Influence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid.
OBJECTIVE
Adequate volume therapy is essential for stable hemodynamics and sufficient urinary output perioperatively. Hydroxyethyl starch (HES) has been reported to attenuate the microvascular hyperpermeability which occasionally occurs in surgical patients. This study was carried out to evaluate the effect of low-molecular-weight HES on the urinary microalbumin/creatinine ratio (MACR), a marker of microvascular permeability, in surgical patients.


METHODS
In a prospective, controlled, and randomized clinical trial, 21 patients undergoing abdominal surgery were divided into two groups. Group HES (n = 10) received HES at 2 ml x kg(-1) x h(-1) during surgery and at 1 ml x kg(-1) x h(-1) after surgery, and additionally they received acetated Ringer's solution (AR) at a rate to keep central venous pressure (CVP) 5 mm Hg. Group AR (n = 11) received AR at a rate to keep CVP at 3-5 mmHg. MACR, soluble intercellular adhesion molecule-1 (sICAM-1), and urinary output were measured intermittently in the perioperative period.


RESULTS
MACR was significantly increased during surgery in both groups. There was no significant difference in MACR between the two groups throughout the study period. The serum concentration of sICAM-1 decreased during surgery in both groups, and that in group HES was significantly lower than that in group AR at the end of surgery. Postoperative urinary output in group HES was greater than that in group AR. The intensive care unit (ICU) stay in group HES was shorter than that in group AR.


CONCLUSIONS
Although low-molecular-weight HES does not improve microvascular hyperpermeability, the expansion of the intravascular volume by HES results in higher urinary output in the postoperative period than that seen with crystalloid solution. The lower concentration of sICAM-1 after surgery may be due to hemodilution.
Ando
Yuko
Y
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, Nagasaki, 857-0134, Japan.
Terao
Yoshiaki
Y
Fukusaki
Makoto
M
Yamashita
Kazunori
K
Takada
Masafumi
M
Tanabe
Takahiro
T
Sumikawa
Koji
K
D000005:Abdomen / Q000033:anatomy & histology / Q000601:surgery*; D000368:Aged; D000419:Albuminuria / Q000139:chemically induced; D000768:Anesthesia, General; D016063:Blood Loss, Surgical; D001831:Body Temperature / Q000187:drug effects; D002199:Capillary Permeability / Q000187:drug effects*; D003404:Creatinine / Q000652:urine; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry / Q000494:pharmacology*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D007552:Isotonic Solutions / Q000494:pharmacology*; D008297:Male; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000737:chemistry / Q000494:pharmacology*; D011446:Prospective Studies
D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D018799:Intercellular Adhesion Molecule-1; D003404:Creatinine