Hydroxylethyl Starch Research Articles

Effect of Goal-Directed Intraoperative Fluid Therapy on Duration of Hospital Stay and Postoperative Complications in Patients Undergoing Excision of Large Supratentorial Tumors.

Optimal fluid management during neurosurgery is controversial. Evidences suggest that goal-directed fluid therapy (GDFT) can improve postoperative outcome. This study aimed to assess the intraoperative use of GDFT on the duration of hospital stay and postoperative complications in patients undergoing craniotomy for large supratentorial tumors. Forty patients of 18-65 years age undergoing large supratentorial tumor surgery were prospectively randomized into two groups. Control-group received fluid regimen based on routine hemodynamic monitoring, whereas patients belonging to GDFT group received fluid based on stroke volume variation (SVV)-guided therapy. A colloid bolus of 250 ml 6% hydroxyl ethyl starch was given, if the SVV was more than 12% in the GDFT group. Hemodynamic parameters, such as blood pressure and heart rate, and dynamic parameters, such as cardiac index, stroke volume index, and SVV, were recorded at different time intervals. The total amount of fluid required was significantly lower in GDFT (P = 0.003) group as compared to the Control group. Intraoperative complications were significantly lower in GDFT group (P = 0.005), but the incidence of tight brain was significantly higher in the control group. The duration of hospital stay (P = 0.07) and incidence of postoperative complications (P = 0.32) were lower in GDFT group. Neurological outcomes at-discharge were similar in both the groups. This study did not show any benefit of GDFT over conventional intraoperative fluid therapy in terms of incidence of postoperative complications, hospital and ICU stay, and Glasgow outcome scores at-discharge in patients undergoing craniotomy for excision of large supratentorial tumors. However, the use of GDFT leads to better perioperative fluid management and brain relaxation scores. CTRI/2016/10/007350.

Hydroxyl Ethyl Starch (HES) Preserves Intrarenal Microcirculatory Perfusion Shown by Contrast-Enhanced Ultrasound (Ceus), and Renal Function in a Severe Hemodilution Model in Pigs.

Acute normovolemic hemodilution (ANH) is associated with low oxygen carrying capacity of blood and purposed to cause renal injury in perioperative setting. It is best accomplished in a perioperative setting by a colloid such as hydroxyl ethyl starch (HES) due its capacity to fill the vascular compartment and maintain colloidal pressure. However, alterations of intra renal microvascular perfusion, flow and its effects on renal function and damage during ANH has not been sufficiently clarified. Based on the extensive use of HES in the perioperative setting we tested the hypothesis that the use of HES during ANH is able to perfuse the kidney microcirculation adequately without causing renal dysfunction and injury in pigs. Hemodilution (n = 8) was performed by stepwise replacing blood with HES to hematocrit (Hct) levels of 20% (T1), 15% (T2), and 10% (T3). Seven control animals were investigated. Systemic and renal hemodynamics were monitored. Renal microcirculatory perfusion was visualized and quantified using contrast-enhanced ultrasound (CEUS) and laser speckle imaging (LSI). In addition, sublingual microcirculation was measured by handheld vital microscopy (HVM). Intrarenal mean transit time of ultrasound contrast agent (IRMTT-CEUS) was reduced in the renal cortex at Hct 10% in comparison to control at T3 (1.4 ± 0.6 vs. 2.2 ± 0.7 seconds, respectively, P < 0.05). Although renal function was preserved, the serum neutrophil gelatinase-associated lipocalin (NGAL) levels was higher at Hct 10% (0.033 ± 0.004 pg/μg protein) in comparison to control at T3 (0.021 ± 0.002 pg/μg protein. A mild correlation between CO and IRMTT (renal RBC velocity) (r -0.53; P = 0.001) and CO and NGAL levels (r 0.66; P = 0.001) was also found. Our results show that HES induced ANH is associated with a preserved intra renal blood volume, perfusion, and function in the clinical range of Hct (<15%). However, at severely low Hct (10%) ANH was associated with renal injury as indicated by increased NGAL levels. Changes in renal microcirculatory flow (CEUS and LSI) followed those seen in the sublingual microcirculation measured with HVM.

