Retracted: Influence of volume replacement with different HES-solutions on microcirculatory blood flow in cardiac surgery.
A variety of hydroxyethyl starch HES preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found. The influence of four different HES preparations on macro- and microcirculation was investigated in 40 patients scheduled for elective aorto-coronary bypass grafting and undergoing ANH (preoperative withdrawn blood: 10 ml.kg-1): 1) 6% HES with Mw of 450,000 dalton and MS of 0.7; 2) 6% HES with Mw of 200,000 dalton and MS of 0.5; 3) 6% HES with Mw of 200,000 dalton and MS of 0.62; 4) 6% HES with Mw of 40,000 dalton and MS of 0.5. A 5th group without ANH served as a control (10 patients in each group). In addition to systemic haemodynamics and various laboratory parameters, skin capillary blood flow was measured by laser Doppler flowmetry. Laser Doppler flow (LDF) was monitored simultaneously at the patient's forehead and forearm. Changes in systemic haemodynamics were similar in all ANH-patients. Systemic vascular resistance (SVR) was lowest after infusion of HES 200/0.5. The most pronounced increase in plasma viscosity was in patients of group 1 (450/0.7) (P < 0.05) and plasma viscosity remained highest during the entire investigation period in these patients. After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. +18%). Group 3 (200/0.62) showed the highest decrease in forehead-LDF. During CPB, forehead-LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5).(ABSTRACT TRUNCATED AT 250 WORDS)
Boldt
J
J
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Zickmann
B
B
Rapin
J
J
Hammermann
H
H
Dapper
F
F
Hempelmann
G
G
D001775:Blood Circulation / Q000187:drug effects; D001809:Blood Viscosity / Q000187:drug effects; D001810:Blood Volume; D001026:Coronary Artery Bypass; D005542:Forearm / Q000098:blood supply; D005546:Forehead / Q000098:blood supply; D006438:Hemodilution; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008970:Molecular Weight; D009994:Osmolar Concentration; D010101:Oxygen Consumption / Q000187:drug effects; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000494:pharmacology*; D012039:Regional Blood Flow / Q000187:drug effects; D012867:Skin / Q000098:blood supply*; D014655:Vascular Resistance / Q000187:drug effects
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes