title: Splanchnic microcirculation protection by hydroxyethyl starches during abdominal aortic aneurysm surgery.
abstract: 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.
authors.affiliation: Department of Vascular Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, B29 6JD, UK. amahmood27@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Mahmood
authors.forename: P
authors.initials: P
authors.lastname: Gosling
authors.forename: R
authors.initials: R
authors.lastname: Barclay
authors.forename: F
authors.initials: F
authors.lastname: Kilvington
authors.forename: R
authors.initials: R
authors.lastname: Vohra
mesh_terms: 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
chemical_list: D000906:Antibodies; D004731:Endotoxins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D002097:C-Reactive Protein