Comparative effects of human albumin versus modern hydroxyethyl starch in living-donor renal transplant

Background Living-donor renal transplantation is considered the best therapy for renal failure patients. The outcome and graft function are affected by various perioperative variables. Fluid management remains a controversy whether to use crystalloids or colloids with the effect of either type of solution on graft function and overall morbidity. Patients and methods We studied 120 patients with end-stage renal disease, who were on regular hemodialysis scheduled for living-related kidney transplantation. The patients were assigned to receive either 6% hydroxylethyl starch (HES) 130/0.4 (Voluven) (HES group: n=60) or albumin 5% (ALB group: n=60) for intraoperative use. In both groups, normal saline was administered at 10 ml/kg/h. In addition, patients received 250 ml boluses of either Voluven (HES group) with a maximum of 50 ml/kg/day or ALB 5% (ALB group) to maintain their central venous pressure between 12 and 15 mmHg. Blood transfusion was given based on the hemoglobin level ( Results There were no statistically significant differences between the two groups regarding hemodynamic variables, onset of diuresis, or need for postoperative dialysis. Perioperative laboratory workup (BUN, creatinine, creatinine clearance, and INR) were similar in both study groups. Conclusion There are no statistically significant differences between the use of HES solutions and ALB 5% on the outcome of living-donor renal transplant recipients. Using either solutions is comparable to the other with no special side effects.

Changes in colloid solution sales in Nordic countries.

Administration of resuscitation fluid is a common intervention in the treatment of critically ill patients, but the right choice of fluid is still a matter of debate. Changes in medical practice are based on new evidence and guidelines as well as traditions and personal preferences. Official warnings against the use of hydroxyl-ethyl-starch (HES) solutions have been issued. Nordic guidelines have issued several strong recommendations favouring crystalloids over colloids in all patient groups. Our objective was to describe the patterns of colloid use in Nordic countries from 2012 to 2016. The data were obtained from companies that provide pharmaceutical statistics in different countries. The data are sales figures from pharmaceutical companies to pharmacies and health institutions. We found a 56% reduction in the total sales of all colloids in Nordic countries over a 5-year period. These findings were mainly related to a 92% reduction in the sales of HES solutions. A reduction in sales of other synthetic colloids has also occurred. During the same period, we found a 46% increase in albumin sales, but these numbers varied between Nordic countries. The general reduction in colloid sales likely reflects the recommendation that colloids should be used only in special circumstances. The dramatic reduction in the sales of HES solutions was expected given evidence of harm and the official warnings. The steady increase in albumin sales and the notable differences between the five Nordic countries cannot be explained.

Reduced amputation rate with isovolemic hemodilution in critical limb ischemia patients.

Critical limb ischemia (CLI) patients are characterized by intractable pain in spite of medication, non-healing ulcers, and gangrene. The objective of this study was to investigate whether or not isovolemic hemodilution treatment can reduce the rate of major amputations in CLI. 28 patients were studied who had tissue loss on Rutherford Grade III, Category 5 or 6. The subjects were divided into two arms: standard-of-care, conventional therapy (CT) (n = 15) as a control group and hemodilution therapy (HT) (n = 13) as a study group. For the HT group, weekly isovolemic hemodilution was performed over 4 consecutive weeks, removing 250 ml of whole blood with the infusion of hydroxyl-ethyl starch solution. Blood viscosity, hematocrit, hemoglobin, ankle-brachial index, VA pain scale, time-to-amputation from admission, and survival time were measured. The mean Hct gradually decreased from 36.6 to 35.1, whereas the WBV at a shear rate of 1 s-1 significantly decreased from 18.2 to 10.5 during the same period. Subsequently, tissue oxygen delivery index, defined as the ratio of Hct to WBV at a shear rate of 1 s-1, increased from 24.4 to 37.0 by 51.7%, suggesting improvements in oxygen delivery in the patients. The average rate of lower limb major amputation in the control group was 93% (14/15), whereas that in the study group was 31% (4/13) (p = 0.001). Amputation-free median survival time and amputation-free 5-year survival rate in the control group were 1.2 months and 7%, while those in the study group were 30.2 months and 44% (p = 0.001). There were no adverse effects from repetitive hemodilution in the study group. Isovolemic hemodilution treatment of CLI patients was found to be well-tolerated and reduced the rate of major amputation resulting from the deterioration of CLI.

