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A total balanced volume replacement strategy using a new balanced hydoxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery

Published online by Cambridge University Press:  01 March 2007

J. Boldt ,
T. Schöllhorn ,
J. Münchbach  and
M. Pabsdorf
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Summary

Background and objective

The kind of fluid for correcting hypovolaemia is still a focus of debate. In a prospective, randomized, controlled and double-blind study in patients undergoing major abdominal surgery, a total balanced volume replacement strategy including a new balanced hydroxyethyl starch (HES) solution was compared with a conventional, non-balanced fluid regimen.

Methods

In Group A (n = 15), a new balanced 6% HES 130/0.42 was given along with a balanced crystalloid solution; in Group B (n = 15), an unbalanced conventional HES 130/0.42 plus an unbalanced crystalloid (saline solution) were administered. Volume was given when mean arterial pressure (MAP) was <65 mmHg and central venous pressure (CVP) minus positive end-expiratoric pressure (PEEP) level was <10 mmHg. Haemodynamics, acid–base status, coagulation (thrombelastography (TEG)) and kidney function (including kidney-specific proteins, N-acetyl-beta-d-glucosaminidase (beta-NAG) and alpha-1-microglobulin) were measured after induction of anaesthesia, at the end of surgery, 5 and 24 h after surgery.

Results

Group A received 3533 ± 1302 mL of HES and 5333 ± 1063 mL of crystalloids, in Group B, 3866 ± 1674 mL of HES and 5966 ± 1202 mL of crystalloids were given. Haemodynamics, laboratory data, TEG data and kidney function were without significant differences between the groups. Cl− concentration and base excess (−5 ± 2.4 mmol L−1 vs. 0.4 ± 2.4 mmol L−1) were significantly higher in patients of Group B than of Group A.

Conclusions

A complete balanced volume replacement strategy including a new balanced HES preparation resulted in significantly less derangement in acid–base status compared with a non-balanced volume replacement regimen. The new HES preparation showed no negative effects on coagulation and kidney function.

