EXTRA PROTEIN LOSS NOT CAUSED BY SURGICAL BLEEDING IN PATIENTS WITH OVARIAN-CANCER

Backround: Clinical experience in patients with ovarian cancer has sho wn special difficulties in maintaining cardiovascular stability during surgery. Methods: To evaluate the causes for this observation, 15 pat ients with benign ovarian tumours (group I) and 13 patients with ovari an cancer (group II) were investigated perioperatively. Plasma volume (indocyanine green-dilution technique), haematocrit, plasma protein co ncentration, mean arterial pressure, heart rate, and central venous pr essure were measured immediately before and after cytoreductive surger y. Results: Normal values of blood-, plasma-, and red cell volume were determined preoperatively in both groups, and in relation to body sur face area there were no intergroup differences of these parameters. In group I, the significant decrease in red cell volume of 313 ml postop eratively was compensated for by an increase in plasma volume of 371 m l (median values). In contrast to group I, the decrease in red cell vo lume of 328 ml in group II was not related to a significant increase i n plasma volume, so that blood volume postoperatively was 483 ml lower than preoperatively, although the same standardized infusion regimen as in group I was applied. Patients of group II had a significantly hi gher loss of intravascular protein (49 g vs 13 g in group I), which le ft the intravascular space by another way than by surgical bleeding. T his extra protein loss is termed Intraoperative Protein Shift (IPS). C onclusion: IPS could be an important quantity in perioperative fluid b alance. We assume that different surgical procedures predispose to occ urrence of differing amounts of IPS. (C) Acta Anaesthesiologica Scandi navica 42 (1998).