Renal response to intravascular volume expansion in euvolemic heart failure patients with reduced ejection fraction: Mechanistic insights and clinical implications

BackgroundUntreated and preclinical heart failure patients with reduced ejection fraction (HFrEF) have an impaired ability to alleviate excess intravascular volume. ObjectivesTo investigate 1) the renal response to intravascular volume expansion in euvolemic and optimally treated HFrEF patients and 2) loop diuretic efficiency. Methods14 healthy and 28 HFrEF patients underwent intravascular volume expansion with 1l hydroxyl ethyl starch 6% during 3h after which a loop diuretic was administered. Clinical parameters, neurohormones and urine were hourly measured. ResultsIn response to intravascular volume expansion (+0.6±0.2L; p<0.001 vs baseline) HFrEF patients demonstrated significantly lower natriuresis compared to healthy subjects (0.9±0.5 versus 1.7±0.6g/3h; p<0.001). However, natriuresis varied substantially with half of HFrEF patients exhibiting a response within the range of healthy and the other half demonstrating a significantly decreased response (1.4±0.4 vs 0.5±0.2g/3h; p<0.001). Natriuresis was associated with glomerular filtration function (eGFR), NT-proBNP and tubular fractional sodium excretion (FENa). Loop diuretic efficiency was significantly lower in HFrEF patients compared to healthy subjects (3.4±0.7 vs 2.6±1.1g/2h; p=0.044) but was only related to eGFR (R2=0.47; p<0.001) and independent of FENa (R2=0.07; p=0.20). Loop diuretics increased FENa similarly in healthy subjects and HFrEF patients (9.1±2.4 vs 9.3±3.3%; p=0.64). ConclusionThe ability of the kidneys to remove excess intravascular volume is decreased in a substantial amount of euvolemic and optimally treated HFrEF patients. Renal response relates to filtration function and tubular sodium handling. In contrast, loop diuretics can surmount decreased renal tubular sodium excretion but remain dependent on eGFR.

Comparison of 6% Hydroxyl Ethyl Starch and Ringer’s Lactate for Preloading in Caesarean Section under Spinal Anaesthesia

Comparison of 6% Hydroxyl Ethyl Starch and Ringer’s Lactate for Preloading in Caesarean Section under Spinal Anaesthesia

Hydroxyethyl starch solution for extracorporeal tissue perfusion

In the field of free flap transfer in reconstructive surgery, the trans- or replanted tissue always undergoes cell damage during ischemia to a more or less strong extent. In previous studies we already showed that conserving muscle transplants by means of extracorporeal perfusion over a period of 6 hours by using a crystalloid solution for perfusion. However, we observed significant edema formation. In this study we aimed at reducing the edema formation by using an iso-oncotic colloid as perfusion solution. This way we wanted to evaluate a possible new application of hydroxyl-ethyl starch in an extracorporeal setup to exploit potential benefits of the colloid.Examined parameters include the muscles' functionality with external field stimulation, histological examination and edema formation. Perfused muscles showed a statistically significant higher ability to exert force compared to nonperfused ones. These findings can be confirmed using Annexin V as marker for cell damage, as perfusion of muscle tissue limits damage significantly compared to nonperfused tissue. Substituting the electrolyte perfusion solution with a colloidal one shows the tendency to reduce the edema formation however without statistical significance.

Comparative Study of Preloading with Ringer Lactate V/S 6% Hexa Starch Solutions to Prevent Hypotension Following Spinal Anaesthesia in Elective Surgery

Background: Hemodynamic variations are commonly encountered following subarchnoid block and can attribute to significant mortality and morbidity. To counteract the hypotension, fluid adminstration before spinal anaesthesia is recommended (preloading). Crystalloids and colloids are recommended as preloading fluids but both have their own merits and demerits. Objective: This comparative study was done to compare the effectiveness of ringer lactate versus 6% hydroxyl ethyl starch for preventing spinal anesthesia induced hypotension. Material and Methods: In this prospective study, we compare the effectiveness of ringer lactate versus 6% hydroxy ethyl starch at 10ml/kg over a period of 20 minutes before spinal anaesthesia in preventing hypotension. After administration of spinal anaestheisa mean arterial pressure were recorded at 1, 5, 10, 15, 30, 45, 60, 90 minutes and 3 hours after spinal anaesthesia. Number of patient, recieving injection Mephentermine sulphate for persistent hypotension was also recorded. Results: We found that hydroxy ethyl starch is more effective than ringer lactate solution as a preloading fluid in prevention of hypotension following spinal anaesthesia. Conclusion: Hydroxy ethyl starch is superior to ringer lactate in preventing hypotension in patients undergoing elective lower abdominal surgeries under spinal anaesthesia but the incidence of hypotension is not completely eliminated.

