Document Detail


Influence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid.
MedLine Citation:
PMID:  19011778     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Adequate volume therapy is essential for stable hemodynamics and sufficient urinary output perioperatively. Hydroxyethyl starch (HES) has been reported to attenuate the microvascular hyperpermeability which occasionally occurs in surgical patients. This study was carried out to evaluate the effect of low-molecular-weight HES on the urinary microalbumin/creatinine ratio (MACR), a marker of microvascular permeability, in surgical patients. METHODS: In a prospective, controlled, and randomized clinical trial, 21 patients undergoing abdominal surgery were divided into two groups. Group HES (n = 10) received HES at 2 ml x kg(-1) x h(-1) during surgery and at 1 ml x kg(-1) x h(-1) after surgery, and additionally they received acetated Ringer's solution (AR) at a rate to keep central venous pressure (CVP) 5 mm Hg. Group AR (n = 11) received AR at a rate to keep CVP at 3-5 mmHg. MACR, soluble intercellular adhesion molecule-1 (sICAM-1), and urinary output were measured intermittently in the perioperative period. RESULTS: MACR was significantly increased during surgery in both groups. There was no significant difference in MACR between the two groups throughout the study period. The serum concentration of sICAM-1 decreased during surgery in both groups, and that in group HES was significantly lower than that in group AR at the end of surgery. Postoperative urinary output in group HES was greater than that in group AR. The intensive care unit (ICU) stay in group HES was shorter than that in group AR. CONCLUSION: Although low-molecular-weight HES does not improve microvascular hyperpermeability, the expansion of the intravascular volume by HES results in higher urinary output in the postoperative period than that seen with crystalloid solution. The lower concentration of sICAM-1 after surgery may be due to hemodilution.
Authors:
Yuko Ando; Yoshiaki Terao; Makoto Fukusaki; Kazunori Yamashita; Masafumi Takada; Takahiro Tanabe; Koji Sumikawa
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-11-15
Journal Detail:
Title:  Journal of anesthesia     Volume:  22     ISSN:  0913-8668     ISO Abbreviation:  J Anesth     Publication Date:  2008  
Date Detail:
Created Date:  2008-11-17     Completed Date:  2009-02-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8905667     Medline TA:  J Anesth     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  391-6     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, Nagasaki, 857-0134, Japan.
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MeSH Terms
Descriptor/Qualifier:
Abdomen / anatomy & histology,  surgery*
Aged
Albuminuria / chemically induced
Anesthesia, General
Blood Loss, Surgical
Body Temperature / drug effects
Capillary Permeability / drug effects*
Creatinine / urine
Double-Blind Method
Female
Hemodynamics / drug effects
Hetastarch / chemistry,  pharmacology*
Humans
Intercellular Adhesion Molecule-1 / blood
Isotonic Solutions / pharmacology*
Male
Molecular Weight
Plasma Substitutes / chemistry,  pharmacology*
Prospective Studies
Chemical
Reg. No./Substance:
0/Isotonic Solutions; 0/Plasma Substitutes; 0/crystalloid solutions; 126547-89-5/Intercellular Adhesion Molecule-1; 60-27-5/Creatinine; 9005-27-0/Hetastarch

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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