Abstract
BackgroundThe time course of plasma albumin concentration (P-alb) and cumulative perioperative albumin shift as a measure of albumin extravasation in major abdominal surgery is not well described. Knowledge of these indices of the vascular barrier and vascular content are important for our understanding of fluid physiology during surgery and anesthesia.MethodsPatients (n = 10) were studied during esophageal or pancreatic surgery. P-alb was repeatedly measured over 72 h, and the mass balance of albumin and hemoglobin were obtained from measures of P-alb, blood hemoglobin and hematocrit.ResultsP-alb decreased rapidly from baseline (32.8 ± 4.8 g/L) until the start of surgical reconstruction (18.7 ± 4.8 g/L; p < 0.001), and was thereafter stable until postoperative day 3. Cumulative perioperative albumin shift increased until 1 h after the end of surgery, when 24 ± 17 g (p < 0.001) had been lost from the circulation.ConclusionsThe rapid fall in P-alb of more than 40 % consistently occurred during the first part of the surgical procedure, but albumin leakage progressed until 1 h after the end of surgery. After the initial drop, P-alb was stable for 72 h.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1283-8) contains supplementary material, which is available to authorized users.
Highlights
The time course of plasma albumin concentration (P-alb) and cumulative perioperative albumin shift as a measure of albumin extravasation in major abdominal surgery is not well described
In a previous study we reported a 35 % decrease in P-alb 2 days after major abdominal surgery compared to preoperative values [6]
We were unable to demonstrate any persistent elevation of albumin transcapillary escape rate on the second postoperative day, suggesting that capillary leakage had ceased at that time point
Summary
The time course of plasma albumin concentration (P-alb) and cumulative perioperative albumin shift as a measure of albumin extravasation in major abdominal surgery is not well described. Knowledge of these indices of the vascular barrier and vascular content are important for our understanding of fluid physiology during surgery and anesthesia. The decrease in plasma albumin concentration (P-alb) in association with surgical trauma is well known, and the mechanisms are probably multifactorial, but an increase in capillary leakage is thought to be a major component. We were unable to demonstrate any persistent elevation of albumin transcapillary escape rate on the second postoperative day, suggesting that capillary leakage had ceased at that time point
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