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Volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major abdominal surgery

[Le remplissage vasculaire avec de l’HEA 130/0,4 peut réduire la réaction inflammatoire chez des patients en chirurgie abdominale majeure]

Katrin Lang, MD^*, Stefan Suttner, MD^*, Joachim Boldt, PhD^*, Bernhard Kumle, MD^* and Dietmar Nagel, MD

^* From the Departments of Anesthesiology and Intensive Care Medicine,
and Clinical Chemistry, Klinikum der Stadt Ludwigshafen, Akademisches Lehrkrankenhaus der Universität Mainz, Ludwigshafen, Germany.

Address correspondence to: Dr. Katrin Lang, Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany. Fax: +49-621-503–3024; E-mail: Lang.Katrin{at}gmx.de

Purpose: To investigate the effects of intravascular volume replacement therapy on the inflammatory response during major surgery.

Methods: Thirty-six patients scheduled for elective abdominal surgery were randomized to receive either 6% hydroxyethylstarch (130,000 Dalton mean molecular weight, degree of substitution 0.4; n = 18, HES-group) or lactated Ringer’s solution (RL-group; n = 18) for intravascular volume replacement. Fluid therapy was given perioperatively and continued for 48 hr in the intensive care unit. Volume replacement was guided by physiological parameters. Serum concentrations of interleukin (IL)-6, IL-8 and IL-10 and soluble adhesion molecules (sELAM-1 and sICAM-1) were measured after induction of anesthesia, four hours after the end of surgery, as well as 24 hr and 48 hr postoperatively.

Results: Biometric and perioperative data, hemodynamics and oxygenation were similar between groups. On average, 4470 ± 340 mL of HES 130/0.4 per patient were administered in the HES-group compared to 14310 ± 750 mL of RL in the RL-group during the study period. Release of pro-inflammatory cytokines IL-6 and IL-8 was significantly lower in the HES-group [(peak values) 47.8 ± 12.1 pg•dL^-1 of IL-6 and 35.8 ± 11.2 pg•mL^-1 of IL-8 (HES-group) vs 61.2 ± 11.2 pg•dL^-1 of IL-6 and 57.9 ± 9.7 pg•mL^-1 of IL-8 (RL-group); P < 0.05]. Serum concentrations of sICAM-1 were significantly higher in the RL-group [(peak values) 1007 ± 152 ng•mL^-1 (RL-group) vs 687 ± 122 ng•mL^-1, (HES group); P < 0.05)]. Values of sELAM-1 were similar in both groups.

Conclusion: Intravascular volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major surgery compared to a crystalloid-based volume therapy. We hypothesize that this is most likely due to an improved microcirculation with reduced endothelial activation and less endothelial damage.

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