Fluid resuscitation with human albumin or hydroxyethyl starch--are there differences in the healing of experimental intestinal anastomoses?
OBJECTIVE
Restoration of the macro- and microcirculation is important for the healing of gastrointestinal anastomoses. Colloids and crystalloids are widely used for blood volume therapy. We evaluated the effects of human albumin, hydroxyethyl starch (HES) 130/0.4 and saline on the microcirculation and on wound healing in colon anastomoses in rats.


METHODS
Male Wistar rats received a colonic end-to-end anastomosis. The animals were randomized into three groups and a single 3-ml dose of either 20% human albumin, 6% HES 130/0.4 or 0.9% saline was applied intravenously. Six, 24, 48, 96 h and 2 weeks after the procedure, 10 animals per group were reanesthetized. Measurements of capillary blood flow, vessel permeability and anastomosis bursting pressure were performed. The amounts of vascular endothelial growth factor (VEGF) and IL-6 in the plasma were determined by enzyme-linked immunosorbent assays, and the mRNA levels of VEGF and collagen types I and III were measured by real-time polymerase chain reaction.


RESULTS
No significant differences were found between albumin, HES 130/0.4 and saline in capillary blood flow, vessel permeability and anastomotic bursting pressure in this rat model. Concentrations of collagen I and III mRNA were significantly elevated after 96 h in animals that had received HES 130/0.4 or albumin. RNA and protein levels of VEGF and interleukin-6 were unaffected by therapy.


CONCLUSIONS
Human albumin, which is still widely used in the clinical setting, had no advantage over HES 130/0.4 and saline with regard to anastomotic healing in this animal model. Nevertheless, we prefer HES 130/0.4 because it is more effective for volume therapy than saline and has a better availability and is less expensive than human albumin.
Hotz
Birgit
B
Department of Surgery I, Charité-Medical School, Campus Benjamin Franklin, Berlin, Germany.
Hotz
Hubert G
HG
Arndt
Marco
M
Holmer
Christoph
C
Buhr
Heinz-J
HJ
Ritz
Jörg-P
JP
D000418:Albumins / Q000008:administration & dosage*; D000714:Anastomosis, Surgical; D000818:Animals; D003106:Colon / Q000601:surgery; D004195:Disease Models, Animal; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D010952:Plasma Substitutes / Q000008:administration & dosage; D051381:Rats; D017208:Rats, Wistar; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
D000418:Albumins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes