Ringer’s lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial

Li, Yuhong; He, Rui; Ying, Xiaojiang; Hahn, Robert G.

doi:10.1186/s12871-015-0053-5

Cited by 23 publications

(17 citation statements)

References 22 publications

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“…Adverse effects of crystalloids are associated with their preferential distribution to the subcutis, gut, and lungs. When more than 2 L is administered, the gastrointestinal recovery time is delayed by 2 days [76]. Infusion of even larger amounts of crystalloids during open abdominal surgery causes impaired wound healing, pulmonary edema, pneumonia, and pitting edema in the leg [53,54].…”

Section: Adverse Effects Of Fluidsmentioning

confidence: 99%

Fluid management in perioperative and critically ill patients

Kang

Yoo²

2019

Acute Crit Care

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Fluid management in perioperative and critically ill patients Fluid therapy to restore and/or maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. Kinetic analyses and outcome-oriented studies have provided more insight into fluid management. Crystalloids are slowly distributed to the interstitial space, and the efficiency (proportion of infused fluid retained in the bloodstream) is 50%−75% as long as infusion continues and may increase up to 100% when the arterial pressure has decreased. Elimination of the infused fluid during general anesthesia and surgery is very slow, amounting to only 10%-20% compared with that in conscious patients. When the endothelial glycocalyx layer is degraded in sepsis or trauma-induced systemic inflammation, turnover of colloids and crystalloids is accelerated and the efficiency is reduced, which may lead to tissue edema, inflammation, poor wound healing, and organ dysfunction. Balanced crystalloids are pragmatic initial resuscitation fluids and improve patient outcomes compared to saline (0.9% sodium chloride). Albumin may be beneficial, but other synthetic colloids appear to increase the risk of acute kidney injury and death among patients in the intensive care unit. Fluid kinetics is likely to change based on patient physiological conditions (e.g., general anesthesia, surgery, stress, dehydration, blood pressure, or inflammation) and fluid types. To maximize efficacy and minimize iatrogenic side effects, fluids should be prescribed based on individual patient factors, disease states, and other treatment remedies.

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Section: Adverse Effects Of Fluidsmentioning

confidence: 99%

Fluid management in perioperative and critically ill patients

Kang

Yoo²

2019

Acute Crit Care

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“…Anesthesiologists select the appropriate fluid type for the patient and administer the appropriate amount of fluid. Previous studies have shown that the type of fluid therapy is associated with postoperative recovery and prognosis [1][2][3][4]. For successful fluid therapy, it is helpful to quantify how the administered fluid is distributed and eliminated from the body.…”

Section: Introductionmentioning

confidence: 99%

Population-based volume kinetics of Ringer’s lactate solution in patients undergoing open gastrectomy

Lee¹,

Choo

Lee

et al. 2018

Acta Pharmacol Sin

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In order to maintain stable blood pressure and heart rate during surgery, anesthesiologists need to administer the appropriate amount of fluid with appropriate fluid type to the patient, then quantifying how fluid is distributed and eliminated from the body is useful for establishing a fluid administration strategy. In this study we characterized the volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy. When propofol and remifentanil reached a pseudosteady state at the target concentration and blood pressure was stabilized following surgical stimulation, enrolled patients were administered 1000 mL of Ringer's lactate solution for 20 min, followed by continuous infusion at a rate of 6 mL/kg/h until the time of the last blood collection for volume kinetic analysis. Arterial blood samples were collected to measure the hemoglobin concentration at different time points. The change in hemoglobin-derived plasma dilution induced by the administration of Ringer's lactate solution was evaluated by nonlinear mixed effects modeling. Three hundred and twenty-three plasma dilution data points from 27 patients were used to determine the pharmacokinetic characteristics of Ringer's lactate solution. A two-volume model best described the pharmacokinetics of Ringer's lactate solution. The mean arterial pressure (MAP) and body weight (WT) were significant covariates for the elimination clearance (k r ) and central volume of distribution at baseline (V c0 ), respectively. The parameter estimates were as follows: k r (mL/min) = 124 + (MAP/70) 14.2 , V c0 (mL) = 0.95 + 3440 × (WT/63), V t0 (mL) = 2730, and k t (mL/min) = 181. A higher MAP was associated with a greater elimination clearance and, consequently, less water accumulation in the interstitium. As body weight increases, volume expansion in the blood vessels increases.

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“…The first clinical consequence when administrating more than 2 litres of fluid is a delay in the gastrointestinal recovery time of 2 days [9]. However, the total number of postoperative complications still seems to be lowest when providing between 1.75 and 2.75 L of crystalloid fluid during open abdominal surgery [10].…”

Section: Adverse Effects Of Crystalloid Fluidsmentioning

confidence: 99%

Adverse effects of crystalloid and colloid fluids

Hahn¹

2014

Anaesthesiol Intensive Ther

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Guidelines for infusion fluid therapy rarely take into account that adverse effects occur in a dose-dependent fashion. Adverse effects of crystalloid fluids are related to their preferential distribution to the interstitium of the subcutis, the gut, and the lungs. The gastrointestinal recovery time is prolonged by 2 days when more than 2 litres is administered. Infusion of 6-7 litres during open abdominal surgery results in poor wound healing, pulmonary oedema, and pneumonia. There is also a risk of fatal postoperative pulmonary oedema that might develop several days after the surgery. Even larger amounts cause organ dysfunction by breaking up the interstitial matrix and allowing the formation of lacunae of fluid in the skin and central organs, such as the heart. Adverse effects of colloid fluids include anaphylactic reactions, which occur in 1 out of 500 infusions. The possibility that hydroxyethyl starch causes kidney injury in patients other than those with sepsis is still unclear. For both crystalloid and colloid fluids, coagulation becomes impaired when the induced haemodilution has reached 40%. Coagulopathy is aggravated by co-existing hypothermia. Although oedema can occur from both crystalloid and colloid fluids, these differ in pathophysiology. To balance fluid-induced adverse effects, this review suggests that a colloid fluid is indicated when the infused crystalloid volume exceeds 3-4 litres, plasma volume support is still needed, and the transfusion of blood products is not yet indicated.

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Ringer’s lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial

Cited by 23 publications

References 22 publications

Fluid management in perioperative and critically ill patients

Fluid management in perioperative and critically ill patients

Population-based volume kinetics of Ringer’s lactate solution in patients undergoing open gastrectomy

Adverse effects of crystalloid and colloid fluids

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