HES Group Research Articles

Anesthesia Literature Review

Anesthesia Literature Review

Early fluid resuscitation with hydroxyethyl starch 130/0.4 (6%) in severe burn injury: a randomized, controlled, double-blind clinical trial

IntroductionThere are limited data on the efficacy of early fluid resuscitation with third-generation hydroxyethyl starch (HES 130) in burn injury. Adverse effects of HES on survival and organ function have been reported.MethodsIn this randomized, controlled, double-blind trial, 48 patients with severe burn injury were assigned to receive either lactated Ringer’s solution plus 6% HES 130/0.4 in a ratio of 2:1 or lactated Ringer’s solution with no colloid supplement for the first 72 hours. Primary outcome parameter was the group difference of administered total fluid from intensive care unit (ICU) admission up to day 3. Secondary outcomes included kidney and lung injury and failure, length of stay, and mortality.ResultsThree-day totals of administered resuscitation fluid (medians) were 21,190 mL in the lactated Ringer’s group and 19,535 mL in the HES group (HES: −1,213 mL; P = 0.39). Creatinine levels from day 1 to 3 (HES: +0.4 μmol/L; 95% confidence interval (CI) −18.7 to 19.5; P = 0.97) and urinary outputs from day 1 to 3 (HES: −58 mL; 95% CI −400 to 283; P = 0.90) were not different. Six patients in each group developed acute respiratory distress syndrome (ARDS) (risk ratio 0.96; 95% CI 0.35 to 2.64; P = 0.95). Length of ICU stay (HES vs. lactated Ringer’s: 28 vs. 24 days; P = 0.80) and length of hospital stay (31 vs. 29 days; P = 0.57) were similar. Twenty-eight-day mortality was 4 patients in each group (risk ratio 0.96; 95% CI 0.27 to 4.45; P = 0.95), and in-hospital mortality was 8 in the HES group vs. 5 patients in the lactated Ringer’s group (hazard ratio 1.86; 95% CI 0.56 to 6.19; P = 0.31).ConclusionsThere was no evidence that early fluid resuscitation with balanced HES 130/0.4 (6%) in addition to lactated Ringer’s solution would lead to a volume-sparing effect in severe burn injury. Together with the findings that early renal function, incidence of ARDS, length of stay, and mortality were not negatively influenced by HES in this setting, balanced HES 130/0.4 (6%) plus lactated Ringer’s solution could not be considered superior to lactated Ringer’s solution alone.Trial registrationClinicalTrials.gov NCT01012648

Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4) Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection

Background and objectivesHydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes. MethodsIn this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15mL.kg-1 of HES 130/0.4 and 24 patients received a preload of 30mL.kg-1 lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications. ResultsRed blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p = .029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p = .037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection. ConclusionsDuring hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.

Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4) Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection

Background and objectivesHydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes. MethodsIn this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15mL.kg−1 of HES 130/0.4 and 24 patients received a preload of 30mL.kg−1 lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications. ResultsRed blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p=.029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p=.037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection. ConclusionsDuring hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.

The effect of 6% Hydroxyethyl starch vs. Ringer's lactate on acute kidney injury after renal ischemia in rats

To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (RL) in a rodent model of non-septic renal ischemia. Forty male Wistar rats were randomized to receive HES 2 ml.kg(-1).hr(-1) or RL 5 ml.kg(-1).hr(-1) that underwent 30 minutes of renal ischemia followed by reperfusion. Twelve hours after kidney ischemia, the kidneys were evaluated for histological changes. Serum NGAL levels were obtained at different times of the experimental protocol. Rodents in the HES group had a median (IQR) grade of renal injury 3 (3 to 5) compared to 2 (2 to 4) in the RL group (p=0.03). NGAL levels were not associated with the severity of kidney injury. Hydroxyethyl starch administration caused more kidney injury than Ringer's lactate in a non-infectious model of renal hypoperfusion.

