Effects of anaesthesia‐induced hypotension and phenylephrine on plasma volume expansion by hydroxyethyl starch: A randomised controlled study

Abstract

Background Changes in blood haemoglobin concentration indicate plasma volume expansion following hydroxyethyl starch (HES) infusion, but may be affected by vascular tone and HES‐induced shedding of the endothelial surface layer (ESL). We hypothesised that anaesthesia‐induced hypotension enhances changes in plasma volume as assessed by blood haemoglobin concentration (ΔPVHb, %) following HES infusion. Methods Fifty‐two patients undergoing abdominal surgery were randomised to receive a continuous infusion of saline (S group) or phenylephrine to restore vascular tone (P group) (n = 26 each). Both groups received an infusion of 8 mL/kg 6% HES solution after induction of general anaesthesia. We compared ΔPVHb at the end of fluid infusion (15 minutes) and 15 minutes later (30 minutes) between the two groups. We assessed changes in ESL structure by measuring plasma concentrations of hyaluronate and syndecan‐1. P < .05 was considered statistically significant. Results Mean arterial blood pressure was lower in the S group approximately by 30‐40% compared to the P group (P < .001). ΔPVHb was larger in the S group compared to the P group at 15 minutes (24.9 [5.2] % vs 19.0 [5.2] %; P < .001) and 30 minutes (26.5 [5.9] % vs 16.9 [6.6] %; P < .001). There were no clinically significant differences in plasma concentrations of hyaluronate and syndecan‐1 with time and between the groups. Conclusions Increased volume expansion of circulating plasma following HES infusion in anaesthesia‐induced hypotension compared to when blood pressure is restored by phenylephrine may result from an attenuation of transcapillary fluid filtration, rather than ESL shedding. UMIN Clinical Trial Registration Number: UMIN000017394 (http://www.umin.ac.jp/ctr/index.htm).

Resuscitation fluids as drugs: targeting the endothelial glycocalyx

“…In vitro Cheung-Flynn et al (2019) [30] Balanced crystalloid Harmful NS Animal Byrne et al (2018) [18] -Harmful NS Animal Torres et al (2017) [31] LR, Albumin, FFP Harmful Balanced crystalloid Animal Ergin et al (2020) [34] NS Beneficial Balanced crystalloid Animal Guerci et al (2019) [35] NS Harmful HES Animal Zhao et al (2020) [40] -Beneficial HES, albumin Clinical Li et al (2020) [41] -May be beneficial HES Clinical Kaneko et al (2020) [42] -Uncertain HES Animal Smart et al (2018) [43] FWB Beneficial Gelatin Animal Smart et al (2018) [43] FWB Harmful Isotonic crystalloids Animal Smart et al (2018) [43] FWB Harmful Gelatin, dextran -Smart and Hughes (2021) [44] -Uncertain HES Animal Wong et al (2016) [49] -Harmful Albumin Animal Wong et al (2016) [49] HES Beneficial 20% Albumin Animal Damiani et al (2016) [52] 4% Albumin More beneficial NS, balanced crystalloid Animal Torres et al (2017) [31] FFP, Albumin Harmful 5% Albumin, HES Clinical Suzuki and Koyama (2020) [53] -Beneficial Albumin Clinical Piotti et al (2021) [54] -Beneficial Albumin Clinical Hariri et al (2018) [55] -Beneficial Albumin Animal, In vitro Pati et al (2016) [57] FFP Little effect Albumin Clinical Yanase et al (2021) [58] -No effect FFP Animal Nikolian et al (2017) [60] NS Beneficial FFP Animal, In vitro Wu et al (2017) [17] -Beneficial LR plus FFP Animal Vigiola et al (2019) [62] LR, LR plus albumin Beneficial FFP Clinical Straat et al (2015) [63] -Beneficial Plasma Clinical Wei et al (2018) [64] Balanced crystalloids Uncompleted OctaplasLG Clinical Stensballe et al (2018) [65] FFP More beneficial FFP Animal Nelson et al (2016) [66] Albumin, RA No difference FFP: Fresh frozen plasma; FWB: Fresh whole blood; HES: Hydroxyethyl starch; LR: Lactated Ringer solution; NS: Normal saline; OctaplasLG: Solvent-/ detergent-treated pooled plasma; RA: Ringer acetate; -: Not available.…”

“…Li et al [ 41 ] speculated that 6% HES and albumin might protect the glycocalyx integrity in patients undergoing brain surgery, excluding the factor of fluid overload. Kaneko et al [ 42 ] also found that HES administration did not aggravate the glycocalyx degradation in patients undergoing abdominal surgery. Moreover, Smart et al [ 43 ] found that compared with fresh whole blood, fluid resuscitation with HES significantly decreased the plasma hyaluronan concentration 20 min after fluid administration in a canine model of hemorrhagic shock.…”

Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II

“…A study reported that 59.0% of patients who developed PIH might have hypovolemia before anesthesia induction [ 10 ]. Previous studies have indicated that inadequate volume before anesthesia induction is the primary cause of PIH and perioperative fluid therapy in surgical patients before induction reduces the incidence of PIH while promoting more stable intraoperative circulation [ 11 , 12 ]. Resting pupil size and maximum constriction velocity, as well as heart rate (HR) variability can predict PIH, but these predictive indices do not comprehensively assess preoperative blood volume status in its development [ 13 – 15 ].…”

Editorial: Fluid Therapy in Animals: Physiologic Principles and Contemporary Fluid Resuscitation Considerations

“…In addition, vasoactive drugs are known to alter fluid volume kinetics ( 215 – 219 ). Stimulation of alpha1- adrenergic receptors (e.g., norepinephrine; phenylephrine) increases V d , Cl d , the accumulation of fluid in V t , and Cl r while stimulation of beta-1 adrenergic receptors (e.g., isoproterenol) increase V c and decrease V d , Cl d , and Cl r ( 69 , 216 , 217 , 220 ). Notably, fluid accumulation in V t is more significantly influenced by the rate of infusion (i.e., ml/kg/min) than by the infused fluid volume; higher infusion rates produce greater degrees of interstitial fluid accumulation, hemodilution, coagulation abnormalities, and organ dysfunction ( 79 , 199 , 203 , 221 , 222 ).…”