Comparing blood coagulation effects of spinal preloading solutions as poligelin, succinated gelatin, HES (130/0,4), ringer lactat with TEG

AIM: The aim of the study is to evaluate the effects of loading fluids as HES(130/0.4), succinated gelatin, poligelin, lactated ringer on coagulation, haematologic,biochemical and blood gas parameters for more effective fluid management inpatients who were undergone spinal anaesthesia.MATERIALS AND METHODS: In this study, 64 ASA I-II patients between18- 75 ages scheduled for lower extremity surgery with neuroaxial anesthesia werepropespectively randomized in 4 groups in a double blinded manner; Group A:Lactated Ringer, Group B: HES (130/0.4), Group C: poligelin, Group D: succinylatedgelatine. Lactated Ringer was used as maintanence fluid and TEG(thromboelastogram), haemogram, PT, aPTT, fibrinogen, glucose, BUN, creatinin,albumin, total protein, Na+, Cl-, K+, Ca++, Mg++, serum osmolarity levels, blood gasparameters measured at zero hours and second hour after fluid infusion and comparedbetween groups.RESULTS: There were no statistitical differences between groups by meansof patient?s demographics, volume of loading fluid, urine output, amount of surgicalhaemorrhage, surgery duration, hemodynamic parameters, bromage score 3 and T7level time. While there was no significant between the basal and second hour valuesof Na+ levels; blood glucose, K+ and Cl- levels were increased and the remainingbiochemical and hameogram parameters were assessed as haemo-dilution effect, nodifference was observed between groups. Regarding to coagulation parameters, PTlevels in group A, C and D; PT-INR levels in group A and C, aPTT levels in group Aand group B were increased and that differences were statistically significant.Regarding to TEG parameters as R, K,CI and TMA values were decreased exceptgroup B, and ? angel values were increased in group A and D in a statisticallysignificant manner.DISCUSSION: As a result; although 7 mL kg-1 fluid loading for orthopaedicpatients caused mild coagulopathic changes, these changes didn?t cause any negativeclinical effects on bleeding and coagulation profile. We believe that, colloid infusionscan be safely used inpatients with spinal anaesthesia induced hypotension.KEYWORDS: Hiper coagulability, TEG, Tromboelastogram, HES,hetastarch, gelatine, poligeline, succinylated gelatine, loading fluid, plasmasubstitutes, colloids, spinal anesthesia