Persistence of 20% albumin in post-operative patients
- The endothelial glycocalyx layer plays an important role in the maintenance of fluid homeostasis in the body
- Shedding of the endothelial glycocalyx layer as a result of inflammation and hypervolaemia following major surgery may result in reduced intravascular persistence of albumin in surgical patients as compared to healthy volunteers
- The study described below investigated the pharmacological and volumetric properties of hyper-oncotic albumin
Do the degree and duration of the plasma volume expansion after IV infusion of 20% albumin differ between postoperative patients and healthy volunteers?
Albumin is an increasingly popular choice when it comes to selecting a colloid for the induction of plasma volume expansion in the surgical and postsurgical setting.
Currently, both iso-oncotic (4–5%) or hyper-oncotic (20%) solutions of albumin are available, however the pharmacokinetic properties of hyper-oncotic solutions are not yet fully understood and represent a source of controversy within the field of fluid management (Hasselgren et al., 2019).
In particular, it has been suggested that intravascular persistence of hyper-oncotic albumin may be reduced in surgical patients as a result of post-operative shedding of the endothelial glycocalyx layer which normally prevents the leakage of plasma proteins, including albumin, from the blood vessels (Bashandy, 2015).
The following study was therefore conducted to investigate the intravascular persistence of 20% albumin in patients who had undergone major abdominal surgery as compared to healthy volunteers:
References
Hasselgren E, Zdolsek M, Zdolsek JH, Björne H, Krizhanovskii C, Ntika S et al. Long intravascular persistence of 20% albumin in postoperative patients. Anesth Analg. 2019;129:1232–1239.
Bashandy GM. Implications of recent accumulating knowledge about endothelial glycocalyx on anesthetic management. J Anesth. 2015;29:269–278.
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