ABSTRACT
Plasma volume expansion is of great importance during major surgery. To achieve this goal, colloids may be preferred to crystalloids, as they more effectively increase blood volume and consequently, cardiac output. The aim of this study was to assess whether using the new hydroxyethyl starch with a lower molecular weight [HES 130/0.4] will be as effective as standard HES 200/0.5 and Gelatin in restoring the hemodynamics guided by trans-esophageal doppler moniter [EDM]. Sixty adult patients scheduled for major thoracic surgery were randomized to receive either 6% HES BO/0.4 [HES 130/0.4 group] or 3% modified fluid gelatin [Gelatin group] or 6% HES 200/0.5 [HES 200/0.5 group] as their colloid during the intraoperative period. The maximum dosage of all colloids was 33 ml/kg. Each group has 20 patients. Hemodynamic data and Doppler derived measurements; Cardiac index [Cl], Systolic flow time corrected for heart rate [FTc] and Stroke Volume Index [SVI] were recorded serially at 5 time points during the operation. Laboratory Measurements were recorded at baseline and every day postoperative for five days. The mean volume of gelatin 3% given was significantly more than the amount of HES 130/0.4 and HES 200/0.5 given [p < 0.05]. Volume of colloids infused in HES 130/0.4 was higher than HES 200/0.5 without statistical significance. Doppler derived measurements were comparable in all groups throughout the whole procedure. Platelet count was significantly lower in the Gelatin group in comparison to the other HES groups in the five PODs [p < 0.05]. The two HES treated groups were comparable to each other. INR was significantly higher for Gelatin group in comparison to HES 130/0.4 group in the second and third PODs [p <0.05] but in comparison to HES 200/0.5 group the higher level did not reach statistically significance. Serum creatinine was significantly higher and Creatinine clearance was significantly lower in the Gelatin than in the HES-treated patients on the first and second PODs [p =0.004] with no difference between the two starches. The new HES 130/0.4 were as effective as HES 200/0.5 and modified fluid gelatin in intravascular volume expansion in major thoracic surgery. Also administration of the new HES 130/0.4 has more favorable effect on hemostasis and on renal and platelet than Gelatin