New 6% hydroxyethyl starch 130/0.4 does not increase blood loss during major abdominal surgery—A randomized, controlled trial

Ideal fluid management during surgery still poses a clinical dilemma gauging the benefits and adverse effects. This randomized controlled trial compared the tissue perfusion and coagulation profiles under clinically equivalent hydroxyethyl starch (HES 130/0.4) and lactated Ringer's solution (LR). Eighty-four patients undergoing major abdominal surgery were randomized to receive either HES or LR. Tissue perfusion parameters using heart rate, arterial blood pressure, central venous pressure, cardiac index, stroke volume index, and central venous oxygen saturation were measured at T0 (baseline), T1 (start of surgery), T2 (1 hour after start of surgery), and T3 (end of surgery). Coagulation parameters using thrombelastography (TEG) were measured at T0 (baseline), T4 (after 15mL/kg fluid transfused), and T5 (24 hours after baseline). The total amount of fluid administrated was 1547.9±424.0mL in HES group and 2303.1±1033.7mL in LR group (p<0.001). The parameters of tissue perfusion and TEG did not differ significantly between groups at any time point except for a transient decrease in clot kinetic and clot strength at T4 for HES group. There was no significant difference in blood loss and consumption of blood products between the two fluids. HES 130/0.4 is a more efficient intravascular volume expander to maintain tissue perfusion than conventional crystalloid. Transient hypocoagulability induced by HES 130/0.4 does not warrant excessive blood loss and blood transfusion.

Effect of the Cellular-Type Artificial Oxygen Carrier Hemoglobin Vesicle as a Resuscitative Fluid for Prehospital Treatment

The hemoglobin vesicle (Hb-vesicle) is a cellular-type artificial oxygen carrier showing a resuscitative effect comparable to that of blood transfusion in several animal models. However, the efficacy of Hb-vesicles for resuscitation when the hemorrhage cannot be controlled remains unclear. Therefore, we used Hb-vesicles in a rat hemorrhagic shock model caused by continuous bleeding. For inducing uncontrolled hemorrhage, animals were heparinized and bled from the caudal artery. Fluid resuscitation was subsequently performed with five materials: Hb-vesicle suspension in a 5% albumin (Alb) solution (HbV), washed red blood cells (wRBC) in a 6% hydroxyethyl starch (HES) solution, 5% Alb, 6% HES, and saline (Sal). During the experiment, all animals in the HbV and wRBC groups survived, whereas all those in the Alb and HES groups died. In the Sal group, five of seven animals died. In the HbV and wRBC groups, the heart rate, mean arterial pressure, and blood lactic acid levels were stabilized during resuscitation. Meanwhile, the hematocrit levels of the HbV, Alb, and HES groups showed sharp decreases (HbV: 6.8% ± 1.7%, Alb: 6.8% ± 0.8%, HES: 5.5% ± 0.7% at 100% total circulated blood volume; final hematocrit of the HbV group: 1.5% ± 0.5%). These results suggest that shocked animals can survive longer when the Hb-vesicle supply is maintained and that HbV showed a similar effect to wRBC in maintaining the circulating volume and oxygen metabolism. Continuous infusion of Hb-vesicles may extend the survival of trauma victims with uncontrolled hemorrhage until they have reached a trauma center.

Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study

Abstract Introduction Inadequate initial treatment and delayed hemodynamic stabilization (HDS) may be associated with increased risk of death in severe sepsis patients. Methods In order to compare the hemodynamic efficacy and safety of 6% HES 130/0.4 and NaCl 0.9% for HDS in patients with severe sepsis, we designed a prospective, multicenter, active-controlled, double-blind, randomized study in intensive care units. Results 174 out of 196 patients reached HDS (88 and 86 patients for HES and NaCl, respectively). Significantly less HES was used to reach HDS vs. NaCl (1,379 ±886 ml in the HES group and 1,709 ±1,164 ml in the NaCl group (mean difference = -331± 1,033, 95% CI -640 to -21, P = 0.0185). Time to reach HDS was 11.8 10.1 hours vs. 14.3 ±11.1 hours for HES and NaCl, respectively. Total quantity of study drug infused over four consecutive days, ICU and hospital LOS, and area under the curve of SOFA score were comparable. Acute renal failure occurred in 24 (24.5%) and 19 (20%) patients for HES and NaCl, respectively (P = 0.454). There was no difference between AKIN and RIFLE criteria among groups and no difference in mortality, coagulation, or pruritus up to 90 days after treatment initiation. Conclusion Significantly less volume was required to achieve HDS for HES vs. NaCl in the initial phase of fluid resuscitation in severe sepsis patients without any difference for adverse events in both groups. ClinicalTrials.gov NCT00464204

