Comparison of the effects of gelatin, Ringer's solution and a modern hydroxyl ethyl starch solution after coronary artery bypass graft surgery

S M Alavi, B Baharvand Ahmadi, B Baharestani, T Babaei, S M Alavi, B Baharvand Ahmadi, B Baharestani, T Babaei

Abstract

Objective: The aim of this study was to compare the effect of 6% hydroxyl ethyl starch solution with 4% gelatin and Ringer's solutions on the haemodynamic stability of patients after coronary artery bypass graft (CABG) surgery and immediately after discontinuation of cardiopulmonary bypass (CPB).

Methods: This was a randomised, double-blind clinical trial of 92 patients who were candidates for on-pump CABG. After discontinuation of CPB, all patients were transferred to the intensive care unit (ICU) and divided randomly into three groups. The first group received Ringer's solution, the second group 4% gelatin, and the third 6% hydroxyl ethyl starch (HES) solution (Voluven). Haemodynamic parameters such as heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented.

Results: The volume needed for maintaining normal blood pressure and central venous pressure in the range of 10-14 mmHg was less in the HES group than in the other groups. The volume was similar however in the gelatin and Ringer's groups in the first 24 hours after surgery. Urinary output in the first four and 24 hours after surgery were significantly higher in the HES group than in the other two groups. Mean creatinine levels were significantly lower in the HES group.

Conclusion: HES (6%) had a better volume-expanding effect than gelatin (4%) and Ringer's solutions, and its short-term effects on renal function were also better than gelatin and Ringer's solutions.

References

    1. Yatin M, Ajay D, Sujatha Z, Meharwal, Naresh T. Comparison of new Hes (130.0.4) and Hes (200.0.5) in OPCAB surgery. J Anesth Clin Pharmacol. 2007;23:273–278.
    1. Karanko MS. Effects of thre colloid solutions on plasma volume and hemodynamics after coronary bypass surgery. Crit Care Med. 1987;15:1015–1022.
    1. Toraman F, Evrenkaya S, Yuce M. et al. lactic acidosis after cardiac surgery is associated with adverse outcome. Heart Surg Forum. 2004;17:155–159.
    1. Boldt J, Brosch CH, Rohm K, Papsdorf M, Mengistu A. comparison of the effects of gelatin and modern hydroxyethyl starch solution on renal function and inflamnatory response in elderly cardiac surgery patients. Br J Anaesth. 2008:1–8.
    1. Walcher F, Bauer C, Paxian M, Holanda M, Larsen R, Marzi I. The influence of resuscitation on hemodynamics & oxygen radical induced reperfusion injury after arterialized liver transplantation in the rat. J Surg Res. 1996;65:9–14.
    1. Rehm M, Orth V, Scheingraber S, Kreimeier U, Brechtel Sbauer H, Finsterer U. Acid–base changes caused by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution. Anesthesiology. 2000;93:1174–1183.
    1. Niemi T, schramko A, kuitnnen A, Kukkonen S, Suojaranta R. Hemodynamic and acid–base equilibrium after cardiac surgery: comparison of rapidly degradable hydroxyethyl starch solution and albumin. Scand J Surg. 2008;97:259–265.
    1. Bnunkhorst FM, Engel C, Bloos F. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–139.
    1. Dieterich HJ, Weissinmuller T, Rosenberger P, Eltzschig HK. Effect of hydroxyethyl starch on vascular leak syndrome and neutrophil accumulation during hypoxia. Crit Care Med. 2006;34:1775–1782.
    1. Yeh JR, Tigh D, Moss RF. et al. limiting edema in neonatal cardiopulmonary bypass with narrow range molecular weight Hydroxyethyl starch. Circ Shock. 1992;36:93–96.
    1. Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg. 2001;93:405–409.
    1. Feng X, Yan W, Wang Z. et al. Hydroxyethyl starch, but not modified fluid gelatin, affects inflammatory response in a rat model of polymicrobial sepsis with capillary leakage. Anesth Analg. 2007;104:624–630.
    1. Winkelmayer WC, Glynn RJ, Levin R, Avorn J. Hydroxyethyl starch and change in renal function in patients undergoing coronary artery bypass graft surgery. Kidney Int. 2003;64:1046–1049.
    1. Halmaja K, Bishop G, Bristow P. The crystalloid versus colloid controversy: present status. Balleres Clin Anaesth. 1997;11:1–13.
    1. SU F, wang Z, Cai Y, Rogiers P, Vincent JL. Fluid resuscitation in severe sepsis and septic shock: albumin, hydroxyethyl starch, gelatin or Ringer’s lactate – does it really makes a difference? Shock. 2007;27:520–526.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner