title: Hetastarch with hypertonic saline loading is a better choice for the maintenance of systemic and pulmonary circulation during general and epidural anesthesia.
abstract: OBJECTIVE
  Sufficient volume load prior to major surgery is important for better management of anesthesia. In this study we assessed systemic and pulmonary hemodynamic stabilization following a load of hypertonic saline plus hydroxyethyl starch (HHS) solution during anesthesia in elective hepatobiliary surgical patients.
  
  
  METHODS
  Thirty-six hepatobiliary surgical patients, ASA physical status I~II, were randomly and double-blindly divided into: HHS (4 mL/kg) group, hydroxyethyl starch (7 mL/kg) group (HES group) and Ringer's solution (7 mL/kg) group (RL group). All the patients underwent general anesthesia and epidural anesthesia. Mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), right ventricular-stroke work (RVSW) and pulmonary vascular resistance (PVR) were recorded to monitor pulmonary circulation; systemic vascular resistance (SVR), cardiac output (CO) and stroke volume (SV) were recorded to monitor systemic circulation. These parameters were recorded before infusion (T0), 10 min after infusion (T1), 5 min after induction (T2), 5, 10 and 20 min after intubation (T3, T4 and T5, respectively).
  
  
  RESULTS
  In pulmonary circulation, MPAP, PAWP and RVSW were increased at T1 compared to T0 in both HES and HHS groups, the latter being more marked at T1. Pulmonary PVR was decreased in both HHS and HES groups compared to RL group during T2 to T5. In systemic circulation, SVR was decreased in both HHS and HES groups during T1 to T5 compared to RL group. CO and SV were increased at T1 compared to T0 in both HHS and HES groups, and they also increased during T1 to T5 in HHS group compared to RL group.
  
  
  CONCLUSIONS
  HHS solution was superior in maintaining systemic and pulmonary circulation during general anesthesia combined epidural anesthesia.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China - liyuanhai-1@163.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Yang
authors.forename: Z
authors.initials: Z
authors.lastname: Zong
authors.forename: C
authors.initials: C
authors.lastname: Ke
authors.forename: Y
authors.initials: Y
authors.lastname: Wei
authors.forename: D
authors.initials: D
authors.lastname: Yu
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D001652:Bile Ducts / Q000601:surgery; D002302:Cardiac Output; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry*; D007552:Isotonic Solutions / Q000737:chemistry; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000187:drug effects*; D000077331:Ringer's Solution; D012462:Saline Solution, Hypertonic / Q000737:chemistry*; D013318:Stroke Volume; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014655:Vascular Resistance
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D000077331:Ringer's Solution