Six percent hetastarch versus lactated Ringer's solution - for preloading before spinal anesthesia for cesarean section.

Background:Regional anesthesia has been the choice of preference for elective cesarean sections. This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence of hypotension.Materials and Methods:This study was conducted on 50 nonlaboring American Society of Anesthesiologists class I and II women undergoing elective cesarean section. Patients were randomly divided into two groups and were preloaded either with 1000 ml Ringer's lactate (RL) or 500 ml of 6% hetastarch 30 min prior to the surgery. Spinal anesthesia was performed with patients in the left lateral position and 2 cc (10 mg) of 0.5% of bupivacaine injected into subarachnoid space. Hemodynamic variables (heart rate, noninvasive blood pressure, and SpO2) were recorded from prior to preloading until the recovery from the subarachnoid blockade.Results:Our study showed the incidence of hypotension to be 28% in the hetastarch group and 80% in the RL group. Rescue ephedrine requirements for the treatment of hypotension were significantly less in patients who were preloaded with 6% hetastarch prior to cesarean section. The neonatal outcome, as determined by Apgar scores was good and similar in both groups.Conclusion:Hence, we conclude that 6% hydroxyl ethyl starch is more effective than lactated Ringers solution and that its routine use for preloading prior to spinal anesthesia should be considered.

Evaluation of intravenous hydroxylethyl starch, intravenous albumin 20%, and oral cabergoline for prevention of ovarian hyperstimulation syndrome in patients undergoing ovulation induction.

Background:The purpose of this study was to compare the three different strategies, intravenous (IV) hydroxylethyl starch (HES), IV human albumin (HA), and oral Cabergoline (Cb) in the prevention of ovarian hyperstimulation syndrome (OHSS).Materials and Methods:In this prospective randomized clinical trial, 91 women at high risk of developing OHSS were allocated into the three groups, group one received 2 vial (2 × 50 ml) IV HAs, in group two, 1000 ml of 6% HES was administered IV, both groups 30 min after oocyte retrieval within 4 h. Group three, 31 infertile patients received oral Cb 0.5 mg daily for 7 days after oocyte retrieval. Patients were visited 14 ± 1 days after in-vitro fertilization and if β-human chorionic gonadotropin level >10, transvaginal ultrasonography was performed 2 weeks later to confirm intrauterine pregnancy. Patients were followed up weekly for 3 months for signs of OHSS and were also informed about the signs of OHSS and asked to contact immediately if any symptoms of were detected.Results:None of the participants in group HES developed severe OHSS and only 3 patients (10%) developed mild to moderate OHSS. The incident of severe OHSS was significantly higher in albumin group compared to Cb and HES group (P = 0.033 and P < 0.001, respectively). Also, the probability of developing severe OHSS was higher in Cb group than group HES (P = 0.031).Conclusion:The findings from this study suggest that administration of 1000 ml of HES 6% has a higher prophylactic effect compared to administration of IV HA and oral Cb.

Avascular necrosis of left Hip joint secondary to sickle cell anaemia for hip arthroplasty.

Avascular necrosis of left Hip joint secondary to sickle cell anaemia for hip arthroplasty.

A Clinical Scalable Cryopreservation Method of Adipose Tissue for Reconstructive Surgery Assessed by Stromal Vascular Fraction and Mice Studies

