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Splanchnic microcirculation protection by hydroxyethyl starches during abdominal aortic aneurysm surgery
Summary
Hydroxyethyl starch 200 kDa (HES200/0.62) best protected splanchnic microcirculation during abdominal aortic aneurysm surgery. This HES formulation also reduced systemic inflammation and shortened ventilation duration compared to other fluids.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Vascular Surgery
- Fluid Resuscitation and Hemodynamics
Background:
- Splanchnic microcirculation compromise and systemic inflammation are significant concerns during abdominal aortic aneurysm (AAA) surgery.
- The choice of fluid resuscitation can impact peri-operative outcomes, including organ perfusion and inflammatory response.
Purpose of the Study:
- To compare the effects of two hydroxyethyl starches (HES) with different molecular weights (HES200/0.62 and HES130/0.4) versus gelatine on splanchnic microcirculation and systemic inflammation in patients undergoing AAA surgery.
Main Methods:
- A prospective randomized study involving 62 patients.
- Patients received HES200/0.62, HES130/0.4, or gelatine peri-operatively for 24 hours.
- Gastric mucosal pH (GpHi) and anti-endotoxin antibodies measured splanchnic perfusion and endotoxemia; C-reactive protein (CRP) and lung injury score (LIS) assessed systemic inflammation and organ dysfunction.
Main Results:
- HES200/0.62 demonstrated the least drop in GpHi at reperfusion and 2 hours post-reperfusion compared to HES130/0.4 and gelatine.
- Endotoxemia increased only in the gelatine group.
- Lower CRP levels were observed with HES200/0.62 at 48 hours compared to both HES130/0.4 and gelatine.
- Ventilation duration was significantly shorter with HES200/0.62 compared to gelatine.
Conclusions:
- HES200/0.62 offers superior protection of splanchnic microcirculation during AAA surgery.
- This HES formulation effectively reduces systemic inflammation and shortens the duration of mechanical ventilation.
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