TITLE:
Changes in Blood Volume and Colloid Osmotic Pressure during Fluid Absorption in Patients Undergoing Endoscopic Urosurgery: An Observational Study
AUTHORS:
Kaori Yagi, Chihiro Kamagata, Masashi Ishikawa, Yukihiro Kondo, Atsuhiro Sakamoto
KEYWORDS:
Colloid Osmotic Pressure; Blood Volume; Perioperative Period
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.9,
November
21,
2013
ABSTRACT: Background and Objective: Anesthesiologists need to be familiar with perioperative changes in
blood volume (BV); however, there is no standard method for repeated evaluation
of BV over a short interval of time. We evaluated BV in the operation room
using repeatable estimation methods. Method: Eighty-five ASA physical status I-II patients scheduled to undergo
endoscopic urosurgery using irrigation fluid under general anesthesia at Nippon
Medical School Hospital were included in this study. Irrigation with 3% sorbitol
in water was commenced after establishment of general anesthesia and volumetric
fluid balance, which was defined as control water balance (WB). Hematocrit
(Hct), colloid osmotic pressure (COP), total protein (TP) and albumin (Alb)
were repeatedly determined before and during anesthesia. BV was calculated
using Allen’s formula and the changes in Hct, COP, TP and Alb. Main Outcome Measures: The main outcome was the accuracy of measuring changes in BV (△BV) calculated using the four serum markers. WB and the
estimated △BV calculated from Hct, COP, TP and Alb (△BV-Hct, △BV-COP, △BV-TP,
and △BV-Alb) were analysed using Pearson’s correlation coefficient test and Bland-Altman analysis. Results: Sixty-five patients were excluded. In the remaining 20 patients, there was a
significant correlation between WB and △BV-COP (R2 = 0.72; P △BV-TP (R2 = 0.59; P △BV-Alb (R2 = 0.57; P △BV-Hct (R2 = 0.06). Conclusion: △BV-COP, △BV-TP
and △BV-Alb had correlation with WB. However, since COP can be measured
repeatedly with simplified instruments under selected clinical circumstances,
while TP and Alb cannot. COP is the most useful marker to measure △BV during perioperative
period. Hct does not allow precise estimation of △BV.