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CARDIOVASCULAR ANESTHESIA

The Influence of Crystalloid and Colloid Replacement Solutions in Acute Normovolemic Hemodilution: A Preliminary Survey of Hemostatic Markers

Stephanie B. Jones, MD^*, Charles W. Whitten, MD^*, George J. Despotis, MD, and Terri G. Monk, MD

*Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center at Dallas; Departments of Anesthesiology, Pathology, and Immunology, Washington University School of Medicine; Department of Anesthesiology, University of Florida College of Medicine

Address correspondence and reprint requests to Charles Whitten, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390–9068. Address e-mail to charles.whitten{at}utsouthwestern.edu

Acute normovolemic hemodilution (ANH), in which blood for autologous use is collected immediately before the onset of surgical blood loss, is a recommended autologous blood procurement technique for blood conservation. Both crystalloid and colloid replacement fluids have been used to maintain normovolemia during ANH, but few data are available to justify the use of a particular replacement fluid. Therefore, we designed a prospective, randomized study to determine if the replacement fluid choice affects various coagulation variables and perioperative blood loss. Forty adult patients, ASA physical status 1–3, scheduled for ANH during radical prostatectomy were randomly assigned to one of four replacement fluid groups: (a) Ringer’s lactate, (b) 5% albumin, (c) 6% dextran 70 (DEX), or (d) 6% hetastarch (HES). After the induction of a standardized general anesthetic, all patients underwent ANH to a final hemoglobin level of 9 g/dL. Complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, factors V and VIII levels, bleeding time, and thromboelastography (TEG^®) measurements were obtained at similar time points in the procedure. When compared with baseline, activated partial thromboplastin time decreased and factor VIII levels increased in the postanesthesia care unit in both the Ringer’s lactate and 5% albumin groups. The DEX and HES groups demonstrated a decrease in TEG^® maximum amplitude between preoperative and postanesthesia care unit measurements and TEG^® (angle) was decreased from baseline in the DEX group. The changes in factor VIII, activated partial thromboplastin time, and TEG^® measurements indicate that HES and DEX may attenuate the hypercoagulability related to surgery.

IMPLICATIONS: Lactated Ringer’s solution, albumin, dextran, and hetastarch were compared as replacement fluids in an acute normovolemic hemodilution protocol in adult patients undergoing radical prostatectomy. Differences in coagulation measurements suggest that dextran and hetastarch may attenuate surgically induced hypercoagulability.

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