Splanchnic microcirculation protection by hydroxyethyl starches during abdominal aortic aneurysm surgery.
OBJECTIVE
To specifically compare the effect of two hydroxyethyl starches (HES) on the splanchnic microcirculation and systemic inflammation during abdominal aortic aneurysm (AAA) surgery.


METHODS
A prospective randomised study was carried out on 62 patients who received HES of molecular-weight 200 kDa (HES200/0.62), 130 kDa (HES130/0.4) or gelatine for 24h peri-operatively. Gastric-mucosal pHi (GpHi) and anti-endotoxin antibody were used as markers of splanchnic perfusion and endotoxaemia respectively. C-reactive protein (CRP) and lung-injury score (LIS) were used as markers of systemic inflammation and end-organ dysfunction respectively. Data was collected prospectively.


RESULTS
The drop in GpHi was least with HES200/0.62 compared to HES130/0.4 and gelatine at reperfusion (7.32 vs 7.28 and 7.28, p=0.017 and 0.009 respectively) and compared to gelatine at 2h as well (7.43 vs 7.28, p=0.001). GpHi dropped less with HES130/0.4 compared to gelatine at 2h (7.39 vs 7.28, p=0.002). Endotoxaemia increased only with gelatine. CRP was lower with HES200/0.62 (178 mg/mL) than gelatine (221 mg/mL) and HES130/0.4 (223 mg/mL) at 48 h (p=0.049 and p=0.009 respectively). There was no difference in LIS but ventilation duration was less with HES200/0.62 compared with gelatine (4 vs 11h, p=0.012).


CONCLUSIONS
During AAA surgery, HES200/0.62 provides the best splanchnic microcirculation protection, also reducing inflammation and duration of ventilation.
Mahmood
A
A
Department of Vascular Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, B29 6JD, UK. amahmood27@hotmail.com
Gosling
P
P
Barclay
R
R
Kilvington
F
F
Vohra
R
R
D000368:Aged; D000906:Antibodies / Q000097:blood; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D004731:Endotoxins / Q000276:immunology; D005260:Female; D005753:Gastric Mucosa / Q000737:chemistry; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control*; D012121:Respiration, Artificial; D013152:Splanchnic Circulation; D013997:Time Factors; D016896:Treatment Outcome
D000906:Antibodies; D004731:Endotoxins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D002097:C-Reactive Protein