Oliver Kimberger, M.D., Michael Arnberger, M.D., Sebastian Brandt, M.D., Jan Plock, M.D., Gisli H. Sigurdsson, M.D., Ph.D., Andrea Kurz, M.D., Luzius Hiltebrand, M.D.
Anesthesiology 2009; 110:496–504
Background: The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery.
Methods: Pigs (n = 27, 9 per group) were anesthetized and mechanically ventilated. A hand-sewn colon anastomosis was performed. The animals were subsequently randomized to one of the following treatments: R-RL group, 3 ml · kg-1 · h-1 Ringer lactate (RL); GD-RL group, 3 ml · kg-1 · h-1 RL + bolus 250 ml of RL; GD-C group, 3 ml · kg-1 · h-1 RL + bolus 250 ml of hydroxyethyl starch (HES 6%, 130/0.4). A fluid bolus was administered when mixed venous oxygen saturation dropped below 60%. Intestinal tissue oxygen tension and microcirculatory blood flow were measured continuously.
Results: After 4 h of treatment, tissue oxygen tension in healthy colon increased to 150 ± 31% in group GD-C versus 123 ± 40% in group GD-RL versus 94 ± 23% in group R-RL (percent of postoperative baseline values, mean ± SD; P < 0.01). Similarly perianastomotic tissue oxygen tension increased to 245 ± 93% in the GD-C group versus 147 ± 58% in the GD-RL group and 116 ± 22% in the R-RL group (P < 0.01). Microcirculatory flow was higher in group GD-C in healthy colon.
Conclusions: Goal-directed colloid fluid therapy significantly increased microcirculatory blood flow and tissue oxygen tension in healthy and injured colon compared to goal-directed or restricted crystalloid fluid therapy.
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