Keywords

SURGERY, abdominalvolume replacementhydroxyethyl starchbalanced solutionacid–base statuscoagulationrenal function
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 267 - 275
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Mythen, MG, Webb, AR. Intraoperative gut mucosal hypoperfusion is associated with increased post-operative complications and costs. Intensive Care Med 1994; 20: 99–104.CrossRefGoogle Scholar
2.Deane, SA, Gaudry, PL, Woods, P et al. . The management of injuries – a review of death in hospital. Aust NZJ Surg 1988; 58: 463–469.CrossRefGoogle Scholar
3.Hoffmann, JN, Vollmar, B, Laschke, MW, Inthorn, D, Schildberg, FW, Menger, MD. Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia. Anesthesiology 2002; 97: 460–470.CrossRefGoogle Scholar
4.Norberg, A, Brauer, K, Prough, DS et al. . Volume turnover kinetics in fluid shifts after haemorrhage, fluid infusion, and the combination of haemorrhage and fluid infusion in sheep. Anesthesiology 2005; 102: 985–994.CrossRefGoogle ScholarPubMed
5.Hillman, K, Bishop, G, Bristow, P. The crystalloid versus colloid controversy: present status. Ballieres Clin Anaesth 1997; 11: 1–13.CrossRefGoogle Scholar
6.Gan, TJ, Bennett-Guerrero, E, Phillips-Bute, B et al. . Hextend®, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Anesth Analg 1999; 88: 992–998.CrossRefGoogle ScholarPubMed
7.Wilkes, NJ, Woolf, R, Mutch, M et al. . The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid–base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001; 93: 811–816.CrossRefGoogle ScholarPubMed
8.Wilkes, NJ, Woolf, RL, Powanda, MC et al. . Hydroxyethyl starch in balanced electrolyte solution (Hextend®) – pharmacokinetic and pharmacodynamic profiles in healthy volunteers. Anesth Analg 2002; 94: 538–544.CrossRefGoogle ScholarPubMed
9.Kellum, JA. Saline-induced hyperchloremic metabolic acidosis. Crit Care Med 2002; 30: 259–261.CrossRefGoogle ScholarPubMed
10.Prough, DS. Acidosis associated with perioperative saline administration. Anesthesiology 2000; 93: 1184–1187.CrossRefGoogle ScholarPubMed
11.Wilcox, CS. Regulation of renal blood flow by plasma chloride. J Clin Invest 1983; 71: 726–735.CrossRefGoogle ScholarPubMed
12.Bennett-Guerrero, H, Manspeizer, RJ, Frumento, B, Mets, B, Hirsh, AL. Impact of normal saline-based versus balanced salt fluid replacement on postoperative renal function: randomized trial. Preliminary results. Anesth Analg 2001; 92: SCA129.Google Scholar
13.Treib, J, Haass, A, Pindur, G, Grauer, MT, Wenzel, E, Schimrigk, K. All medium starches are not the same: influence of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, haemorrheologic conditions and coagulation. Transfusion 1996; 36: 450–455.CrossRefGoogle ScholarPubMed
14.deJonge, E, Levi, M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med 2001; 29: 1261–1267.CrossRefGoogle Scholar
15.Bick, RL. Evaluation of a new hydroxyethyl starch preparation (Hextend) on selected coagulation parameters. Clin Appl Thromb/Haemost 1995; 1: 215–229.CrossRefGoogle Scholar
16.Martin, G, Bennett-Guerrero, E, Wakeling, H et al. . A prospective, randomized comparison of thrombelastographic coagulation profile in patients receiving lactated Ringer’s solution, 6% hetastarch in a balanced-saline vehicle, or 6% hydroxyethyl starch in saline during major surgery. J Cardiothorac Vasc Anesth 2002; 16: 441–446.CrossRefGoogle ScholarPubMed
17.Boldt, J, Haisch, G, Suttner, S, Kumle, B, Schellhaas, F. In vivo changes of haemostasis with a new modified, balanced hydroxyethyl starch preparation (Hextend). Br J Anaesth 2002; 89: 722–728.CrossRefGoogle Scholar
18.Waitzinger, J, Bepperling, F, Pabst, G, Opitz, J. Hydroxyethyl starch (HES) [130/0.4], a new HES specification – pharmacokinetics and safety after multiple infusions of 10% solution in healthy volunteers. Drugs R&D 2003; 4: 149–157.Google ScholarPubMed
19.Sander, O, Reinhart, K, Meier-Hellmann, A. Equivalence of hydroxyethyl starch HES 130/0.4 and HES 200/0.5 for postoperative volume replacement in major gynaecological surgery. Acta Anaesthesiol Scand 2003; 47: 1151–1158.CrossRefGoogle ScholarPubMed
20.Haisch, G, Boldt, J, Krebs, C, Suttner, S, Lehmann, A, Isgro, F. The influence of a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in cardiac surgical patients. J Cardiothorac Vasc Anesth 2001; 15: 316–321.CrossRefGoogle Scholar
21.Schortgen, F, Lacherade, JC, Bruneel, F et al. . Effects of hydroxyethyl starch and gelatin on renal function in severe sepsis: a multicenter randomised study. Lancet 2001; 357: 911–916.CrossRefGoogle ScholarPubMed
22.Knutson, JE, Deering, JA, Hall, FW et al. . Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery? Anesth Analg 2000; 90: 801–807.CrossRefGoogle ScholarPubMed
23.Franz, A, Bräunlich, P, Gamsjäger, T, Felfernig, M, Gustorff, B, Kozek-Langenecker, SA. The effects of hydroxyethyl starches of varying molecular weights on platelet function. Anesth Analg 2001; 92: 1402–1407.CrossRefGoogle ScholarPubMed
24.Webb, AR. Crystalloid or colloid resuscitation. Are we any wiser? Crit Care 1999; 3: R25–R28.CrossRefGoogle ScholarPubMed
25.Astiz, ME, Rackow, EC. Crystalloid–colloid controversy revisited. Crit Care Med 1999; 27: 34–35.CrossRefGoogle ScholarPubMed
26.Hinder, F, Stubbe, HD, van Aken, H et al. . Early multiple organ failure after recurrent endotoxemia in the presence of vasoconstrictor-masked hypovolaemia. Crit Care Med 2003; 31: 903–909.CrossRefGoogle Scholar
27.Schafer, M, von Ungern-Sternberg, BS, Wight, E, Schneider, MC. Isotonic fluid absorption during hysteroscopy resulting in severe hyperchloremic acidosis. Anesthesiology 2005; 103: 203–204.CrossRefGoogle ScholarPubMed
28.Kellum, JA, Song, M, Venkataraman, R. Effects of hyperchloremic acidosis on arterial pressure and circulating inflammatory molecules in experimental sepsis. Chest 2005; 125: 243–248.CrossRefGoogle Scholar
29.Kellum, JA. Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: improved short-term survival and acid–base balance with Hextend compared with saline. Crit Care Med 2002; 30: 300–530.CrossRefGoogle ScholarPubMed
30.Takil, A, Eti, Z, Irmak, P, Yilmaz Gogus, F. Early postoperative respiratory acidosis after large intravascular volume infusion of lactated Ringer’s solution during major spine surgery. Anesth Analg 2002; 95: 294–298.Google ScholarPubMed
31.Brill, SA, Stewart, TR, Brundage, SI, Schreiber, MA. Base deficit does not predict mortality when secondary to hyperchloremic acidosis. Shock 2002; 17: 459–462.CrossRefGoogle Scholar
32.Brandstrup, B, Tonnesen, H, Beier-Holgersen, R, the Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003; 238: 641–648.CrossRefGoogle ScholarPubMed