Leakage of albumin in major abdominal surgery

Åke Norberg, Olav Rooyackers, Ralf Segersvärd, Jan Wernerman, Åke Norberg, Olav Rooyackers, Ralf Segersvärd, Jan Wernerman

Abstract

Background: The time course of plasma albumin concentration (P-alb) and cumulative perioperative albumin shift as a measure of albumin extravasation in major abdominal surgery is not well described. Knowledge of these indices of the vascular barrier and vascular content are important for our understanding of fluid physiology during surgery and anesthesia.

Methods: Patients (n = 10) were studied during esophageal or pancreatic surgery. P-alb was repeatedly measured over 72 h, and the mass balance of albumin and hemoglobin were obtained from measures of P-alb, blood hemoglobin and hematocrit.

Results: P-alb decreased rapidly from baseline (32.8 ± 4.8 g/L) until the start of surgical reconstruction (18.7 ± 4.8 g/L; p < 0.001), and was thereafter stable until postoperative day 3. Cumulative perioperative albumin shift increased until 1 h after the end of surgery, when 24 ± 17 g (p < 0.001) had been lost from the circulation.

Conclusions: The rapid fall in P-alb of more than 40 % consistently occurred during the first part of the surgical procedure, but albumin leakage progressed until 1 h after the end of surgery. After the initial drop, P-alb was stable for 72 h.

Keywords: Abdominal surgery; Albumin; Inflammation; Transcapillary escape rate.

Figures

Fig. 1
Fig. 1
Temporal pattern of plasma albumin (P-Albumin) (a), fractional plasma dilution calculated from changes in blood hemoglobin and hematocrit (b), and cumulative perioperative albumin shift (c), in patients (n = 10) undergoing major abdominal surgery. Bold line represents the mean value. Shaded area represents time of surgery. Changes over time were assessed by analysis of variance (p < 0.0001 for a and c, and p = 0.0006 for b) followed by Dunnett’s multiple comparison test to compare all time points to baseline. *p < 0.05, **p < 0.01, ***p < 0.001. B-Hct blood hematocrit

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Source: PubMed

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