Colloid solutions in the perioperative setting

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1656 (Published 27 March 2015) Cite this as: BMJ 2015;350:h1656
  1. Nicolai Haase, physician12,
  2. Anders Perner, professor2
  1. 1Department of Anaesthesiology and Intensive Care Medicine, Roskilde Hospital, DK-4000 Roskilde, Denmark
  2. 2Department of Intensive Care, Copenhagen University Hospital–Rigshospitalet, DK-2100 Copenhagen, Denmark
  1. Corresponding author: N Haase nicolai.haase{at}rh.regionh.dk

Use should be suspended, pending further investigation

Hypotension is common during surgery and is often treated with intravenous fluid. The choice of fluid depends mainly on local tradition, and colloids were often selected over crystalloids because of their expected ability to expand plasma volume more effectively. Current guidelines do not recommend choosing colloids over crystalloids1 as improvements in outcome have never been established,2 3 but debate continues on the use of colloids in this setting.

In a linked study Opperer and colleagues (doi:10.1136/bmj.h1567) report a retrospective population based analysis in which they evaluated postoperative complications among patients given hydroxyethyl starch, albumin, or crystalloids during or soon after elective joint surgery.4 From a databases containing procedural codes, ICD-9 diagnosis codes, and prescription data, the authors identified a million patients who underwent elective hip and knee replacement surgery during 2009–13 in the United States. The use of either hydroxyethyl starch or albumin was associated with an increased risk of perioperative and postoperative complications, compared with the use of crystalloid alone (hydroxyethyl starch v crystalloid, odds ratio 1.20 (95% confidence interval 1.15 to 1.25); albumin v crystalloid, odds ratio 1.48 (1.37 to 1.60)). With the exception of thromboembolism, …

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