gms | German Medical Science

Objective: To evaluate adverse effects of administering gelatin to neurosurgical patients with postoperative signs of hypovolemia after elective intracranial surgeries being monitored at a neurosurgical intensive care unit (ICU).

Methods: We performed a retrospective study in our department on 100 consecutive patients operated electively on an intracranial pathology and showing postoperatively clinical signs of hypovolemia. All patients were treated with intravenous colloid fluids containing gelatin and monitored at the neurosurgical ICU. Since former studies have reported severe adverse effects of gelatin in intensive care patients we analyzed the ICU charts for anaphylaxis, renal failure, respiratory distress, bleeding complications and hypercoagulation. Pre-existing pulmonary, renal, thromboembolic conditions and history of bleeding complications or cardiac failure were compiled. In addition vital parameters, blood gas analyses, central venous pressure and the need of catecholamine therapy were compared before administration of gelatin, after 2 hours, after 6 hours and after 24h hours. Blood laboratory findings including blood count, clotting as well as renal parameters were compared postoperatively before administration of gelatin with the findings after one day.

Results: None of the patients presented with severe adverse effects such as anaphylaxis, the need of renal replacement therapy or prolonged ventilation time due to pulmonary edema. One patient presented with multiple thromboembolic complications. Due to extremely elevated D-dimer levels immediately after the operation the presence of thrombosis before gelatin administration was highly suspective. One patient required another surgery due to a major bleeding in the area of operation after initiation of preterm postoperative low-dose heparin therapy. There was no significant difference in laboratory findings before gelatin administration and after one day. Thirtythree percent of the patients were suffering from a preoperatively known minor limitation of their pulmonary, renal and/or cardiac function and/or had a history of thromboembolism. There was no difference in findings between patients with and without preexisting conditions.

Conclusion: Based on our findings we conclude that the use of gelatin based colloids in neurosurgical patients undergoing elective intracranial surgeries is safe even in patients with a history of minor respiratory, renal and/or cardiac disease and/or former thromboembolism.