Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery

Abstract

BackgroundThe European Medicines Agency does not recommend the use of hydroxyethyl starch-based volume replacement solutions in critically ill patients due to an increased risk of renal failure. However, this recommendation is questionable for its perioperative use. Several recent randomised controlled studies do not indicate a risk for renal failure—not even after high-risk surgery. Human albumin is used in our neurointensive care unit as a part of the “Lund concept” of brain injury resuscitation, and albumin has been introduced in elective neurosurgery instead of starch. The aim of our prospective unblinded observational cohort study was to compare the degree of dilutive coagulopathy after albumin and starch intra-operative fluid therapy.MethodsThirty-nine patients undergoing elective brain tumour surgery with craniotomy received either 130/0.42 hydroxyethyl starch or 5 % albumin infusions. The first 18 patients received starch, whereas the rest received albumin. Rotational thromboelastometry with ROTEM and platelet aggregometry with Multiplate were performed before surgery, after the first and second consecutive colloid infusions (250/500 ml albumin or 500/1000 ml starch) and at the end of surgery.ResultsBoth intra- and inter-group comparisons showed more deranged ROTEM parameters after the higher doses of starch. Multiplate detected changes only in the albumin group after 500-ml infusion. Blood los did not differ between groups, nor did haemoglobin preoperatively or at end of surgery. Lower volumes of albumin were required to maintain stable intra-operative haemodynamic parameters; 250/500 ml albumin corresponded to 500/1000 ml starch.ConclusionsHydroxyethyl starch affected coagulation at lower volumes, with a more prominent effect on clot structure at the end of surgery, corroborating previous research. Only albumin decreased platelet aggregation, and 5 % albumin had a more potential volume effect than 130/0.42 hydroxyethyl starch.

Anaemia and red blood cell transfusion in intracranial neurosurgery: a comprehensive review

“…Similarly, synthetic starch solutions inhibit platelet function 46 and recent evidence demonstrated that their use results in alteration in rotational thromboelastography parameters in elective brain tumour resection. 47 Nevertheless, a retrospective cohort study failed to demonstrate an association between post-craniotomy haematoma and the use of hydroxyethyl starch solutions, 45 and further research is needed to clarify their safety in this population. In contrast, certain neurosurgical populations may benefit from anticoagulation, such as those patients with symptomatic carotid stenosis.…”

Vérzésmegelőzés és -kezelés a neuroanesztézia és neurointenzív ellátás során

“…Az utóbbi években azonban több tanulmány iga zolta, hogy alkalmazásuk nem növeli az intraoperatív vérvesztés mértékét. Ezen adatok ismeretében az idegse bészeti anesztéziában csak körültekintéssel alkalmazha tók [14,15]. Masszív vérzés esetén a perioperatív vérzésmenedzs ment elvei szerint kell eljárni, annak figyelembevételével, hogy az idegsebészeti műtétek alatt a fibrinogénszintet 2 g/dl szint fölött kell tartani.…”

Fluid management in infants and children during intracranial surgery

“…Albumin and hydroxyethyl starch 130/0.42 may produce weaker clot in neurosurgical patients, and hence monitoring of coagulation during their use has been advocated. [12,13] These effects are clinically insignificant if infused volume is <25% of the patient's blood volume. [1] Tetrastarch in balanced salt solution (e.g., Volulyte, Tetraspan) offer some advantage in preserving renal function and are considered safe in infants and children.…”