Colloid Transfusion Research Articles

The Relationship Between Colloid Transfusion During Surgical Decompression Hemicraniectomy Period and Postoperative Pneumonia or Long-Term Outcome After Space-Occupying Cerebral Infarction: A Retrospective Study

Colloid transfusion during surgical decompressive hemicraniectomy (DHC) to treat space-occupying cerebral infarction induced by middle cerebral artery (MCA) is controversial. A multicenter retrospective study was conducted to determine whether an increased colloid transfusion during surgery is associated with a lower incidence of postoperative pneumonia and better long-term outcomes after space-occupying cerebral infarction. Data from surgical DHC within 48 hours to treat space-occupying cerebral infarction that took place between November 30, 2013, and March 30, 2016, were collected in a multicenter chart. Univariate analysis, Spearman correlation, χ2 test, and bivariate and multivariate logistic regression were performed to account for the associations between colloid transfusion and postoperative pneumonia or long-term outcomes (indicated by modified Rankin Scale [mRS] scores). Univariate analysis showed that surgical duration and mRS were significantly different between the subjects older and younger than 60 years who underwent surgical DHC (P < 0.05). In the entire population studied, increased National Institutes of Health Stroke Scale was associated with a greater incidence of postoperative pneumonia (odds ratio [OR] 1.255, P= 0.003) and increased mRS (OR 1.229, P= 0.014). In the population older than 60 years, it was revealed that increased colloid transfusion was associated with a lower incidence of postoperative pneumonia (OR 0.761, P= 0.030) or better outcomes, as indicated with lower mRS (OR 0.837, P= 0.045). Our retrospective study demonstrated that there is a robust association between increased perioperative colloid transfusion and lower incidence of postoperative pneumonia and better outcomes among the patients older than 60 years after space-occupying cerebral infarction.

Decreased Tidal Volume With Increased Height, but not Colloid Transfusion, is Associated With Worse Outcomes and Postoperative Pneumonia After Coil Embolization of Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study.

The tidal volume setting as well as colloid transfusion during the peri-operative period after intracranial aneurysm is controversial. A multicenter retrospective study was conducted to determine whether or not an increased tidal volume setting and colloid transfusion are associated with poor outcomes and postoperative pulmonary complications after intracranial aneurysm. Data from endovascular coiling to treat intracranial aneurysms that took place between 30 March 2014 and 30 March 2016 were collected in a multicenter chart. The primary outcomes were better (defined as a Modified Rankin scores [MRS] ≤2) and worse outcomes (MRS ≥3). Secondary outcomes included pneumonia and non-pneumonia in patients with intracranial aneurysms. Univariate analysis, bivariate logistic regression, Spearman correlation, and a linear regression model were performed to account for the association between peri-operative risk factors and different outcomes. Bivariate logistic analysis showed that worse outcomes were correlated with height, Hunt and Hess scores (HHS), and Fisher grade (P < 0.05). There was no significant association between colloid transfusion and worse outcomes and postoperative pneumonia (P > 0.05). Postoperative pneumonia incidence was associated with increased height in a population with intracranial aneurysms (P < 0.05). The Spearman correlation and a linear regression model suggested that increased height was significantly correlated with lower tidal volume setting (per unit of body weight; P < 0.05). Decreased tidal volume with increased height, but not colloid transfusion, was independently associated with worse outcomes and postoperative pneumonia across a spectrum of risk profiles. These findings may help to improve practice decisions regarding tidal volume settings.

Impact of Continuous Intra and Post operative Thoracic Epidural Fentanyl–Bupivacaine Infusion on Patients Undergoing Major Upper Gastrointestinal Cancer Surgery

Background: Major Upper gastrointestinal cancer surgeries induce postoperative pain, that if not controlled may cause various organ dysfunctions and prolonged hospital and ICU stay. Thus an appropriate pain therapy to those patients must be applicated. Objective: To investigate the effects of Continuous intra and post operative thoracic epidural Fentanyl– bupivacaine infusion in patients undergoing Major Upper gastrointestinal cancer Surgery. Methods: 60 patients (ASA II) of either sex were scheduled for elective Upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (30 patients each) to receive, beside GA: continuous intra and post -operative intravenous infusion with fentanyl for 72 hours post-operatively (control group) or continuous intra and post -operative epidural infusion with bupivacaine 0.125% and fentanyl (TEA group) for 72 hours postoperatively. Intra-operative haemodynamics and fluid shift (blood loss, blood transfusion and colloid transfusion) were recorded. Postoperative pain was assessed over 72 h using visual analogue scale (VAS). And post-operative haemodynamics, sedation score and overall fentanyl consumption were recorded. Any concomitant side effects like nausea; vomiting, pruritus or respiratory complications were recorded postoperatively.

