Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery

The effects of intraoperative changes in plasma colloid osmotic pressure (COP) on the formation of intestinal edema were studied in patients during modified Whipple's operation (hemipancreato-duodenectomy). Eighteen patients (ASA physical status I or II) were randomly assigned to one o f three groups. They received either lactated Ringer's (RL group, n = 6), 10% hydroxyethyl starch (HES group, n = 6), or 20% human albumin (HA group, n = 6) as a volume replacement solution, which was given to maintain central venous pressure (CVP) at the preoperative level. Jejunal specimens were obtained after the first transsection of the jejunum and prior to the jejuno jejunostomy. Their water, fraction (g H2O/g tissue dry weight) was measured gravimetrically. COP was determined prior to induction of anesthesia and upon removal of the second jejunal sample. In the RL group, 3,850 ± 584 ml (data are means ± SEM) of volume replacement solution were infused from induction of anesthesia to removal of the second jejunal sample. In the HES group, 1,358 ± 45 ml were infused, and in the HA group, 463 ± 49 ml were infused. During this time, COP decreased from 20.3 ± 0.5 mmHg to 14.1 ± 0.6 mmHg in the RL group, remained at 22.0 ± 0.9 mmHg in the HES group, and increased from 20.7 ± 0.9 mmHg to 28.1 ± 0.9 mmHg in the HA group. The water fractions of the jejunal samples increased from 4.45 ± 0.13 g H2O/g tissue dry weight to 4.79 ± 0.2 in the RL group; remained unchanged with 4.18 ± 0.16 and 4.10 ± 0.26 in the HES group; and decreased from 4.13 ± 0.15 to 3.68 ± 0.1 in the HA group. All changes were statistically significant (Student's t-test for paired data; p ⩽ 0.05). The authors conclude that formation of intestinal edema during lengthy gastrointestinal (GI) surgery can be prevented by avoiding COP decreases.