005173

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Löffel, Lukas; Engel, Dominique and Wüthrich, Patrick Yves

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1526-7598

Publisher:

International Anesthesia Research Society

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

19 Nov 2020 15:00

Last Modified:

16 Jul 2021 01:31

Publisher DOI:

10.1213/ANE.0000000000005173

PubMed ID:

32947291

BORIS DOI:

10.7892/boris.147631

URI:

https://boris.unibe.ch/id/eprint/147631

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