title: Effects of different types of hydroxyethyl starch (HES) on microcirculation perfusion and tissue oxygenation in patients undergoing liver surgery.
abstract: To compare the effects of hydroxyethyl starch (HES) 130/0.4 and HES 200/0.5, which have different molecular weights and degrees of substitution, on microcirculation perfusion and tissue oxygenation in patients undergoing liver surgery. Thirty patients with an American Society of Anesthesiologists status I/II who were scheduled for liver surgery were randomly divided into two groups: one received an intraoperative HES 130/0.4 infusion equal to the amount of blood loss (HES 130/0.4 group, n=15), and the other received HES 200/0.5 equal to the amount of blood loss (HES 200/0.5 group, n=15). Gastric mucosal perfusion and tissue oxygenation were monitored by measuring the gastric mucosal pH (pHi), which was determined using a carbon dioxide tonometer inserted through a nasogastric tube. Gastric mucosal pHi , hemodynamic parameters, body temperature, and blood gas parameters were recorded upon entering the operating room, before skin incision, one hour and two hours after skin incision, and at the end of surgery. The intraoperative pHi decreased in both groups of patients, but the decline in the HES 130/0.4 group was smaller than that of the HES 200/0.5 group. The pHi of the HES 130/0.4 group was significantly higher than that of the HES 200/0.5 group two hours after skin incision and at the end of surgery (P<0.05). A multivariate analysis showed that the type of colloid used intraoperatively was the only variant that affected pHi (F=0.626, P<0.05). Moreover, there were good correlation between pHi at the end of surgery and the length of postoperative hospital stay (r=-0.536, P<0.05) and the time intervals from surgery to the passage of flatus (r=-0.547, P<0.05). Compared with HES 200/0.5, the use of HES 130/0.4 (with a relatively lower molecular weight and lower degree of substitution) could significantly improve internal organ perfusion and tissue oxygenation in patients undergoing liver surgery with a relatively large amount of blood loss.
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Changsong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Shujuan
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Jinghui
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University Harbin, China.
authors.forename: Enyou
authors.initials: E
authors.lastname: Li
keywords: Hydroxyethyl starch; blood loss; gastric mucosa; internal organs; surgery
references.citation: Ann Clin Res. 1981;13 Suppl 33:26-38
references.pmid: 7342841
references.citation: Anesthesiology. 1997 Sep;87(3):504-10
references.pmid: 9316953
references.citation: Can J Anaesth. 2003 Dec;50(10):1009-16
references.pmid: 14656778
references.citation: Am J Physiol. 1986 Aug;251(2 Pt 2):H314-23
references.pmid: 3740286
references.citation: Anesth Analg. 2005 Jun;100(6):1773-1780
references.pmid: 15920212
references.citation: Chin Med J (Engl). 2003 Jul;116(7):996-1000
references.pmid: 12890370
references.citation: Surgery. 1988 Nov;104(5):917-23
references.pmid: 3055397
references.citation: Anaesthesia. 2004 Aug;59(8):738-42
references.pmid: 15270962
references.citation: Crit Care. 2001 Dec;5(6):362-7
references.pmid: 11737926
references.citation: Anesth Analg. 2003 Apr;96(4):936-943
references.pmid: 12651637
references.citation: Crit Care Med. 1991 Aug;19(8):1037-40
references.pmid: 1860328
references.citation: Surgery. 1989 May;105(5):625-31
references.pmid: 2468191
references.citation: Anesth Analg. 2001 Aug;93(2):405-9 , 3rd contents page
references.pmid: 11473870
references.citation: Drugs R D. 2004;5(1):1-9
references.pmid: 14725484
references.citation: Cardiovasc Surg. 2002 Apr;10(2):128-33
references.pmid: 11888741
references.citation: Anesthesiology. 2009 Mar;110(3):496-504
references.pmid: 19225390
references.citation: Anesth Analg. 2004 Jul;99(1):166-72
references.pmid: 15281524
references.citation: Anaesthesia. 1998 Jan;53(1):95
references.pmid: 9505759
references.citation: Anesthesiology. 2002 Aug;97(2):460-70
references.pmid: 12151938
references.citation: Anesth Analg. 2011 Feb;112(2):395-404
references.pmid: 20841408