A total balanced volume replacement strategy using a new balanced hydoxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery.
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.
Boldt
J
J
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany. BoldtJ@gmx.net
Schöllhorn
T
T
Münchbach
J
J
Pabsdorf
M
M
D000005:Abdomen / Q000601:surgery*; D000136:Acid-Base Equilibrium / Q000187:drug effects; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D001810:Blood Volume; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D020896:Hypovolemia / Q000628:therapy; D007552:Isotonic Solutions / Q000008:administration & dosage; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D013916:Thrombelastography / Q000379:methods; D013997:Time Factors
D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012965:Sodium Chloride