Comparison ofHb‐200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation‐volvulus

To compare the use of polymerized stroma-free bovine hemoglobin (Hb-200) and 6% hetastarch 450/0.7 (HES 450/0.7) in 0.9% saline during fluid resuscitation of dogs with gastric dilatation-volvulus (GDV). Prospective, randomized clinical case series. Private specialty and referral clinic. Twenty client-owned dogs presenting with GDV. Dogs presenting with GDV and abnormal perfusion parameters first received rapid IV infusion of a buffered isotonic replacement crystalloid (15 mL/kg) and IV opioids. Patients were then randomized to receive either Hb-200 (N = 10) or HES 450/0.7 (N = 10). Balanced isotonic replacement crystalloids (10-20 mL/kg IV) were rapidly infused along with either Hb-200 or HES in 5 mL/kg IV aliquots to meet resuscitation end points. Resuscitation was defined as meeting at least 2 of 3 criteria: (1) capillary refill time 1-2 seconds, pink mucous membrane color, strong femoral pulse quality; (2) heart rate (HR) ≤ 150/min; or (3) indirect arterial systolic blood pressure (SBP) > 90 mm Hg. HR, SBP, packed cell volume, hemoglobin, glucose, venous pH, bicarbonate, base excess, anion gap, and colloid osmotic pressure were compared at hospital entry and within 30 minutes post-resuscitation. Compared to the HES group, the Hb-200 group required significantly less colloid (4.2 versus 18.4 mL/kg) and crystalloid (31.3 versus 48.1 mL/kg) to reach resuscitation end points (P = 0.001). Time to resuscitation was significantly shorter in the Hb-200 group (12.5 versus 52.5 min). Dogs with GDV receiving Hb-200 during initial resuscitation required smaller volumes of both crystalloid and colloid fluids and reached resuscitation end points faster than dogs receiving HES 450/0.7 (P = 0.02).

Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study

IntroductionInadequate initial treatment and delayed hemodynamic stabilization (HDS) may be associated with increased risk of death in severe sepsis patients.MethodsIn order to compare the hemodynamic efficacy and safety of 6% HES 130/0.4 and NaCl 0.9% for HDS in patients with severe sepsis, we designed a prospective, multicenter, active-controlled, double-blind, randomized study in intensive care units.Results174 out of 196 patients reached HDS (88 and 86 patients for HES and NaCl, respectively). Significantly less HES was used to reach HDS vs. NaCl (1,379 ±886 ml in the HES group and 1,709 ±1,164 ml in the NaCl group (mean difference = -331± 1,033, 95% CI -640 to -21, P = 0.0185). Time to reach HDS was 11.8 10.1 hours vs. 14.3 ±11.1 hours for HES and NaCl, respectively. Total quantity of study drug infused over four consecutive days, ICU and hospital LOS, and area under the curve of SOFA score were comparable. Acute renal failure occurred in 24 (24.5%) and 19 (20%) patients for HES and NaCl, respectively (P = 0.454). There was no difference between AKIN and RIFLE criteria among groups and no difference in mortality, coagulation, or pruritus up to 90 days after treatment initiation.ConclusionSignificantly less volume was required to achieve HDS for HES vs. NaCl in the initial phase of fluid resuscitation in severe sepsis patients without any difference for adverse events in both groups.ClinicalTrials.govNCT00464204

Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma)

