title: Stroke volume-directed administration of hydroxyethyl starch or Ringer's acetate in sitting position during craniotomy.
abstract: BACKGROUND
  To determine the volumes required for stable haemodynamics and possible effects on the coagulation, we studied stroke volume (SV)-directed administration of hydroxyethyl starch (HES 130 kDa/0.4) and Ringer's acetate (RAC) in neurosurgical patients operated on in a sitting position.
  
  
  METHODS
  Thirty craniotomy patients were randomised to receive either HES or RAC. Before positioning, SV, measured by arterial pressure waveform analysis, was maximised by boluses of fluid until SV did not increase more than 10%. SV was maintained by repeated administration of fluid. RAC 3 ml/kg/h was infused in both groups during surgery.
  
  
  RESULTS
  Comparable haemodynamics were achieved with the mean [standard deviation (SD)] cumulative doses of HES or RAC 271 (47) or 264 (50) ml (P = 0.699) before the sitting position. Mean (SD) doses of HES or RAC at 30 min after the positioning were 343 (94) or 450 (156) ml (P = 0.036), and at the end of surgery 464 (284) or 707 (425) ml, respectively (P = 0.087). The intraoperative fluid balance was more positive in the RAC than in the HES group [P = 0.044, 95% confidence interval (CI) -978 to -14]. Cardiac and stroke volume indexes [CI and stroke volume index (SVI)] increased in the HES group (P < 0.05) but not in the RAC group [non significant (N.S.)]. Neither coagulation profile nor blood loss differed between the groups.
  
  
  CONCLUSIONS
  Fluid filling with HES boluses resulted in a positive response in CI and SVI during the sitting position. The 34% smaller volume of HES than crystalloid and less positive fluid balance in the HES group might be important in craniotomy patients with decreased brain compliance.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. ann-christine.lindroos@hus.fi
authors.forename: A-C B
authors.initials: AC
authors.lastname: Lindroos
authors.forename: T
authors.initials: T
authors.lastname: Niiya
authors.forename: M
authors.initials: M
authors.lastname: Silvasti-Lundell
authors.forename: T
authors.initials: T
authors.lastname: Randell
authors.forename: J
authors.initials: J
authors.lastname: Hernesniemi
authors.forename: T T
authors.initials: TT
authors.lastname: Niemi
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001777:Blood Coagulation / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D003399:Craniotomy / Q000379:methods*; D004618:Embolism, Air / Q000517:prevention & control; D005260:Female; D005440:Fluid Therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000494:pharmacology; D007022:Hypotension / Q000517:prevention & control; D007427:Intracranial Pressure; D007431:Intraoperative Complications / Q000517:prevention & control; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000494:pharmacology; D011187:Posture; D011229:Preanesthetic Medication; D013318:Stroke Volume / Q000187:drug effects; D013916:Thrombelastography; D014680:Veins
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; C028570:Ringer's acetate