Colloids Versus Crystalloids and Tissue Oxygen Tension in Patients Undergoing Major Abdominal Surgery

Lang, Katrin; Boldt, Joachim; Suttner, Stefan; Haisch, G.

doi:10.1097/00000539-200108000-00034

Cited by 127 publications

(118 citation statements)

References 12 publications

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“…21 In a recent clinical study, intravascular volume replacement with HES 130/0.4 improved tissue oxygenation in patients undergoing abdominal surgery. 20 In contrast, equivalent volumes of a crystalloid solution were associated with a marked decrease of tissue oxygen tensions. The latter finding was explained by the fact that crystalloids were mainly distributed in the interstitium, resulting in reduced interstitial colloid osmotic pressure and subsequently tissue and endothelial edema.…”

Section: Statisticsmentioning

confidence: 99%

“…Different HES preparations have already been used to improve microcirculatory blood flow. 19,20 The hemorheologic effectiveness of HES preparations is determined by their high hemodilutional capacity in combination with their inherent specific effects on platelet function, plasma viscosity, and blood corpuscle-endothelial cell interactions. 21 In a recent clinical study, intravascular volume replacement with HES 130/0.4 improved tissue oxygenation in patients undergoing abdominal surgery.…”

Section: Statisticsmentioning

confidence: 99%

“…The latter finding was explained by the fact that crystalloids were mainly distributed in the interstitium, resulting in reduced interstitial colloid osmotic pressure and subsequently tissue and endothelial edema. 20 Moreover, low shear rates and microcirculatory alterations in the venules promote neutrophil adhesion and endothelial activation with subsequent increased levels of soluble adhesion molecules. This is supported by the results of an experimental study by Funk and Baldinger, who compared the effects of fluid therapy with Ringer's solution and artificial colloids on microcirculatory blood flow and tissue oxygenation with an in vivo microscopy technique.…”

Section: Statisticsmentioning

confidence: 99%

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RETRACTED ARTICLE: Le remplissage vasculaire avec de l’HEA 130/0,4 peut réduire la réaction inflammatoire chez des patients en chirurgie abdominale majeure

Lang

Suttner

Boldt

et al. 2003

Can J Anesth/J Can Anesth

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Section: Statisticsmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

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RETRACTED ARTICLE: Le remplissage vasculaire avec de l’HEA 130/0,4 peut réduire la réaction inflammatoire chez des patients en chirurgie abdominale majeure

Lang

Suttner

Boldt

et al. 2003

Can J Anesth/J Can Anesth

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“…In this study, the colloid group had an increase in tissue oxygen tension of 54%, whereas a group of similar patients who received crystalloid had a 29% decrease in tissue oxygen tension. 21 Although there is evidence that aggressive fluid management and the use of hydroxyethyl starch improve tissue oxygenation, the only trial that reported on the incidence of SSI with aggressive hydration did not show any statistically significant improvement in the incidence of SSI. In addition, concern over decreased pulmonary function and bowel edema leading to an increase in the time to return of GI function have tempered enthusiasm for aggressive fluid management in general surgical patients.…”

Section: Perioperative Fluid Managementmentioning

confidence: 98%

“…20 The use of colloids has also been evaluated with regard to improving tissue oxygen tension. Lang et al 21 have shown that using hydroxyethyl starch intraoperatively and postoperatively decreases the amount of crystalloid required to maintain stable hemodynamics and urine output while increasing the tissue oxygen tension. In this study, the colloid group had an increase in tissue oxygen tension of 54%, whereas a group of similar patients who received crystalloid had a 29% decrease in tissue oxygen tension.…”

Section: Perioperative Fluid Managementmentioning

confidence: 99%

The Anesthesiologist's Role in the Prevention of Surgical Site Infections

Mauermann

Nemergut²

2006

Anesthesiology

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This article has been selected for the Anesthesiology CME Program. After reading the article, go to http:// www.asahq.org/journal-cme to take the test and apply for Category 1 credit. Complete instructions may be found in the CME section at the back of this issue.SURGICAL site infections (SSIs) continue to be a substantial source of morbidity and mortality in the surgical patient population. They are the second most common cause of nosocomial infection after urinary tract infections and account for approximately 17% of all hospital-acquired infections. 1 These infections lead to longer hospital and intensive care unit stays, lead to substantially increased mortality, and contribute significantly to healthcare costs. 2 In a 1999 series of cardiac surgery patients, each deep sternal wound infection added an average of $26,400 in hospital charges and increased the average duration of stay by 16 days. 3 The incidence of SSI varies for each operative procedure, each surgeon, and each hospital. In addition, each patient presents with his or her own unique risk profile for the development of a SSI. Although sterile surgical technique is extremely important to the prevention of SSIs, there is increasing evidence that anesthesiologists play a prominent yet under appreciated role in the prevention of SSIs. While infections typically present several days postoperatively, the first few hours after bacterial contamination are the critical window for the establishment of infection. 4,5 Therefore, decreasing SSIs hinges on the optimization of perioperative conditions, many of which are controlled by anesthesiologists.In this review, we will discuss the literature surrounding six perioperative factors over which anesthesiologists have at least partial control and how these factors may influence the risk of postoperative surgical site infection. Although we acknowledge that many anesthesiologists care for patients in the intensive care unit, we limit our discussion here to the immediate perioperative period. HypothermiaMild perioperative hypothermia (core body temperature 34°-36°C) is commonly observed in surgical patients. The complications of mild perioperative hypothermia have been studied extensively and include increased duration of hospitalization, 5 increased intraoperative blood loss and transfusion requirements, increased adverse cardiac events, and an increase in patient thermal discomfort in the recovery room. 6 The effects of mild hypothermia on SSI have also been studied.A series of 200 patients undergoing colorectal surgery were randomized to a hypothermic group (34.4°Ϯ 0.4°C) or a normothermic group (37°Ϯ 0.3°C) and followed for 2 weeks postoperatively. 5 The authors had planned to enroll 400 patients; however, the trial was stopped early because of a statistically significant difference in infection between the two groups. The incidence of SSI was 5.8% in the normothermic group and 18.8% in the hypothermic group. The patients who developed SSIs required hospital stays nearly 1 week longer than those who did not d...

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