The role of fluids in trauma resuscitation is controversial. We compared resuscitation with 0.9% saline vs hydroxyethyl starch, HES 130/0.4, in severe trauma with respect to resuscitation, fluid volume, gastrointestinal recovery, renal function, and blood product requirements. Randomized, controlled, double-blind study of severely injured patients requiring >3 litres of fluid resuscitation. Blunt and penetrating trauma were randomized separately. Patients were followed up for 30 days. A total of 115 patients were randomized; of which, 109 were studied. For patients with penetrating trauma (n=67), the mean (sd) fluid requirements were 5.1 (2.7) litres in the HES group and 7.4 (4.3) litres in the saline group (P<0.001). In blunt trauma (n=42), there was no difference in study fluid requirements, but the HES group required significantly more blood products [packed red blood cell volumes 2943 (1628) vs 1473 (1071) ml, P=0.005] and was more severely injured than the saline group (median injury severity score 29.5 vs 18; P=0.01). Haemodynamic data were similar, but, in the penetrating group, plasma lactate concentrations were lower over the first 4 h (P=0.029) and on day 1 with HES than with saline [2.1 (1.4) vs 3.2 (2.2) mmol litre⁻¹; P=0.017]. There was no difference between any groups in time to recovery of bowel function or mortality. In penetrating trauma, renal injury occurred more frequently in the saline group than the HES group (16% vs 0%; P=0.018). In penetrating trauma, maximum sequential organ function scores were lower with HES than with saline (median 2.4 vs 4.5, P=0.012). No differences were seen in safety measures in the blunt trauma patients. In penetrating trauma, HES provided significantly better lactate clearance and less renal injury than saline. No firm conclusions could be drawn for blunt trauma. ISRCTN 42061860.

Randomised study of hypertonic saline infusion during resuscitation from out-of-hospital cardiac arrest

Aim of the studyAnimal models of hypertonic saline infusion during cardiopulmonary resuscitation (CPR) improve survival, as well as myocardial and cerebral perfusion during CPR. We studied the effect of hypertonic saline infusion during CPR (Guidelines 2000) on survival to hospital admission and hospital discharge, and neurological outcome on hospital discharge. MethodsThe study was performed by the EMS of Bonn, Germany, with ethical committee approval. Study inclusion criteria were non-traumatic out-of-hospital cardiac arrest, aged 18–80 years, and given of adrenaline (epinephrine) during CPR. Patients were randomly infused 2mlkg−1 HHS (7.2% NaCl with 6% hydroxyethyl starch 200,000/0.5 [HES]) or HES over 10min. Results203 patients were randomised between May 2001 and June 2004. After HHS infusion, plasma sodium concentration increased significantly to 162±36mmoll−1 at 10min after infusion and decreased to near normal (144±6mmoll−1) at hospital admission. Survival to hospital admission and hospital discharge was similar in both groups (50/100 HHS vs. 49/103 HES for hospital admission, 23/100 HHS vs. 22/103 HES for hospital discharge). There was a small improvement in neurological outcome in survivors on discharge (cerebral performance category 1 or 2) in the HHS group compared to the HES group (13/100 HHS vs. 5/100 HES, p<0.05, odds-ratio 2.9, 95% confidence interval 1.004–8.5). ConclusionHypertonic saline infusion during CPR using Guidelines 2000 did not improve survival to hospital admission or hospital discharge. There was a small improvement with hypertonic saline in the secondary endpoint of neurological outcome on discharge in survivors. Further adequately powered studies using current guidelines are needed.

Effect of small volume hypertonic sodium chloride hydroxyethyl starch 40 injection on focal cerebral ischemia/reperfusion injury in mice

Objective To investigate the effect of the hypertonic sodium chloride hydroxyethyl starch 40 injection on focal cerebral ischemia/reperfusion injury (I/RI) in mice. Methods Thirty KM mice were divided into three groups (n=10) randomly:hypertonic hydroxyethyl starch 40 sodium chloride group (group HSH), hydroxyethyl starch 130/0.4 group (group HES), control group (group control). At onset of ischemic insult, different agents were injected via the tail vein instantly. Mice in group HSH received 4 ml/kg of hypertonic hydroxyethyl starch 40 sodium chloride injection. Mice in group HES received 4 ml/kg of hydroxyethyl starch 130/0.4 sodium chloride injection. Mice in group control received 4 ml/kg of 0.9％ physiological saline injection. Neurological behavioral testing was performed at 12, 24 and 72 h after ischemia, respectively. TTC staining was performed at 24 h after ischemia,and the percentage of infarction area was calculated. Toluidine blue staining was performed at 72 h after ischemia and surviving neurons in the penumbra were counted. Results Neurological scoring at 12, 24 h and 72 h after ischemia: HSH group 10.0±2.0,11.4±1.8, 10.4±1.8; HES group 12.8±1.8, 10.2±1.9, 10.6±2.7; Control group 12.0±2.1, 10.2±2.4, 10.0±2.5. The percentage of infarct area at 24 h after ischemia: HSH group (34.0±7.8)％; HES group (38.8±2.9)％; Control group (35.6±6.5)％. The density of surviving neurons in the penumbra at 72 h after ischemia: HSH group (264±57)/mm2; HES group (302±49)/mm2; Control group (288±69)/mm2. There were no difference in neurological deficit score, percentage of infarct areas and density of surviving neurons in the penumbra among three groups, respectively(P＞0.05). Conclusion Hypertonic hydroxyethyl starch 40 sodium chloride injection has no effect on focal cerebral I/RI in mice. Key words: Hydroxyethyl starch 130/0.4 sodium chloride injection; Hypertonic sodium chloride hydroxyethyl starch 40 injection; Ischemia/reperfusion injury; Penumbra