Adipose tissue is widely used in plastic surgery. The main obstacle is that it can be used only immediately after liposuction, while reconstruction often requires several procedures to achieve optimal results. This study aimed to develop a cryopreservation protocol directly applicable to clinical situations, allowing repetitive procedures without multiple tissue harvests. The authors first tested scalable bags suitable for therapeutic uses. All subsequent experiments were performed in those bags. The authors evaluated in vitro, on the basis of cell viability, cell number, phenotype, and stromal cell proliferation, the efficacy of six cryopreservation media composed of an external cryoprotectant (human albumin or hydroxylethyl starch) with or without an internal cryoprotectant (dimethyl sulfoxide). Two storage temperatures (-196°C and -80°C) were tested in vitro and in vivo (subcutaneous graft in 30 nude mice) with the selected medium. The combination of 5% dimethyl sulfoxide and 95% hydroxylethyl yielded in vitro results that were good and the most consistent. With this cryoprotective solution, the authors observed no significant difference in vitro for a storage period of 7 days. When the storage was extended to 1 month, the cell viability was decreased by 10 percent for both storage temperatures. The in vivo experiments assessed the superiority of cryopreservation at -80°C with less graft resorption (60 percent and 70 percent, respectively, for -80°C and -196°C) and less fibrosis. The study's protocol with a chemically defined cryoprotective solution, specific scalable bags constrained in an aluminum holder, and a storage temperature of -80°C is promising for long-term adipose tissue cryopreservation.

Goal-directed fluid optimization using plethysmography variability index in laparoscopic bariatric obese patients: is it the answer?

Objective The aim of the study was to compare effect of goal-directed fluid replacement using plethysmography variability index (PVI) guidance versus liberal fluid regimen in elective laparoscopic bariatric surgery on pulmonary oxygenation and gastrointestinal, cerebral, and renal function. Materials and methods This randomized-controlled trial included 60 consecutive patients who were 20-40 years of age with BMI greater than 40 scheduled for elective laparoscopic bariatric surgery between June 2010 and December 2011. Patients were randomized into 'liberal fluid' (LF) or 'goal-directed' (GD) fluid infusion group. All patients received 500 ml lactated Ringer's solution then 1-2 ml/kg/h in the GD group or 6-8 ml/kg/h in the LF group. A 5-min bolus infusion of 200 ml of 6% hydroxyl ethyl starch was administered, if PVI goes above 14, urine output less than 0.5 ml/kg/h, heart rate greater than 100/min, or decreased systolic blood pressure less than 20% of baseline value. This colloid bolus was repeated until 20 ml/kg is reached then lactated Ringer's solution was used for further boluses. The primary outcome measures were length of hospital stay, postoperative hypoxemia assessed by PO 2 /FiO 2 ratio, and serum lactate level. Results Intraoperatively, lactate level and volumes of infused Ringer's lactate and hydroxyl ethyl starch were significantly lower in the GD group (P < 0.001). PVI was significantly higher in the GD group (P < 0.001). Intraoperatively, lactate level and urine output were significantly lower in the GD group (P < 0.001). Postoperatively, the GD group showed significantly lower urine output (P < 0.001) and shorter time to recovery (P < 0.001) to first bowel movement (P < 0.001) and to resume normal diet (P < 0.001). Hypoxemia, diuresis, and fatigue were significantly more frequent in the LF group. No significant difference was seen in other postoperative complications. ConclusionGoal-directed, PVI-guided intraoperative fluid replacement significantly improved clinical outcome compared with liberal fluid intake. PVI guidance provides a sensitive and accurate determinant of fluid responsiveness and allowed for lower fluid intake. We recommend GD intraoperative fluid replacement with PVI and arterial blood gases (ABG) guidance in morbidly obese patients undergoing laparoscopic bariatric surgery.

English

BACKGROUND: Spinal anesthesia is the more commonly administered procedure for pelvic, lower abdominal and lower limb procedures. Hypotension is the most common complication of spinal anesthesia. It is a common practice to give intravenous fluids, usually crystalloids, prior to centro neuraxial block in order to prevent hypotension and this is usually referred as preloading. AIMS: Compare the efficacy of preloading with crystalloid to that of colloids in reducing the incidence and severity of hypotension in spinal anesthesia for lower abdominal surgery and also to find out if hydroxyl ethyl starch (HES) is a better colloid than polygelatin. STUDY DESIGN: The study population included 150 patients belonging to either sex undergoing elective lower abdominal surgeries under spinal anesthesia. METHODS AND MATERIAL: One hundred and fifty ASA I and II patients posted for lower abdominal surgeries under spinal anesthesia were randomly allocated to receive either 10mL/Kg of HES (Group A), 10mL/Kg of polygelatin (Group B) or 10mL/Kg of Ringer's lactate solution as preloading solution. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded once in two minutes for the first ten minutes and once in five minutes for the next fifty minutes. The incidence of hypotension and the mean dose requirement of mephentermine were noted after spinal anesthesia. STATISTICAL METHODS: The analysis of variance to find the significance difference of pulse rate, SBP and MAP between the three groups of patients. The Post hoc test by Tukey to find the pair wise significance between the three groups. The Chi-square test to find the significance of proportions of mephentermine dose requirement between the three groups. RESULTS: The incidence of hypotension was 9 of 50 (18%) in Group A, 17 of 50 (34%) in Group B and 27 of 50 (54%) in group C. The mephentermine bolus requirements were also less in group A (9 times) when compared to group B (18times) and group C (32 times), which was statistically significant. INTERPRETATION AND CONCLUSION: HES reduced the incidence of hypotension after spinal anesthesia and required lesser mean dose requirements of mephentermine when compared to polygelatin and ringers lactate. It can be concluded from the present study that colloids offset hypotension and hypovolemia more effectively than crystalloids. Also it can be concluded that hydroxyethyl starch is a better

