OJAnes  Vol.3 No.9 , November 2013
Changes in Blood Volume and Colloid Osmotic Pressure during Fluid Absorption in Patients Undergoing Endoscopic Urosurgery: An Observational Study
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 < 0.01), WB and △BV-TP (R2 = 0.59; P < 0.01) and WB and △BV-Alb (R2 = 0.57; P < 0.01), while there was no correlation between WB and △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.
Cite this paper: K. Yagi, C. Kamagata, M. Ishikawa, Y. Kondo and A. Sakamoto, "Changes in Blood Volume and Colloid Osmotic Pressure during Fluid Absorption in Patients Undergoing Endoscopic Urosurgery: An Observational Study," Open Journal of Anesthesiology, Vol. 3 No. 9, 2013, pp. 396-401. doi: 10.4236/ojanes.2013.39084.

[1]   [1] M. R. Ujhelyi, A. W. Miller, S. Raibon, J. Corley, V. J. Robinson, J. J. Sims, T. Tonnessen, G. Burke, A. llebekk and D. L. Rutlen, “Endotoxemia Alters Splanchnic Capacitance,” Shock (Augusta, Ga.), Vol. 14, No. 1, 2000, pp. 68-72.

[2]   C. Veillon, K. Y. Patterson, D. A. Nagey and A. M. Tehan, “Measurement of Blood Volume with an Enriched Stable Isotope of Chromium (53Cr) and Isotope Dilution by Combined Gas Chromatography-Mass Spectrometry,” Clinical Chemistry, Vol. 40, No. 1, 1994, pp. 71-73.

[3]   Y. Sano, A. Sakamoto, Y. Oi and R. Ogawa, “Anaesthesia and Circulating Blood Volume,” European Journal of Anaesthesiology, Vol. 22, No. 4, 2005, pp. 258-262.

[4]   H. L. Webster, “Colloid Osmotic Pressure: Theoretical Aspects and Background,” Clinics in Perinatology, Vol. 9, No 3, 1982, pp. 505-521.

[5]   T. H. Allen, M. T. Peng, K. P. Chen, T. F. Huang, C. Chang and H. S. Fang, “Prediction of Blood Volume and Adiposity in Man from Body Weight and Cube of Height,” Metabolism, Vol. 5, No. 3, 1956, pp. 328-345.

[6]   R. G. Hahn, “Blood Volume at the Onset of Hypotentin during TURP Performed under Epidural Anaesthesia,” European Journal of Anaesthesiology, Vol. 10, No 3, 1993, pp. 219-225.

[7]   D. L. Bourke and T. C. Smith, “Estimating Allowable Hemodilution,” Anesthesiology, Vol. 41, No. 6, 1974, pp. 609-611.

[8]   M. Rehm, V. Orth, U. Kreimeier, M. Thiel, M. Haller, H. Brechtelsbauer and U. Finsterer, “Changes in Intravascular Volume during Acute Normovolemic Hemodilution and Intraoperative Retransfusion in Patients with Radical Hysterectomy,” Anesthesiology, Vol. 92, No. 3, 2000, pp. 657-664.

[9]   A. R. Pries, T. W. Sevomb and P. Gaehtgens, “The Endothelial Surface Layer,” Pflügers Archiv: European Journal of Physiology, Vol. 440, No. 5, 2000, pp. 653-666.

[10]   A. R. Pries, A. Fritzsche, K. Ley and P. Gaehtgens, “Redistribution of Red Blood Cell Flow in Microcirculatory Networks by Hemodilution,” Circulation Research, Vol. 70, No. 6, 1992, pp. 1113-1121.

[11]   J. D. Oliver III, S. Anderson, J. L. Try, B. M. Brenner and W. H. Deen, “Determination of Glomerular Size-Selectivity in the Normal Rat with Ficoll,” Journal of the American Society of Nephrology, Vol. 3, No. 2, 1992, pp. 214-228.

[12]   J. F. Danielli, “Capillary Permeability and Edema in the Perfused Frog,” The Journal of Physiology, Vol. 98, No. 1, 1940, pp. 109-129.

[13]   R. Chambers and B. W. Zweifach, “Intracellular Cement and Capillary Permeability,” Physiological Reviews, Vol. 27, No. 3, 1947, pp. 436-463.

[14]   M. Rehm, S. Zahler, M. Lötsch, U. Welsch, P. Conzen, M. Jacob and B. F. Becker, “Endo Thelial Glycocalyx as an Additional Barrier Determining Extravasation of 6% Hydroxyethyl Starch or 5% Albumin Solutions in the Coronary Vascular Bed,” Anesthesiology, Vol. 100, No. 5, 2004, pp. 1211-1223.

[15]   M. Jacob, D. Bruegger, M. Rehm, M Stoeckelhuber, U. Welsch, P. Conzen and B. F. Becker, “The Endothelial Glycocalyx Affords Compatibility of Starling’s Principle and High Cardiac Interstitial Albumin Levels,” Cardiovascular Research, Vol. 73, No. 3, 2007, pp. 575-586.

[16]   C. R. Bell, P. J. Murdock, K. J. Pasi and R. J. Morgan, “Thrombotic Risk Factors Associated with Transurethral Prostatectomy,” BJU International, Vol. 83, No. 9, 1999, pp. 984-989.