O-60 Dexmedetomidine as a sedative adjuvant to anaesthetics in off-pump coronary bypass surgery in hypertensive patients

On arrival in the ICU, CFT-Intem values were significantly different (P 0.0001) between groups with the highest values being detected in the HES group and the lowest in the RL group. Twenty-four hours after surgery, the HA 5% group showed significantly higher values than patients of the RL (P 0.0001) and the HES group (P 0.0042). No significant difference was found between the HES and the RL group (P 0.1929). Discussion. Both colloids induced prolongation of CFT-Intem. However, 24 hours after surgery, it only persisted in the HA 5% group. Thus, both colloids might negatively affect coagulation. In contrast, RL did not influence coagulation parameters.

Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output (CO) and incidence of hypotension in elderly patients under spinal anesthesia (SA). A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement (THR), who were randomized to three groups: the control group (C group, n = 15), crystalloid (RS group, n = 16) and colloid group (HES group, n = 16). An intravenous preload of 8 mL/kg of either lactated Ringer's solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline ( P < 0.01). Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respectively ( P = 0.362). Intravascular volume preload with colloid is more effective than crystalloid solution in maintaining CO, which may be improved the hemodynamic stability in elderly patients during SA.

Effect of hydroxyethyl starch on the expression of aquaporin-1 of liver and liver injury in rats with severe acute pancreatitis

Objective To investigate the effect of hydroxyethyl starch (HES 130/0. 4) on the expression of aquaporin 1 (AQP-1) and liver injury in rats with severe acute pancreatitis(SAP).Methods Forty-eight male SD rats were randomly divided into three groups: Sham, SAP, and HES;each group was divided into 6 hour and 24 hour timepoints, with 8 in each subgroup. An SAP model was induced by injecting 5% sodium taurodeoxycholate into the biliary pancreatic duct. AMY, ALT,AST and water content in the liver were measured and TNF-a was examined by ELISA, and the expression of liver AQP-1mRNA was determined by RT-PCR, and the expression of liver AQP-Ⅰ protein was evaluated by immunohistochemical methods. Results Compared with the Sham group, the level of AMY, ALT, AST, TNF-a, water content, AQP-1mRNA and AQP-1 protein increased significantly in the SAP group (P＜0.05). Compared with the SAP group, the level of AMY, ALT, AST,TNF-a, water content, AQP-1mRNA and AQP-1 protein decreased significantly in the HES group (P＜0.05). At 6 hours, the expressions of liver AQP-1mRNA were (0. 402 ± 0. 023), (0. 811 ±0. 032) and (0. 595 ± 0. 015) in the Sham, SAP, and HES groups, respectively; at 24 hours, they were(0. 412 ± 0. 017), ( 0. 823 ± 0. 029) and (0. 607 ± 0. 021 ), with significant differences between each group (P＜0. 05). At 6 hours, the expressions of liver AQP-1 proteins were (2.07±0.25),(6.90±0.38)and (4.48±0.29) in the Sham, SAP and HES groups, respectively;at 24 hours, they were (2. 32±0. 31 ), (7. 04 ± 0. 32) and (4. 56 ± 0. 35), with significant differences between each group (P＜0. 05). Compared with the SAP group, the pathology of the pancreas and liver ameliorated significantly in the HES group. Conclusions Hydroxyethyl starch 130/0.4 may ameliorate liver injury of severe acute pancreatitis and alleviate the capillary leak. AQP-1 may play a role in the capillary leak caused by the liver injury of severe acute pancreatitis. Key words: Hydroxyethyl starch; Pancreatitis, severe acute; Liver injury; Aquaporin-1; Capillary Permeability

