The Next Generation of Colloids: Ready for “Prime Time”?

Nussmeier, Nancy A.; Searles, Bruce

doi:10.1213/ane.0b013e3181bef685

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…The crystalloid carrier solutions of individual colloids contain varying quantities of chloride, and in large volumes, can cause hyperchloraemic acidosis, which may have clinical significance 48,50 . Future studies should also evaluate the role of newer balanced colloid solutions in this setting as done by Senagore 51 …”

Section: Discussionmentioning

confidence: 99%

Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials

Srinivasa

Taylor

Sammour

et al. 2010

Acta Anaesthesiologica Scandinavica

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The evidence underpinning oesophageal Doppler monitoring (ODM)-guided fluid administration in colorectal surgery has not been critically appraised despite quantitative meta-analyses. A qualitative systematic review of the methodology and findings of all published randomised-controlled trials (RCTs) exploring ODM-guided fluid administration in major abdominal surgery was conducted. Four, well-designed single-centre trials inclusive of 393 patients in total have primarily demonstrated that ODM-guided intraoperative fluid administration decreases hospital length of stay (LOS) and complications by optimising intraoperative cardiac parameters. One subsequently published RCT shows that ODM-guided fluid administration predisposes to a greater LOS and significantly increased complications. However, all the trials have been hampered by imprecise definitions with heterogeneity in patient selection, intraoperative fluid administration strategies and methods of outcome assessment. ODM-guided fluid administration has only been investigated in the setting of laparoscopic colonic surgery and within an optimised perioperative care protocol in one trial, where it was not shown to be beneficial. Nevertheless, it was recommended for use in this context before the trial was even published. ODM-guided fluid administration has not been compared with intraoperative fluid restriction. Current evidence regarding the use of Doppler-guided fluid administration is limited by heterogeneity in the trial design, and the initial clinical benefits observed may be largely offset by recent advances in surgical techniques and perioperative care.

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Section: Discussionmentioning

confidence: 99%

Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials

Srinivasa

Taylor

Sammour

et al. 2010

Acta Anaesthesiologica Scandinavica

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“…Hydroxyethyl starches are modified natural polysaccharides. 5,6 Crystalloids and Colloids have an impact on blood coagulation and also have an effect on metabolism causing hyperglycemia.and the same has been evaluated in our study. A majority of the studies conducted on starch solutions have evaluated their volume expansion properties and their impact on blood coagulation.…”

Section: Discussionmentioning

confidence: 94%

A Comparative Study of Effect of 6% Hestar and Ringer’s Lactate on Intraoperative Blood Sugar Levels During Lower Abdominal Surgeries Under Spinal Anaesthesia

Raghu¹,

Indira²,

R³

2015

jebmh

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BACKGROUND: Crystalloids and Colloids are extensively used as maintenance fluids in the perioperative period to maintain normal Homeostatic mechanisms. Ringer's Lactate and Hydroxy Ethyl Starches produce significant levels of free glucose residues. AIM: To compare blood glucose levels by preloading with Ringers lactate solution at 20 ml/kg body weight versus 6% Hydroxy Ethyl starch @10ml/ kg body in non diabetic patients posted for elective surgeries under spinal anaesthesia. MATERIALS AND METHODS: 60 non-diabetic adult patients of ASA Physical Status I and II posted for elective lower abdominal surgeries under spinal anaesthesia were randomly divided into two groups of 30 in each group. Group-R to receive Ringers lactate-20 ml/kg and Group-H received 6% Hestar-10 ml /kg over half an hour prior to subarachnoid block as preloading fluid. Serial random glucose measurements were taken thereafter at specified time intervals upto 180 minutes. RESULTS: Group R (RL), maximal mean blood glucose levels of 94.72mg/dl were found at 60 mins from the onset of preloading indicating an increase of 12.8mg/dl from the baseline which was found to be statistically significant p=0.031 (p<0.05). This was followed by a gradual fall upto 93.88mg/dl at end of study period of 180 min. In Group-H the difference between the reading at the end of 180mins and the baseline was 13.88mg/dl and this difference was found to be still statistically significant p=0.022 (p<0.05). CONCLUSION: In addition to stress response to surgery, use of Ringers lactate and HES 6% significantly raised the blood sugar levels more with Hydroxyethyl Starch 6%. So their use in the perioperative period should be judicious as inadvertent usage can result in potential ill effects.

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“…Les auteurs rapportaient au bénéfice de l'HEA, l'absence d'acidose induite, une moindre réponse inflammatoire, une meilleure préservation des paramètres de la crase sanguine, l'absence d'augmentation de marqueurs sériques infracliniques d'altération tubulaire rénale. Un éditorial accompagnait l'article [2], insistant sur les limites de l'étude, mais se plaçant aussi dans une perspective raisonnable d'utilisation des HEA de dernière génération dans cette indication, sous réserve, bien sûr, d'essais contrôlés de plus forte puissance.…”

Section: Les Faitsunclassified

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Dequin

2011

Réanimation

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The Next Generation of Colloids: Ready for “Prime Time”?

Cited by 8 publications

References 26 publications

Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials

Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials

A Comparative Study of Effect of 6% Hestar and Ringer’s Lactate on Intraoperative Blood Sugar Levels During Lower Abdominal Surgeries Under Spinal Anaesthesia

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