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The Brain Relaxation and Cerebral Metabolism in Stroke Volume Variation–directed Fluid Therapy During Supratentorial Tumors Resection: Crystalloid Solution Versus Colloid Solution

Xia, Juan MD*; He, Zhiyong MD*; Cao, Xiaoying MD*; Che, Xuehua MD*; Chen, Liang MD, PhD; Zhang, Jun MD, PhD*; Liang, Weimin MD, PhD*

Journal of Neurosurgical Anesthesiology: October 2014 - Volume 26 - Issue 4 - p 320–327
doi: 10.1097/ANA.0000000000000046
Clinical Investigations
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Background: Compared with goal-directed crystalloid therapy, goal-directed colloid therapy during high-risk surgery may improve postoperative outcome. Whether intraoperative fluid therapy based on goal-directed protocol with different types of fluid has distinctive effects on brain relaxation and cerebral metabolism during craniotomy remains unclear.

Methods: Forty patients with supratentorial brain tumors undergoing craniotomy were randomly assigned to either a Ringer’s Lactate-based goal-directed group (LR group, n=20) or a 6% hydroxyethyl starch–based goal-directed group (HES group, n=20). The goal was achieved by maintaining a target stroke volume variation (SVV<13%) by volume loading with LR or HES throughout the procedure. The primary outcome is brain relaxation scales, an indirect evaluation of ICP; secondary endpoints include cerebral metabolism variables (jugular venous oxygen saturation [SjvO2], arterial-jugular venous differences in oxygen [CajvO2], glucose [A-JvGD], lactate [A-JvLD], and cerebral extraction ratio for oxygen [CERO2]) and fluid volumes.

Results: There is no significant difference between the LR and HES groups on brain relaxation scales (P=0.845), or measures of cerebral oxygenation and metabolism. Intragroup comparisons showed that CERO2 increased by 14.3% (P=0.009, LR group) and 13.2% (P=0.032, HES group), respectively, and SjvO2 was decreased by 8.8% (P=0.016, LR group) and 8.1% (P=0.026, HES group), respectively, after tumor removal, compared with baseline. During surgery, the LR group (3070±1138 mL) received more fluid than the HES group (2041±758 mL, P=0.002).

Conclusions: In patients undergoing supratentorial tumor resection, goal-directed HES therapy was not superior to goal-directed LR therapy for brain relaxation or cerebral metabolism, although less fluid was needed to maintain the target SVV in the HES-based group than in the LR-based group.

Departments of *Anesthesiology

Neurosurgery, Huashan Hospital, Fudan University, Shanghai, P. R. China

J.X.: data collection, analysis, and manuscript preparation. Z.H., X. Cao, and X. Che: data collection and analysis. L.C.: brain relaxation evaluation. J.Z.: study design and manuscript preparation. W.L.: manuscript preparation. All authors approved the final manuscript.

The authors have no funding or conflicts of interest to disclose.

Reprints: Jun Zhang, MD, PhD, Department of Anesthesiology, Huashan Hospital, Fudan University, No. 12, Urumqi Central Rd., Shanghai 200040, P.R. China. (e-mail: snapzhang@aliyun.com).

Received August 27, 2013

Accepted December 30, 2013

© 2014 by Lippincott Williams & Wilkins