Prevención de la hipotensión arterial en cesáreas con anestesia subaracnoidea. Estudio prospectivo, aleatorizado comparativo entre hidroxietilalmidón 130/0,4 y efedrina

Background and objectiveSpinal anesthesia is the technique of choice for scheduled or emergency cesarean section, but the prevalence of hypotension is high in this setting. Our aim was to compare the efficacy of a colloid (6% hydroxyethyl starch [HES] 130/0.4) to ephedrine for preventing hypotension. Patients and methodsPatients undergoing elective or emergency cesarean section (in non-life-threatening situations) were enrolled. Patients were randomized to 3 groups for prophylaxis. The first ephedrine group received 5mg of ephedrine intravenously (EPHE-5); the second ephedrine group received 10mg of the drug intravenously (EPHE-10); and the HES group received 500mL of HES 130/0.4 in rapid infusion in 15minutes. We recorded systolic and diastolic blood pressures and heart rate after 10minutes in the operating room and 2, 5, 10, 15, 20, and 30minutes after injection of the anesthetic. We also assessed the sensory and motor blockades on both sides 2, 5, 10, 15, 20, and 30minutes after injection. Neonatal status was assessed by Apgar score and umbilical cord blood gas analysis. ResultsNinety-six patients, 33 in each ephedrine group and 30 in the HES group, were enrolled. Blood pressure decreased similarly in all 3 groups (36% EPHE-5 group, 36% EPHE-10 group and 40% HES group); no significant between-group differences were observed. Nor were there significant differences in the percentages of patients requiring bolus doses of ephedrine to treat hypotension (23% in the HES group vs 33% in the EPHE-5 group and 27% in the EPHE-10 group) or in the cumulative doses of ephedrine. Neonatal status was also similarly satisfactory in all 3 groups. ConclusionsHES 130/0.4 is as useful for hypotension prophylaxis as 5-mg or 10-mg intravenous doses of ephedrine. HES 130/0.4 might be a substitute for sympathomimetic agents if adverse effects are predicted or contraindications to the use of such drugs are present.

The effects of hydroxyethyl starch on lipopolysaccharide-induced endothelial injury in rat mesenteric venules

To investigate the effect of hydroxyethyl starch (HES, 130/0.4) on lipopolysaccharide (LPS)-induced endothelial injury in rat mesenteric venules. Thirty-six Wistar rats weighing 200 - 250 g were randomly divided into 3 groups, n = 12 for each group. Rats were given LPS (2 mg/kg) and followed by normal saline 16 ml x kg(-1) x h(-1) in LPS group or HES 16 ml x kg(-1) x h(-1) in HES group for 60 min. Rats in control group received equal volume of saline. The dynamic changes in diameters of postcapillary venules, red blood cell velocities in venules, and hydrogen peroxide released from venules were evaluated. The ultrastructure of postcapillary venule was observed by electron microscopy. Mesenteric venular RBC velocities, vascular diameters and shear rates on the venular wall remained constant in any of the groups during the observation (P > 0.05). The hydrogen peroxide generation from venules increased in both HES and LPS groups (P < 0.05). In HES group, the hydrogen peroxide generation and cytoplasmic caveolae in postcapillary venule induced by LPS were significantly inhibited compared with LPS group (P < 0.05). Hydroxyethyl starch (130/0.4) could reduce the LPS-induced endothelial injury in rat mesentery. The effect was related to the inhibition of hydrogen peroxide generation on venular wall.

