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The circulatory effect of a bolus infusion with 4 ml/kg body weight of acetated Ringers will be studied. If cardiac output increase with 10% a second bolus will be infused and further studied.

The circulatory effect of a bolus infusion with 4 ml/kg body weight of Albumin 5% will be studied. If cardiac output increases with 10% a second bolus will be infused and further studied.

The circulatory effect of a bolus infusion with 1 ml/kg body weight of Albumin 20% will be studied. If cardiac output increase with 10% a second bolus will be infused and further studied.

After insufflation of carbon dioxide during an abdominal laparoscopic procedure, the first fluid bolus is infused. Circulatory and volume effects are studied. If cardiac output increase a second bolus is infused and studied.

acetated Ringers

After insufflation of carbon dioxide during an abdominal laparoscopic procedure, the first bolus of fluid is infused. Circulatory and volume effects are studied. If cardiac output increases a second bolus is infused and studied.

albumin 5%

albumin 20%

Robert Svensson, MD

Hans Bahlmann, MD, PhD

Fredrik Schiöler, MD

Joachim Zdolsek, MD PhD

A short bolus infusion of fluid, called "fluid challenge" is commonly recommended for fluid treatment during longer surgery. However a prolonged increase of the blood volume is a prerequisite to recommend the technique. The purpose with the study is to examine the plasma expanding effect of three different fluid challenge strategies (acetated Ringers 4 ml/kg body weight, albumin 5% 4 ml/kg body weight or albumin 20% 1 ml/kg body weight), using hemoglobin as a dilution indicator.

60 patients scheduled for laparoscopic abdominal surgery, with a duration exceeding 90 minutes will be included in the study. These are randomized to three different groups (20 in each groups): The first group of patients will receive boluses of acetated Ringers 4 ml/kg body weight. The second albumin 4 ml/kg body weight and the third group albumin 20% 1 ml/kg body weight.

Hemoglobin, albumin and colloid osmotic pressure (COP) is sampled the day before surgery and in the morning directly prior to the anesthesia. Bioimpedance, urine osmolality and urine-creatinin are also measured. After induction of surgery a Cardio Q probe is inserted threw the nose into the esophagus, for circulatory measurements. Initial/baseline blood samples are taken after insufflation of carbon dioxide to the abdomen. Before every bolus of fluid and 5, (10), 15, 20, 30, 40, (50) and (60) minutes new blood samples are taken for determination of hemoglobin, albumin and COP. Artery blood gases are sampled 15 minutes after every infusion or depending on the clinical need.

3 randomized parallel groups, with 20 patients in each group. Each group receives a prespecified fluid regime with: 1. acetated Ringers 2. albumin 5% or 3. albumin 20%

Fluid Challenge and Plasma Volume, During Surgery

Comparison of Albumin and Ringer's Solution for Optimization of the Plasma Volume and Hemodynamics During Laparoscopic Surgery.

Individual de-identified results will be shared, when results are published.

Plasma volume using hemoglobin as an indicator of dilution

Change in stroke volume, measured with Cardio Q (oesophageal Doppler monitoring (ODM))

Mean Arterial Pressure, measured with an arterial line.

Heart rate, measured with ECG and pulseoximeter.

Bioimpedance measures, resistance and impedance converted to volume of body fluid compartments.

Serum Creatinin as a measure of kidney function

Influence of a fluid bolus on arterial blood gases

Influence of a fluid bolus on Sodium concentration

Influence of a fluid bolus on Chloride concentrations

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Fluid Challenge and Plasma Volume, During Surgery	NCT05726136	Colorectal Canc... Urologic Cancer Gynecologic Can... Colorectal Diso... Benign Neoplasm	acetated Ringer... albumin 5% albumin 20%	18 Years - 80 Years	University Hospital, Linkoeping
Fluid Challenge and Plasma Volume, During Surgery	NCT05726136	Colorectal Canc... Urologic Cancer Gynecologic Can... Colorectal Diso... Benign Neoplasm	acetated Ringer... albumin 5% albumin 20%	18 Years - 80 Years	University Hospital, Linkoeping

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