Plasma volume replacement with HES 130/0.42 obviates negative side effects of pneumoperitoneum in piglets.
BACKGROUND
Evidence-based guidelines on optimal perioperative fluid management in infants have not been established. Recent randomized trials in major abdominal surgery in adults suggest that large volumes of fluid may increase morbidity and hospital stay. Our own clinical experience in infants undergoing laparoscopic surgery is different. So the aim of this study was to compare a crystalloid vs a plasma volume stabilizing fluid management regime during prolonged pneumoperitoneum (PP) in an experimental setting.


METHODS
Fifteen German landrace piglets were randomized to one of the following treatment groups: control (no PP, 5 ml x kg(-1) x h(-1) electrolyte solution); crystalloid (180 min of PP, 5 ml x kg(-1) x h(-1) electrolyte solution); colloid (180 min of PP, single bolus of 5 ml x kg(-1) followed by 5 ml x kg(-1) x h(-1) hydroxyethyl starch 130/0.42/6:2). After decompression, monitoring was continued for a further 120 min. During the investigation, the hemodynamic situation including transpulmonary thermodilution and blood gases was monitored periodically.


RESULTS
During the study, mean arterial pressure remained within the normal range in colloid-treated animals and controls, but was significantly lower in crystalloid-treated animals after decompression of PP. Cardiac output remained within the normal range in the colloid and control groups, but decreased in the crystalloid-treated animals. In the crystalloid group, the lactate concentrations were higher and base excess was lower than in the colloid and control groups at 240 and 300 min (study end).


CONCLUSIONS
This study shows that the negative effects of prolonged PP on hemodynamics and acid-base balance can be obviated by a liberal plasma volume stabilization regimen with colloids.
Osthaus
Wilhelm Alexander
WA
Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Germany. osthaus.alexander@mh-hannover.de
Huber
Dirk
D
Bäumker
Christoph
C
Witt
Lars
L
Metzelder
Martin
M
Kuebler
Jochen
J
Sümpelmann
Robert
R
D000818:Animals; D001639:Bicarbonates / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D005440:Fluid Therapy; D006339:Heart Rate / Q000502:physiology; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D019344:Lactic Acid / Q000097:blood; D010952:Plasma Substitutes / Q000627:therapeutic use*; D010953:Plasma Volume / Q000187:drug effects*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011897:Random Allocation; D012965:Sodium Chloride / Q000494:pharmacology; D013552:Swine; D016896:Treatment Outcome
D001639:Bicarbonates; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D019344:Lactic Acid; D012965:Sodium Chloride