RINGERS LACTATE WITH OR WITHOUT 3-PERCENT DEXTRAN-60 AS VOLUME EXPANDERS DURING ABDOMINAL AORTIC-SURGERY

Objective: To compare a solution of 3% dextran-60 (D60) in Ringer's lactate (RL) with RL alone as maintenance fluids for abdominal aortic surgery. Design: Randomized control trial of 20 consecutive patients undergoing elective aortic reconstructive surgery. Setting: A surgical ICU in a university hospital. Patients: Consecutive patients, mean age 64 yr. Five patients had abdominal aneurysm, 12 had aortic obstruction disease, and three had aortic renal bypass surgery. These patients were followed for 1 month. Interventions: Pulmonary artery occlusion pressure of at least 10 mm Hg and a urine output > 30 mL/h were used to guide the intraoperative fluid infusion rates, which were 36 and 104 mL/kg of D60 and RL, respectively (ratio 1:2.9). Measurements and Main Results: Body weight at 24 hr had increased more with RL (7.8 kg) than with D60 (3.5 kg) infusion (p < .01), despite intraoperative urine volumes of 151 and 92 mg/kg with RL and D60, respectively. Total intravascular albumin decreased from 0.7 g/kg (1.4 to 0.7 g/kg) in both groups, corresponding to a plasma volume (PV) loss of 13 mg/kg without fluid infusions. A total intravascular dextran of 0.5 g/kg resulted in a PV expansion at 1 hr of 4.4 mL/kg above preoperative level, in sharp contrast to 7.0 mL/kg decrease in PV with RL. Of the intraoperative 3% D60 and RL infused, an estimated 51% D60 and 6% RL remained as PV expansion at 1 hr. Conclusions: A diluted colloid solution in Ringer's lactate is of significant value in maintaining intravascular volumes and hemodynamics during and after major operative procedures.