ABSTRACT
Major surgery may alert the systemic inflammatory response which may progress to severe postoperative complications. The present study investigated the effect of HES 130/0.4 compared to lactated ringer's solution on the postoperative systemic inflammatory response and pulmonary outcome during pediatric major abdominal surgery. Thirty children ASA I or II, aged [6 months- 36 months], scheduled for elective major abdominal surgery were randomized to receive either Hydroxyethyl Starch 130/0.4 solution in HES group or Lactated Ringer's solution in LR group for intraoperative fluid replacement. Volume of HES 130/0.4 or LR infused to replace blood loss was recorded. Serum level of IL6, IL8 and CRP were measured before induction and at 6, 12, 24; 48 hours postoperatively in pediatric intensive care unit. Hypoxia score [Po2/Fio2 ratio] was also assessed at the same time interval. HES group received 103.7 [12.6] ml of Hydroxyethyl Starch 130/0.4 solution. The mean volume of crystalloid infused was significantly higher in LR group 613.2 [47.1] ml versus 396.4 [29.1] ml in HES group [P <0.05]. Serum levels of IL-6, IL-8 and CRP were significantly increased from baseline in both groups during the study period [P<0.05]. This increase was significantly lower in the HES 130/0.4 treated patients compared to those in Lactated Ringer's group [P<0.05]. The peak value was reached at 12 hours for IL-6 and IL-8 and at 48h for CRP. The PO2/FiO2 significantly decreased relative to the baseline values throughout the study period in both groups. The decrease was significantly less in the HES group compared with the LR group at all postoperative time interval P <0.05. HES 130/0.4 is effective for intravascular volume replacement with the advantage of reducing the inflammatory response and improving pulmonary outcome in paediatric patients undergoing elective major abdominal surgery