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Article

Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial

1
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
2
Department of Surgery, HPB-Center, Kaiser Franz Josef Hospital Vienna, Kundratstrasse 3, 1100 Vienna, Austria
*
Author to whom correspondence should be addressed.
Academic Editors: Giustino Varrassi and Katarzyna Kotfis
J. Clin. Med. 2021, 10(8), 1651; https://doi.org/10.3390/jcm10081651
Received: 3 March 2021 / Revised: 27 March 2021 / Accepted: 9 April 2021 / Published: 13 April 2021
(This article belongs to the Section Anesthesiology)
The use of colloids may impair hemostatic capacity. However, it remains unclear whether this also holds true when colloids are administered in a goal-directed manner. The aim of the present study was to assess the effect of goal-directed fluid management with 6% hydroxyethyl starch 130/0.4 on hemostasis compared to lactated Ringer’s solution in patients undergoing partial hepatectomy. We included 50 patients in this prospective, randomized, controlled trial. According to randomization, patients received boluses of either hydroxyethyl starch or lactated Ringer’s solution within the scope of goal-directed fluid management. Minimum perioperative FIBTEM maximum clot firmness (MCF) served as the primary outcome parameter. Secondary outcome parameters included fibrinogen levels and estimated blood loss. In the hydroxyethyl starch (HES) group the minimum FIBTEM MCF value was significantly lower (effect size −6 mm, 95% CI −10 to −3, p < 0.001) in comparison to the lactated Ringer’s solution (RL) group. These results returned to normal within 24 h. We observed no difference in plasma fibrinogen levels (RL 3.08 ± 0.37 g L−1 vs HES 2.65 ± 0.64 g L−1, p = 0.18) or the amount of blood loss between the two groups (RL 470 ± 299 mL vs HES 604 ± 351 mL, p = 0.18). We showed that goal-directed use of HES impairs fibrin polymerization in a dose-dependent manner when compared with RL. Results returned to normal on the first postoperative day without administration of procoagulant drugs and no differences in blood loss were observed. View Full-Text
Keywords: goal-directed fluid management; perioperative hemostasis; colloids; abdominal surgery; viscoelastic coagulation tests goal-directed fluid management; perioperative hemostasis; colloids; abdominal surgery; viscoelastic coagulation tests
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MDPI and ACS Style

Gratz, J.; Zotti, O.; Pausch, A.; Wiegele, M.; Fleischmann, E.; Gruenberger, T.; Krenn, C.G.; Kabon, B. Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial. J. Clin. Med. 2021, 10, 1651. https://doi.org/10.3390/jcm10081651

AMA Style

Gratz J, Zotti O, Pausch A, Wiegele M, Fleischmann E, Gruenberger T, Krenn CG, Kabon B. Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial. Journal of Clinical Medicine. 2021; 10(8):1651. https://doi.org/10.3390/jcm10081651

Chicago/Turabian Style

Gratz, Johannes, Oliver Zotti, André Pausch, Marion Wiegele, Edith Fleischmann, Thomas Gruenberger, Claus G. Krenn, and Barbara Kabon. 2021. "Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial" Journal of Clinical Medicine 10, no. 8: 1651. https://doi.org/10.3390/jcm10081651

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