The Research Of Acute Hypervolemic Hemodilution With 6% Hydroxyethyl Starch 130/0.4 In Pediatric Patients Undergoing Intracranial Tumor Surgery

ObjectiveTo compare the effect of blood coagulation function and renal function upon 6% hydroxyethyl starch and sodium chloride injection or 5% human albumin for acute hypervolemic hemodilution(AHH)in pediatric patients undergoing intracranial tumor resection,we try to explore the safety of acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/0.4 in pediatric patients undergoing intracranial tumor surgery.MethodsSixty pediatric patients prepared for elective brain tumor surgery under general anesthesia were randomly divided into 6% hydroxyethyl starch 130/0.4 and sodium chloride injection(HES)group and 5% human albumin(HA)group,there were 30 cases in each group.Children were routinely monitored after entering the operating room,intravenous anesthesia induction was used.When invasive arterial pressure and right internal jugular vein catheter were established,HES and HA(20ml/kg)were infused for AHH prior to dura opening in two groups,respectively.Venous blood was drawn for thromboelastography(TEG)measurement before AHH(T0),immediately after AHH(T1),1 h after AHH(T2),and at the end of surgery(T3),the TEG parameters included with reaction time(R),clot formation time(K),?-angle(?),maximum amplitude(MA)and coagulation index(CI)were tested for blood coagulation function.Blood gas parameters and hematology parameters with arterial blood gas analysis were recorded at each time point,and also hemodynamic parameters.Renal function was compared between two groups in the first day of postoperation: conventional renal function tests including blood urea nitrogen(Bun)and serum creatinine(Cr),and urinary n-acetyl-beta-D amino glycosidase enzymes(NAG)levels for renal tubular function.Blood transfusion,perioperative fluid balance,intracranial pressure,mortality,intensive care unit duration,and time of hospital stay were also assessed.ResultsTEG parameters did not differ after preloading compared to baseline values in either group,except for a decrease in maximum amplitude immediately after infusion(HES group,57.6 ± 6.0 mm vs.50.9 ± 9.2 mm;HA group,60.1 ± 7.9 mm vs.56.6 ± 7.1 mm;p < 0.01),which was restored to preoperative levels 1 h after fluid infusion,but all values within the normal range.The other TEG parameters between groups and in groups were no statistically significant difference(P > 0.05).The creatinine level was mild increased at the first day of postoperation in HES group compared with baseline(29.2±5.90umol/L vs.35.5±5.09umol/L;P<0.05),while no significant difference in HA group(30.9±6.40 umol/L vs.32.0±6.91umol/L;P>0.05).Blood urea nitrogen and NAG values were no significant difference between groups or within groups.The hemoglobin(Hb)and hematokrit(HCT)at T1 were significantly lower than those at T0 in both groups(both P< 0.05),Central venous pressure(CVP)at T1 were significantly higher than those at T0 in both groups(both P< 0.05),but no significant difference between groups at each time point(P>0.05).Total perioperative fluid balance,blood loss or transfusion,intracranial pressure,and hematological and hemodynamic variables were similar between both groups(p > 0.05).Mortality,length of hospital stay or ICU duration,and clinical complications were similar between both groups.ConclusionThese findings suggest that HES and HA might have no significant differences regarding coagulation as evaluated by TEG during pediatric intracranial tumor surgery with 20 ml/kg volume for AHH,and both have less influence on renal function,which can maintain stable hemodynamics.Since HES price is lower,it may represent a new avenue for volume therapy during brain tumor resection in pediatric patients.