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Long Intravascular Persistence of 20% Albumin in Postoperative Patients
Karolinska Univ Hosp, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
Karolinska Univ Hosp, Sweden.
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2019 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 129, no 5, p. 1232-1239Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Albumin may persist intravascularly for a shorter time in patients after major surgery than in healthy volunteers due to a surgery-induced breakdown (shedding) of the endothelial glycocalyx layer. METHODS: In this nonrandomized clinical trial, an IV infusion of 3 mL/kg of 20% albumin was given at a constant rate during 30 minutes to 15 patients on the first day after major open abdominal surgery (mean operating time 5.9 h) and to 15 conscious volunteers. Blood samples and urine were collected during 5 h and mass balance calculations used to estimate the half-lives of the administered albumin molecules and the induced plasma volume expansion, based on measurements of hemodilution and the plasma albumin concentration. RESULTS: At the end of the infusions, albumin had diluted the plasma volume by 13.3% +/- 4.9% (mean +/- SD) in the postoperative patients and by 14.2% +/- 4.8% in the volunteers (mean difference -0.9, 95% CI, -4.7 to 2.9; 1-way ANOVA P = .61), which amounted to twice the infused volume. The intravascular half-life of the infused albumin molecules was 9.1 (5.7-11.2) h in the surgical patients and 6.0 (5.1-9.0) h in the volunteers (Mann-Whitney U test, P = .26; geometric mean difference 1.2, 95% CI, 0.8-2.0). The half-life of the plasma volume expansion was 10.3 (5.3-17.6; median and interquartile range) h in the surgical patients and 7.6 (3.5-9.0) h in the volunteers (P = .10; geometric mean difference 1.5, 95% CI, 0.8-2.8). All of these parameters correlated positively with the body mass index (correlation coefficients being 0.42-0.47) while age and sex did not affect the results. CONCLUSIONS: Twenty percent albumin caused a long-lasting plasma volume expansion of similar magnitude in postoperative patients and volunteers.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2019. Vol. 129, no 5, p. 1232-1239
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Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-161371DOI: 10.1213/ANE.0000000000004047ISI: 000490258700027PubMedID: 30768453OAI: oai:DiVA.org:liu-161371DiVA, id: diva2:1367569
Note

Funding Agencies|Mats Kleberg Foundation

Available from: 2019-11-04 Created: 2019-11-04 Last updated: 2019-11-04

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Zdolsek, MarkusZdolsek, Joachim
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDivision of Drug ResearchDepartment of Anaesthesiology and Intensive Care in Linköping (ANOPIVA)
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Anesthesia and Analgesia
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