Effects of different resuscitation fluids on pulmonary expression of aquaporin1 and aquaporin5 in a rat model of uncontrolled hemorrhagic shock and infection.

BackgroundTo investigate the effects of fluids resuscitation on pulmonary expression of aquaporin1 and aquaporin5 in a rat model of uncontrolled hemorrhagic shock and infection.MethodsSixty Sprague-Dawley rats were randomly assigned to five groups, sham operation group (Group C) and four treated groups: no fluid resuscitation group (Group NF), groups resuscitated with Lactated Ringer's (LR),7.5% NaCl (HTS) and Hydroxyl ethyl starch (HES) respectively. Three-phased uncontrolled hemorrhagic shock and infection model was used. Phase I: Massive hemorrhage with a mean arterial pressure of 35–40 mmHg for 60 min, and followed by infection of lipopolysaccharide. Then some animals were resuscitated with solutions mentioned above, until 90 min. Phase II: At hemorrhagic shock 90 minutes, phase II of 60 minutes began with hemostasis and returning of all the initial shed blood. Phase III: Observation phase for 3.5 hours. After phase III, arterial blood gas analysis and the survival rates of the rats were recorded, Wet-to-dry lung weight ratio, BALF protein, pulmonary permeability index, and expressions of aquaporin1 and aquaporin5 were tested.ResultsThe expressions of aquaporin1 and aquaporin5 were decreased in treatment groups comparing with sham operation group. Group HES and Group HTS decreased pulmonary vascular permeability and Wet-to-dry lung weight ratio, improved arterial blood gas analysis and survival rates, and attenuated the decreased pulmonary expression of aquaporin1 and aquaporin5 after the “two-hit”, comparing with groups NF and LR,but these beneficial effects were blunted in group HTS.ConclusionThe expression of aquaporin1 and aquaporin5 may play important roles in formation of pulmonary edema. Resuscitation with HTS and HES, especially HES can reduce lung injury after hemorrhagic shock, partly by up-regulating the expressions of aquaporin1 and aquaporin5.

Plethysmographic variation index predicts fluid responsiveness in ventilated patients in the early phase of septic shock in the emergency department: A pilot study

PurposeFeasibility study examining whether plethysmographic variability index (PVI) can predict fluid responsiveness in mechanically ventilated patients in the early phase of septic shock in the emergency department. Materials and MethodsMonocentric, prospective, observational study that included 31 mechanically ventilated and sedated patients with septic shock in whom volume expansion was planned. The patients were equipped with a pulse oximeter that automatically calculated and displayed PVI. The intervention consisted in infusing 8 mL/kg of hydroxylethyl starch over a 20-minute period. Before and after intervention, we recorded PVI and measured the aortic velocity-time integral (VTIao) using transthoracic echocardiography. Responders were defined as patients who increased their VTIao by 15% or higher after fluid infusion. ResultsSixteen patients were classified as responders, and 15 as nonresponders. Mean PVI values before intervention were significantly higher in responders vs nonresponders (30% ± 9% vs 8% ± 5%, P < .001). Plethysmographic variability index values before intervention were correlated with percent changes in VTIao induced by intervention (R2 = 0.67; P < .001). A PVI threshold value of 19% discriminates responders from nonresponders with a sensitivity of 94% and a specificity of 87% (area under the curve, 0.97; P < .001). ConclusionOur study suggests that PVI is a feasible and interesting method to predict fluid responsiveness in early phase septic shock patients in the emergency department.

