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Stroke volume‐directed administration of hydroxyethyl starch or R inger's acetate in sitting position during craniotomy
Author(s) -
LINDROOS A.C. B.,
NIIYA T.,
SILVASTILUNDELL M.,
RANDELL T.,
HERNESNIEMI J.,
NIEMI T. T.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12105
Subject(s) - medicine , hydroxyethyl starch , anesthesia , stroke volume , hemodynamics , cardiac index , craniotomy , sitting , cardiac output , stroke (engine) , mean arterial pressure , blood pressure , heart rate , pathology , engineering , mechanical engineering
Background To determine the volumes required for stable haemodynamics and possible effects on the coagulation, we studied stroke volume ( SV )‐directed administration of hydroxyethyl starch ( HES 130 k D a/0.4) and Ringer's acetate ( RAC ) in neurosurgical patients operated on in a sitting position. Methods Thirty craniotomy patients were randomised to receive either HES or RAC . Before positioning, SV , measured by arterial pressure waveform analysis, was maximised by boluses of fluid until SV did not increase more than 10%. SV was maintained by repeated administration of fluid. RAC 3 ml/kg/h was infused in both groups during surgery. Results Comparable haemodynamics were achieved with the mean [standard deviation ( SD )] cumulative doses of HES or RAC 271 (47) or 264 (50) ml ( P = 0.699) before the sitting position. Mean ( SD ) doses of HES or RAC at 30 min after the positioning were 343 (94) or 450 (156) ml ( P = 0.036), and at the end of surgery 464 (284) or 707 (425) ml, respectively ( P = 0.087). The intraoperative fluid balance was more positive in the RAC than in the HES group [ P = 0.044, 95% confidence interval ( CI ) −978 to −14]. Cardiac and stroke volume indexes [ CI and stroke volume index ( SVI )] increased in the HES group ( P < 0.05) but not in the RAC group [non significant (N.S.)]. Neither coagulation profile nor blood loss differed between the groups. Conclusion Fluid filling with HES boluses resulted in a positive response in CI and SVI during the sitting position. The 34% smaller volume of HES than crystalloid and less positive fluid balance in the HES group might be important in craniotomy patients with decreased brain compliance.