Effects of colloid pre-loading on thromboelastography during elective intracranial tumor surgery in pediatric patients: hydroxyethyl starch 130/0.4 versus 5% human albumin

Abstract

BackgroundVolume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients.MethodsIn this randomized controlled trial, 60 patients undergoing intracranial tumor resection under general anesthesia were assigned to HES and HA groups (n = 30), and administered preloads of 20 mL · kg−1 HES 130/0.4 and 5% HA, respectively, prior to dura opening. Primary outcomes were perioperative thromboelastography findings, and hemodynamic and hematological parameters. Blood transfusion, perioperative fluid balance, intracranial pressure, mortality, intensive care unit stay, and hospital stay were also assessed.ResultsTEG parameters did not differ after preloading compared to baseline values in either group, except for a decrease in maximum amplitude immediately after infusion (HES group, 57.6 ± 6.0 mm vs. 50.9 ± 9.2 mm; HA group, 60.1 ± 7.9 mm vs. 56.6 ± 7.1 mm; p < 0.01), which was restored to preoperative levels 1 h after fluid infusion. Total perioperative fluid balance, blood loss or transfusion, intracranial pressure, and hematological and hemodynamic variables were similar between both groups (p > 0.05). Mortality, length of hospital stay, and clinical complications were similar between both groups.ConclusionThese findings suggest that HES and HA might have no significant differences regarding coagulation as assessed by TEG during pediatric intracranial tumor surgery with 20 ml/kg volume pre-loading, which can maintain stable hemodynamics and may represent a new avenue for volume therapy during brain tumor resection in pediatrics.Trial registrationChiCTR-IPR-16009333, retrospectively registered October 8, 2016

Evaluation of renal function with administration of 6% hydroxyethyl starch and 4% gelatin in major abdominal surgeries: A pilot study

“…[20] Sawhney et al [20] compared standard and dynamic tests of coagulation (thromboelastogram) following the administration of HES, gelatin, and crystalloids in trauma patients and showed derangements in the thromboelastogram with administration of both HES and gelatins. However, Peng et al [21] did not find alterations in the thromboelastogram following colloid preloading with HES versus albumin in pediatric intracranial surgery. The results from Sawhney's study could be related to alterations in coagulation due to the underlying trauma, and we could not see any alteration in standard tests at the doses of colloids used in our study.…”

Comparison of hydroxyethylstarch (HES 130/0.4) and 5% human albumin for volume substitution in pediatric neurosurgery: A retrospective, single center study

“…Therefore, reduced Ca 2+ might be an advantage for the cellular survival in the penumbra, but is a disadvantage for the coagulation system since decreased Ca 2+ levels reduce its efficiency. HES impaired coagulation system in different ways and reduced clot formation in adults as well as in children [ 20 ]. Our results showed normal parameters in the HES group, whereas HA application decreased fibrinogen, increased PTT and blood loss.…”

Thromboelastography for the Orthopaedic Surgeon

“…Typically, TEG is used by a variety of medical subspecialties, including pathology, general surgery, and anesthesiology. 3,4,[8][9][10][11] The use of TEG in general surgery has revolutionized the acute care of traumatically injured patients because of the test's comprehensive ability to rapidly evaluate traumatic coagulopathy. 7,[12][13][14][15][16][17] By having a detailed picture of the coagulation profile, trauma surgeons are able to offer a more patient-specific delivery of blood products outside the generic 1:1:1 ratio (Packed Red Blood Cell [PRBC]:FFP:Platelets) for transfusion.…”