Isolation of B-1 subtype B lymphocytes from human cord blood

Introduction: B-1 lymphocytes with high levels of CD5 markers are capable of differentiation and transformation into macrophage-like cells, as B-1 cells. This study aims to isolate and purify this unique subset from umbilical cord blood cell. Materials and Methods: 14 umbilical cord samples from healthy neonates of natural or elective cesarean deliveries were used. White blood cells were separated from red blood cells using hydroxyethyl starch or gelatin 3%. Cell culture was performed to separate adhesive and non-adhesive cells. Umbilical cord lymphocytes subsets were separated from the remaining leukocyte contents by Ficoll densitygradient centrifugation. Lymphocyte rosette test was used to assess purification stage. Results: Despite lack of difference in cell count between the two blood dilution methods, cell vitality in hydroxylethyl starch method was less than 87%, while cell vital activity in the dilution method by gelatin 3% was measured between 90 and 95%. Lymphocyte rosette test results indicate B-1 cell purification rate of approximately 99% by using the above method. Conclusion: This process indicates most of the extracted B-cells from human umbilical cord blood belong to the B-1 cell subtype, and gelatin 3% procedure is the best and most appropriate method in terms of number and vitality of cells.

Comparison of colloid preload versus coload under low dose spinal anesthesia for cesarean delivery.

Background:Although fluid bolus is considered as a conventional prophylactic measure to prevent spinal-induced hypotension; vasopressors are nevertheless required. Low dose spinal anesthetics could markedly reduce such episodes of hypotension, by minimizing sympathetic blockade.Aims:We chose to compare the relative efficacy of colloid preload versus coload under low dose spinal anesthesia, for elective cesarean delivery.Settings and Design:A prospective, randomized, double-blinded study.Materials and Methods:In total, 42 parturients were randomized to receive a preload (Group P) of hydroxyl ethyl starch (10 ml/kg) over 20 min before initiation of low dose spinal anesthesia (hyperbaric bupivacaine 5.5 mg with fentanyl 25 μg) or coload (Group C) of an identical fluid over 5 min, starting at the time of identification of cerebrospinal fluid. Our primary outcome included hemodynamic parameters and the incidence of hypotension. The neonatal outcome and side-effects were also monitored.Statistical Analysis:Mann-Whitney U test and Fisher's exact/Chi-square test, whichever appropriate. A P < 0.05 was considered to be significant.Results:The incidence of hypotension was lower in Group P (10%) when compared with Group C (25%), though insignificant statistically. The hemodynamic parameters were better in Group P, though intergroup statistical differences were not observed. The time to the first episode of hypotension was longer in the Group P (17 min) as compared with Group C (14 min). No notable side-effects or adverse neonatal outcome was noted.Conclusion:Colloid preload has a clinical advantage over the coload strategy, in reducing hypotensive episodes under low dose spinal anesthesia. Preload is better under large hemodynamic fluctuations while coload is preferable for emergency scenarios.

Comparison of the effects of gelatin, Ringer's solution and a modern hydroxyl ethyl starch solution after coronary artery bypass graft surgery : cardiovascular topic

The aim of this study was to compare the effect of 6% hydroxyl ethyl starch solution with 4% gelatin and Ringer's solutions on the haemodynamic stability of patients after coronary artery bypass graft (CABG) surgery and immediately after discontinuation of cardiopulmonary bypass (CPB). This was a randomised, double-blind clinical trial of 92 patients who were candidates for on-pump CABG. After discontinuation of CPB, all patients were transferred to the intensive care unit (ICU) and divided randomly into three groups. The first group received Ringer's solution, the second group 4% gelatin, and the third 6% hydroxyl ethyl starch (HES) solution (Voluven). Haemodynamic parameters such as heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented. The volume needed for maintaining normal blood pressure and central venous pressure in the range of 10-14 mmHg was less in the HES group than in the other groups. The volume was similar however in the gelatin and Ringer's groups in the first 24 hours after surgery. Urinary output in the first four and 24 hours after surgery were significantly higher in the HES group than in the other two groups. Mean creatinine levels were significantly lower in the HES group. HES (6%) had a better volume-expanding effect than gelatin (4%) and Ringer's solutions, and its short-term effects on renal function were also better than gelatin and Ringer's solutions.