Infusion therapy in the perioperative period
Background. Inadequate volume of perioperative infusion therapy (IT) is one of the predictors of postoperative complications. There are different types of infusion solutions on the pharmaceutical market: albumin, dextrans (Reopoliglukin), polyatomic alcohols (Reosorbilact, Sorbilact), hydroxyethyl starch preparations (Gekodez), modified gelatin (Volutenz), balanced colloid-hyperosmolar solution (Gekoton), etc (all listed solutions are produced by “Yuria-Pharm”).
Objective. To describe the main features of perioperative IT.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. Inadequate IT can cause hypo- and hypervolemia, as well as slow the recovery after surgery, so the choice of infusion solution should be made very carefully. To eliminate endothelial dysfunction, which often accompanies the perioperative period, it is advisable to prescribe L-arginine (Tivortin, “Yuria-Pharm”), which acts as a substrate for the synthesis of nitric oxide. Tivortin has the following properties: membrane stabilizing, antioxidant, cytoprotective, detoxifying, endothelioprotective, anabolic, hepatoprotective, antihypoxic. L-arginine (Tivortin) also helps to correct acid-base balance, neutralizes and removes ammonia, promotes insulin synthesis and regulates blood glucose, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium. The position paper of the International Fluid Optimization Group (2015) states that in planned operations without blood loss, crystalloids can be prescribed (2 ml/kg/h for surgeries lasting >4 hours, up to 10 ml/kg/h for surgeries lasting up to 1 hour). However, the disadvantages of the most famous crystalloid (0.9 % saline) are the risk of hyperchloremic acidosis and the development of edema in case of overdose, so it is advisable to use ion-balanced solutions instead of 0.9 % NaCl. The ideal electrolyte solution should be isovolemic, isohydric, isooncotic, isoionic, and isotonic to the blood plasma. Elimination of the metabolic acidosis is an important task of perioperative IT. Soda-Bufer (“Yuria-Pharm”) can be used for this purpose, as the administration of sodium bicarbonate reduces mortality in patients with severe metabolic acidosis and acute kidney damage. To eliminate the intoxication syndrome, drugs of polyatomic alcohols (Reosorbilact) have been successfully used. Efficiency of Reosorbilact in the treatment of sepsis, peritonitis, pneumonia, burns, etc. was confirmed in the numerous studies. In addition to detoxification, Reosorbilact supports hemodynamics and microcirculation, corrects metabolic acidosis and water-electrolyte disorders, stimulates diuresis, normalizes the rheological properties of blood, which makes it the main drug for low-volume IT in the perioperative period. In turn, Xylate is the main solution in diabetes because it has antiketogenic and lipotropic properties, improves hemodynamics and microcirculation, corrects metabolic acidosis and has an osmodiuretic effect. In shock settings IT should be administered according to the ROSE concept (R (rescue) – aggressive IT; O (optimization) – support of tissue perfusion; S (stabilization) – supportive IT; E (evacuation) – deresuscitation, restoration of body functions).
Conclusions. 1. Optimal IT improves the consequences of the surgery. 2. To eliminate endothelial dysfunction, it is advisable to prescribe L-arginine (Tivortin). 3. Reosorbilact is successfully used to eliminate the intoxication syndrome, which also supports hemodynamics and microcirculation, corrects metabolic acidosis and water-electrolyte disorders, which makes it the main drug for low-volume IT in the perioperative period. 4. Xylate is the main solution in diabetes because it has antiketogenic and lipotropic properties, improves hemodynamics and microcirculation. 5. In shock settings IT should be administered according to the ROSE concept (rescue, optimization, stabilization, evacuation).
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