ABSTRACT
Major surgery may alter the physiologic immune balance and initiate systemic inflammatory processes which may progress to severe postoperative complication e.g. multiple organ dysfunction syndrome [MODS] or adult respiratory distress syndrome [ARDS]. The colloid used for intra vascular volume replacement in surgical patients may affect the inflammatory response during major surgery. Thirty six patients scheduled for elective abdominal aortic aneurysm surgery were randomized to receive either 6% hydroxyethly starch HES 200/0.5 or 6% hydroxyethyl starch HES 130/0.4 for colloid replacement. Lung function was assessed with PO[2]/FiO[2]ratio, respiratory compliance, chest X-ray and a score for lung injury. Serum concentrations of interleukin [IL]-6, IL-8 and IL-10 were measured. After aortic cross clamp release the PO[2]/FiO[2] ratio was 354.6 +/- 7.95 mmHg for the HES 130/0.4 compared with318 +/- 9.52 mmHg for the HES 200/0.5 treated patients. Twelve hours after aortic cross clamp release, PO[2]/FiO[2]ratio for the HES 130/0.4 patients was 316 +/- 9.04 compared with 259.44 +/- 6.92 for HES 200/0.5 patients [p<0.001]. In the first postoperative day it was 251.6 +/- 4.2 for HES 130/0.4 patients compared with 217 +/- 9.74 for HES 130/0.4 treated patients. Respiratory compliance was greater for HES 200/0.5 treated patients compared with HES 130/0.4 treated patients. Peak values of IL-6 and IL-8 were significantly lower in HES 200/0.5 treated patients compared with HES 130/0.4 treated patients serum IL-6 were 52.9 +/- 10.2pg/dl in HES 200/0.5 group compared with 46 +/- 11.8pg/dl for HES 130/0.4 group serum IL-8 were 45 +/- 8.9pg/ml in HES 200/0.5 group compared with 37 +/- 9.8pg/ml in HES 130/0.4 group. Intravascular volume replacement with HES 130/0.4 resulted in better perioperative pulmonary function and reduced inflammatory response in patients undergoing abdominal aortic surgery compared with HES 200/0.5