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S to be given for 4CzIPN the same PV expansion. PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/12711626 Since the surgery, and bleeding is not likely to give the same greater permeability increase, it is more probable that the ratio for the conditions prevailing at neurosurgery are closer to 1.5 than 2.4, maybe 2. The Saline protocol used by department may not be optimal, although we did not find any signs of hyperchloremic acidosis, hypernatremia or renal failure in our patients. Balanced crystalloids may be better [van Haren et al. 2014] from these aspects. Also, balanced crystalloids may be better than saline (and albumin) to maintain coagulation (Smith et al. 2015; Pathirana et al. 2015). Finally, as this is a pilot study carried out during a limited period of time, the sample sizes are small, and conclusions must therefore be drawn with care regarding the preference of HA over HES as a neurosurgical fluid therapy. Nevertheless, as this study investigates clinically used fluid-therapy routines as opposed to fluid regimes designed a priori, the results are easier to apply to real-life clinical settings.Conclusions There n-Phenylpiperazine-1-carboxamide were no clinically relevant differences concerning kidney function, bleeding or coagulation; although, ROTEM and Multiplate measurements indicated both inter- and intra-group statistical differences. Albumin had a certain impact on coagulation; especially after 500 ml infusion, the ROTEM changes are close to those induced by 1000 ml hydroxyethyl starch. Clot structure measured by ROTEM FIBTEM-MCF was significantly lower with HES at the end of surgery, but HES had been infused at higher volumes to maintain intra-operative haemodynamics. Unlike previous studies that focused on thromboelastography, we also used Multiplate to assess coagulation, but no significant changes could be detected other than after 500 ml HA infusion, and those changes were normalised by the end of surgery. HA seems to be a more favourable fluid for volume replacement in neurosurgical patients at restricted volumes of infusion; however, larger studies need to be carried out for more conclusive results and preferably with plasma volume measurements. Irrespective of the type of fluid regimen, intra-operative monitoring of coagulation during neurosurgery is recommended.Abbreviations AA: alpha angle; ADP: adenosine diphosphate; aPTT: activated thromboplastin time; AUS: area under curve; CFT: clot formation time; CT: clotting time; F: factor; HA: human albumin; HES: hydroxyethyl starch; MCF: maximal clot formation; PT: prothrombin PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/9544797 time; ROTEM: rotational thromboelastometry; TRAP: thrombin receptor-activating peptide. Competing interests The authors declare that they have no competing interests. Authors' contributions NL performed the ROTEM and Multiplate analyses, compiled the statistics and prepared the tables and figures and took part in drafting the manuscript. SS collected clinical and other laboratory data from ROTEM/ Multiplate and took part gahmj.2015.132 in drafting the final manuscript. BA is the director of neurosurgical anaesthesia, collected signed consent and took part in drafting the final manuscript. US planned, financed, prepared ethical committee application, informed patients and collected signed consents and took part in drafting the final manuscript. All authors have read and approved the final version of the manuscript. Acknowledgements The study was funded by Lund University ISEX/ALF funds for Ulf Sch t. Author details 1 Department of Medicine, V j?County Hospital, V j? Sweden. 2 Department of Anaesthesia a.