PLASMA SUBSTITUTION WITH 3-PERCENT DEXTRAN-60 IN ORTHOPEDIC-SURGERY - INFLUENCE ON PLASMA COLLOID OSMOTIC-PRESSURE, COAGULATION PARAMETERS, IMMUNOGLOBULINS AND OTHER PLASMA CONSTITUENTS

To study the effects on plasma proteins, blood coagulation and fibrinolysis of dextran‐60, given as plasma volume substitute in a 3% solution, 57 patients were studied preoperatively and for 8 days postoperatively in conjunction with elective orthopaedic surgery. Three groups were formed according to the blood loss during the day of surgery: Group I (n=22) <30%, Group II (n=24) 30–50% and Group III (n=11) > 50% of the estimated blood volume. Dilution to a haemoglobin concentration of 110 g · 1‐1 was intended and erythrocytes transfused accordingly. No platelets were transfused. All patients received similar amounts of crystalloids. Nine patients in Group III received plasma and/or albumin solution for further volume replacement once the maximum dose of dextran (1.5 g · kg‐1) was reached. Dextran‐70 was given on days I and 3 postoperatively for thromboprophylaxis. No patient exhibited clinical signs of thrombosis or embolism. Mean postoperative bleeding times were longer than preoperatively, but still within the normal range in all groups. They were both pre‐ and postoperatively slightly longer in Group III, compared to the other groups, perhaps due to mild haemostatic disorders and/or undisclosed antiphlogistic therapy. Postoperative colloid osmotic pressures decreased by 11–19% in the three groups. Dilution of plasma constituents was also seen in the postoperative fall of platelet counts and of albumin, antithrombin and Factor X levels, most marked in Group III. Albumin levels on day 8 were still only 77–83% of preoperative values. IgG and IgM were decreased and the IgG level was still only 75% of preoperative on day 8. Dilution of other plasma proteins, e.g. von Willebrand Factor, C‐Reactive Protein and Factor VIII:C, were offset by their function as acute phase reactants, with an 8‐to‐10‐fold increase of CRP on day 3 and a two‐fold increase of F VIII:C on day 8. An activation of the coagulation and fibrinolytic systems not only immediately postoperatively, but also extending up to the eighth postoperative day, was shown by elevations of fibrinopeptide A and D‐dimer levels in all groups. We conclude that 3% dextran‐60 in doses not exceeding 1.5 g · kg‐1 can be safely used for plasma volume replacement in surgery, provided there are no preoperative haemostatic disorders. Our findings also indicate that thromboprophylaxis should be continued until at least the eighth postoperative day. © 1990 Acta Anaesthesiologica Scandinavica Fonden