[Perioperative fluid therapy influences coagulation, blood loss and post-operative complications].

Literature on fluid therapy for surgery is updated in regard to coagulation, blood loss and post-operative complications. Haemorrhage depends on the surgical intervention but also on the chosen fluid therapy with artificial colloids affecting coagulation competence and in turn the blood loss. Furthermore, a stable central blood volume as indicated by plasma pro-atrial natriuretic peptide requires a calculated fluid surplus by approximately 2.5 l. Randomized controlled trials recommend haemorrhage to be treated by administration of a crystalloid; however, if the calculated excess of fluid approaches 2 l, albumin may be added.

Effect of perioperative colloid and crystalloid fluid therapy on coagulation competence, haemorrhage and outcome.

BACKGROUND: Haemorrhage follows surgical intervention, but also fluid substitution may affect the blood loss. Here influence of colloids and lactated Ringer's solution (LR) on coagulation competence and haemorrhage is evaluated during cystectomy. METHODS: A meta-analysis, a prospective observational study and three randomized controlled trials were conducted - 17 patients received HES 130/0.4, 19 patients Dextran 70, 19 patients human albumin, and 54 patients LR - with blinded evaluation of blood loss and outcome while coagulation competence was evaluated by thromboelastography (TEG) and plasma coagulation analyses. RESULTS: Administration of HES reduced TEG determined "maximal amplitude" (TEG-MA) from 64±6 to 52±7 mm associated with a 2181±1190 mL blood loss. For Dextran values were 65±7 to 49±9 mm and 2339±1471 mL, respectively, for albumin 62±6 to 59±6 mm and 1658±684 mL compared to 65±6 to 64±6 mm and 1559±976 mL with the use of LR. Furthermore, reduced TEG-MA was independently associated with the perioperative blood loss.  A straight postoperative course was seen less often after infusion of synthetic colloids versus albumin/LR (7/36 vs. 31/73), P=0.02. CONCLUSIONS: Perioperative bleeding is related to administration of Dextran 70 followed by HES 130/0.4 whereas albumin and LR result in a similar low level of haemorrhage. Furthermore, evaluation of coagulation competence by TEG-MA appears superior to plasma coagulation analyses for predicting the perioperative blood loss and supports that haemorrhage depends not only on the surgical intervention but also on the perioperative fluid therapy of apparent consequence for outcome.