Abstract
BackgroundVolume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients.MethodsIn this randomized controlled trial, 60 patients undergoing intracranial tumor resection under general anesthesia were assigned to HES and HA groups (n = 30), and administered preloads of 20 mL · kg−1 HES 130/0.4 and 5% HA, respectively, prior to dura opening. Primary outcomes were perioperative thromboelastography findings, and hemodynamic and hematological parameters. Blood transfusion, perioperative fluid balance, intracranial pressure, mortality, intensive care unit stay, and hospital stay were also assessed.ResultsTEG parameters did not differ after preloading compared to baseline values in either group, except for a decrease in maximum amplitude immediately after infusion (HES group, 57.6 ± 6.0 mm vs. 50.9 ± 9.2 mm; HA group, 60.1 ± 7.9 mm vs. 56.6 ± 7.1 mm; p < 0.01), which was restored to preoperative levels 1 h after fluid infusion. Total perioperative fluid balance, blood loss or transfusion, intracranial pressure, and hematological and hemodynamic variables were similar between both groups (p > 0.05). Mortality, length of hospital stay, and clinical complications were similar between both groups.ConclusionThese findings suggest that HES and HA might have no significant differences regarding coagulation as assessed by TEG during pediatric intracranial tumor surgery with 20 ml/kg volume pre-loading, which can maintain stable hemodynamics and may represent a new avenue for volume therapy during brain tumor resection in pediatrics.Trial registrationChiCTR-IPR-16009333, retrospectively registered October 8, 2016
Highlights
Volume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding
We tested the hypothesis that 6% hydroxyethyl starch (HES) 130/0.4 more effectively affects blood coagulation than 5% Human Albumin (HA), as assessed by thromboelastography (TEG), during brain tumor resection in pediatric patients. In this prospective, randomized, double blind trial, 60 pediatric patients with American Society of Anesthesiologists physical status III, scheduled to undergo elective intracranial tumor resection at Xinhua Hospital affiliated to Shanghai Jiao Tong between October 2011 and January 2013, were sequentially enrolled
Patient demographic and biometric data, and anesthesia and surgery durations did not differ between groups (Table 1)
Summary
Volume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients. Hypovolemia is the most common cause of circulatory failure in children during intracranial tumor surgery. Treatment options for replacing blood volume deficiencies in pediatric surgical patients include crystalloids and colloids. In case of acute and massive blood loss, colloids may be used to rapidly treat or prevent hypovolemia, due to prolonged intravascular halflife and improved intravascular volume effects [1, 2]. The ideal colloid therapy has not been found in pediatric patients undergoing intracranial tumor surgery. Synthetic colloids are increasingly used, with each having unique physicochemical characteristics that determine the likely efficacy and adverse effects [4]
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