Effects of volume therapy with different doses of 6% hydroxyethyl starch 130/0.4 on lung injury in a rat model of hemorrhagic shock

Objective To evaluate the effects of volume therapy with different doses of 6% hydroxyethyl starch 130/0.4 (6% HES 130/0.4) on lung injury in a rat model of hemonhagic shock.Methods Twenty-four male SD rats weighing 220-300 g were randomly divided into 4 groups ( n = 6 each) : group I sham operation (group S); group II Ringer's solution (group RS); group HI and IV 2 HES groups (group H1, H2 ). The animals were anesthetized with intraperitoneal 1% sodium pentobarbital 45 ing/kg. Right common carotid artery (CCA) and left femoral vein were cannulated for blood letting, MAP monitoring, fluid administration and blood sampling. Hemonhagic shock was induced by withdrawing blood from right CCA in group II , III and IV . MAP was reduced to 35-45 mmHg which was maintained for 90 min. In group RS, hemorrhagic shock was resuscitated with Ringer's solution 3 times of the volume of blood withdrawn, while group H1 and H2 received HES 33 and 50 ml/kg respectively and Ringer' s solution (the total volume was equal to 3 times of the volume of blood removed) . Arterial blood samples were taken before blood letting (T0 , baseline), and at 2, 3 h after volume therapy (T1,2) for blood gas analysis and PaO2/FiO2 was calculated. The animals were then sacrificed by exsanguination and the lungs were immediately removed for microscopic examination and determination of protein concentration in broncho-alveolar lavage fuid (BALF), W/D lung weight ratio and TNF-α, IL-1 β and IL-10 contents in the lung.Results TNF-α, IL-1β and IL-10 content in the lung, protein concentration in BALF and W/D ratio were significantly higher in group RS, H1 and H2, while PaO2/FiO2 was significantly lower at T,2 in group RS and at T2 in group H2 than in group S (P < 0.05). TNF-α and IL-1β contents in the lung, protein concentration in BALF and W/D ratio were significantly lower in group H1 and H2 , while PaO2/FiO2 was significantly higher at T,i2 in group H1 and at T1 in group H2 than in group RS (P <0.05) . PaO2/FiO2 at T2 and IL-10 content in the lung were significantly lower in group H2 than in group H, ( P < 0.05) . The lung damage was significantly ameliorated in group H1 and H2 especially in group H, as compared with group RS. Conclusion Volume therapy with 6% HES 130/0.4 33 or 50 ml/kg can attenuate lung injury in a rat model of hemorrhagic shock and the efficacy of 33 ml/kg is better. Key words: Hetastarch; Shock,hemorrhagic; Respiratory distress syndrome,adult

Effect of fluid therapy on skin microcirculatory perfusion during induction of general anesthesia in patients undergoing major abdominal surgery

Objective To investigate the changes in skin microcirculatory perfusion during induction of general anesthesia and the effects oftwo fluid therapy regimens in patients undergoing abdominal surgery.Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 18-64 yr scheduled for elective major abdominal surgery were randomized to receive either 6% hydroxyetlayl starch(130/0.4)7 ml/kg(HES group,n=18)or lactated Ringer's solution 7 ml/kg(RL group,n=18)for compensatory intravascular volultne expansion(CVE)before tracheal intubation.Meanwhile both groups received continuous intravenous infusion of RL at a of 8 ml·kg~(-1)·h~(-1).Tracheal intubation was performed at 40 min after the onset of infusion.Anesthesia was maintained with with sevoflurane,remifentanil and rocuronium.Operation was started at 20 min after tracheal intubation.The microcirculatory perfusion was measured on forehead skin by using Doppler perfusion imaging system(LDPI)PI)at the onset of fluid infusion(T_0,baseline),the end of endotracheal intubation(T_1)and the onset of skin incision(T_2).Rwsults The MAP,HR,blood gases and body temperature were within the normal during the experiment and there was no significant difference between the 2 groups.The skin microcirculatory perfusion and CVP at T_1 were significantly higher in group HES than in group RL(P 0.05),the skin microcirculatory perfusion at T_2 was singificantly decreased in both groups(P<0.01),and CVP and PaO_2/FiO_2 at T_(1.2) were significantly increased,while Hb at T_(1.2) was significantly decreased in both groups(P<0.05).The skin microcirculatory perfusion in both groups was significantly lower at T_2 than at T_1(P<0.01).Conclusion The infusion of 6% HES 130/0.4 can improve the skin microcirculatory perfusion and the effect is better than that of RL during induction of general anesthesia in patients seheduled for abdominal surgery. Key words: Microcirculation; Skin; Fluid therapy