Ringer's lactate with or without 3% dextran-60 as volume expanders during abdominal aortic surgery

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Maintaining adequate intravascular volume is crucial during major abdominal aortic surgery.
• Ringer's lactate (RL) is a common crystalloid fluid, but its use may lead to significant fluid shifts.
• Colloid solutions are often considered for improved volume expansion.

Purpose of the Study:

• To compare the efficacy of a 3% dextran-60 (D60) in Ringer's lactate (RL) solution versus RL alone as maintenance fluids.
• To evaluate the impact on intravascular volume and hemodynamic stability during and after abdominal aortic surgery.

Main Methods:

• A randomized controlled trial involving 20 patients undergoing elective aortic reconstructive surgery.
• Fluid management guided by pulmonary artery occlusion pressure and urine output.
• Intraoperative fluid infusion rates: 36 mL/kg D60 and 104 mL/kg RL (1:2.9 ratio).

Main Results:

• Patients receiving RL alone experienced a significantly greater increase in body weight at 24 hours (7.8 kg) compared to those receiving D60 (3.2 kg).
• Intravascular albumin decreased in both groups, but D60 infusion resulted in plasma volume expansion (4.4 mL/kg) at 1 hour, unlike RL which caused a decrease (-7.0 mL/kg).
• Approximately 51% of infused D60 and 6% of RL contributed to plasma volume expansion at 1 hour.

Conclusions:

• A diluted colloid solution (3% dextran-60 in Ringer's lactate) is valuable for maintaining intravascular volumes.
• This D60/RL solution significantly improves hemodynamic stability during and after major operative procedures.
• Dextran-60 demonstrates superior plasma volume expansion compared to Ringer's lactate alone in this surgical context.