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Journal of Anesthesia

Published in:

01-04-2014 | Original Article

Stroke volume-directed administration of hydroxyethyl starch (HES 130/0.4) and Ringer’s acetate in prone position during neurosurgery: a randomized controlled trial

Authors: Ann-Christine Lindroos, Tomohisa Niiya, Tarja Randell, Tomi T. Niemi

Published in: Journal of Anesthesia | Issue 2/2014

Abstract

Purpose

General anesthesia in the prone position is associated with hypotension. 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 prone position to determine the volumes required for stable hemodynamics and possible coagulatory effects.

Methods

Thirty elective neurosurgical patients received either HES (n = 15) or RAC (n = 15). Before positioning, SV measured by arterial pressure waveform analysis was maximized by fluid boluses 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. Thromboelastometry assessed coagulation. Mann–Whitney U test, Wilcoxon signed-rank test, ANOVA on ranks, and a linear mixed model were applied.

Results

Comparable hemodynamics were achieved with the mean cumulative (SD) boluses of HES or RAC 240 (51) or 267 (62) ml (P = 0.207) before positioning, 340 (124) or 453 (160) ml (P = 0.039) 30 min after positioning, and 440 (229) or 653 (368) ml at the end of surgery (P = 0.067). The mean dose of basal RAC infusion was 813 (235) and 868 (354) ml (P = 0.620) in the HES and RAC group, respectively. Formation and maximum strength of the fibrin clot were decreased in the HES group. Intraoperative blood loss was comparable between groups (P = 0.861).

Conclusion

The amount of RAC needed in the prone position was 25 % greater. The cumulative dose of 440 ml HES induced a slight disturbance in fibrin formation and clot strength. We suggest cautious administration of HES during neurosurgery.

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Title: Stroke volume-directed administration of hydroxyethyl starch (HES 130/0.4) and Ringer’s acetate in prone position during neurosurgery: a randomized controlled trial
Authors: Ann-Christine Lindroos
Tomohisa Niiya
Tarja Randell
Tomi T. Niemi
Publication date: 01-04-2014
Publisher: Springer Japan
Published in: Journal of Anesthesia / Issue 2/2014
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-013-1711-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stroke volume-directed administration of hydroxyethyl starch (HES 130/0.4) and Ringer’s acetate in prone position during neurosurgery: a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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