The occurrence, management and outcomes of post partum haemorrhage in a teaching hospital in Sri Lanka

<p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: x-small;"><em><strong>Introduction: </strong></em>In Sri Lanka post partum haemorrhage (PPH) accounted for 12.7% of maternal deaths in 2008. In 2009 The Sri Lanka College of Obstetricians and Gynaecologists carried out an in-service training program to reduce maternal morbidity and mortality from PPH.</span></span> <p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: x-small;"><em><strong>Objective: </strong></em>To evaluate the occurrence, management and outcomes of PPH in a teaching hospital in Sri Lanka and to identify appropriate remedial measures to improve the outcome of PPH.</span></span> <p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: x-small;"><em><strong>Design, Setting and Methods: </strong></em>Criteria based input, process and outcome indicators were used to carry out a clinical audit at the Academic Unit of the Teaching Hospital, Mahamodara Galle from 01 June 2010 to 31 December 2011. Areas where appropriate remedial measures could be adopted to prevent PPH and also improve its outcome were identified.</span></span> <p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: x-small;"><em><strong>Results: </strong></em>Of the 61 cases of PPH, 97% were identified by the need for blood or colloid transfusion. Morbidity and severe morbidity due to PPH and severe PPH were approx. 130 times and 50 times more respectively, compared to the deaths from PPH in 2008. PPH following Caesarean section (CS) and instrumental vaginal delivery (IVD) were approx. 1.3 times and 3.5 times higher compared to PPH after normal vaginal delivery. Induction of labour (IOL) or Augmentation of labour (AOL) were the two leading risk factors identified. Genital tract trauma was an underlying cause in 59% of cases. Suboptimal management processes identified included: delayed shifting to the operating theatre, delayed involvement of a specialist, not checking haematological status of the patient prior to discharge from hospital, and poor documentation.</span></span> <span style="font-family: Times New Roman,serif;"><span style="font-size: x-small;"><em><strong>Conclusions: </strong></em>Morbidity due to PPH is far greater than mortality. IVD and CS should be carried out only when indicated and in properly selected cases. Measures should be adopted to prevent or reduce genital tract trauma. Women with IOL and AOL need close monitoring after delivery. The suboptimal management processes identified should be corrected.</span></span> DOI: <a href="http://dx.doi.org/10.4038/sljog.v34i4.5931">http://dx.doi.org/10.4038/sljog.v34i4.5931</a> <span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2012; <strong>34</strong>: 144-154</span></span>

Adverse Reactions to 6% Hydroxyethyl Starch in the Operating Room

Sir, We are reporting a case of allergic reaction to 6% Hydroxyethyl Starch (HES) in the operating room. A 18-year-old male with intertrochanteric fracture in right femur was referred for pre-anaesthetic check-up for dynamic hip screw fixation. Patient had no history of drug allergies and surgery was planned under American Society of Anaesthesiologists grade I (ASA-I). Successful subarachnoid block was achieved with 0.5% Bupivacaine. Crystalloids like Ringer Lactate, 5% Dextrose in 0.9% Sodium Chloride were used to correct fasting status of patient and also as intraoperative fluid of choice. During surgery, pulse volume was low and blood pressure was 90/60mm Hg. 6% HES was used to correct the blood pressure. 6% HES is highly effective plasma expander, less expensive as compared to others and was available in our operating theatres. After few minutes of colloid transfusion, patient started to develop cough, difficulty in breathing, tachypnoea, tachycardia (120/min), hypotension (80/50mmHg). 6% HES transfusion was stopped and 100% oxygen was delivered to the patient via a face mask. Normal saline bolus was given, followed by intravenous (IV) Chlorpheniramine Maleate, Hydrocortisone, Ephedrine, which made the patient haemodynamically stable after some time. HES is synthetic nonprotein colloid solutions that are modified natural polysaccharides consisting of hydroxyethylated polymers of glucose. They are defined by concentration, molar substitution ratio and average molecular weight [1]. The side effects of HES range from mild allergic reactions to severe anaphylactoid reactions. However, their incidences are lowest as compared to those of other colloids and very few cases have been reported till date [2,3]. We couldn’t perform tests like measurement of serum tryptase, plasma histamine or allergen-specific IgE in our patient. We would like to attribute HES as the cause of allergic reaction, because of the signs and symptoms caused soon after its initiation. Here, we would like to stress on the importance of identification of allergic reactions/anaphylaxis intraoperatively, when a colloid is given to a patient, though it is rare. Diagnosis is difficult in a patient under general anaesthesia, as various types of medications are used. Awareness, aggressive therapy with hydration, vasopressors, antihistamines and steroids result in better outcomes in such patients.

Hemodynamic effects of amrinone in children after Fontan surgery.

After Fontan repair in children, we performed a prospective, open-label study to evaluate the effect of amrinone on pulmonary vascular resistance (PVRI). Eight patients who underwent the Fontan repair had baseline arterial pressure, left atrial pressure, central venous pressure, and cardiac output measured postoperatively. Hemodynamic measurements were repeated after amrinone 4.5 mg/kg. The PVRI tended to decrease, but the change was not statistically significant. Although the systemic vascular resistance decreased to 802 +/- 222 from 941 +/- 191 dynes.s.cm-5.m-2 (P < 0.05), mean arterial blood pressure was unchanged. Cardiac index (3.8 +/- 1.2 to 4.7 +/- 1.6 L.min-1.m-2) and stroke volume index (23.6 +/- 6.7 to 30.5 +/- 8.1 mL.beat-1.m-2) increased, and heart rate decreased (160 +/- 21 to 151 +/- 24 bpm) (P < 0.05). Colloid transfusion during amrinone bolus administration was 13.9 mL/kg. The mean serum amrinone concentration was 4.2 micrograms/mL at the end of bolus and clearance was 2.24 mL.kg-1.min-1. Arrhythmias and thrombocytopenia were not noted. We conclude that amrinone administration is effective in increasing cardiac output in children who have undergone a Fontan repair.