Impact of colloids or crystalloids in renal function assessed by NGAL and KIM-1 after hysterectomy: randomized controlled trial

Abstract Background Hydroxyethyl starches are colloids used in fluid therapy that may reduce volume infusion compared with crystalloids, but they can affect renal function in critical care patients. This study aims to assess renal effects of starches using renal biomarkers in the perioperative setting. Methods This prospective, controlled, randomized study compared Hydroxyethyl starch 6% (HES) with Ringer's lactate (RL) in hysterectomy. Each episode of mean arterial pressure (MAP) below 60 mmHg guided the fluid replacement protocol. The RL group received 300 mL bolus of RL solution while the HES group received 150 mL of HES solution. All patients received RL (2 mL.kg−1.h−1) intraoperatively to replace insensible losses. Blood and urine samples were collected at three time points (preoperatively, 24 hours, and 40 days postoperatively) to assess urinary NGAL and KIM-1, as primary outcome, and other markers of renal function. Results Seventy patients were randomized and 60 completed the study. The RL group received a higher crystalloid volume (1,277 ± 812.7 mL vs. 630.4 ± 310.2 mL; p= 0.0002) with a higher fluid balance (780 ± 720 mL vs. 430 ± 440 mL; p= 0.03) and fluid overload (11.7% ± 10.4% vs. 7.0% ± 6.3%; p= 0.04) compared to the HES group. NGAL and KIM-1 did not differ between groups at each time point, however both biomarkers increased 24 hours postoperatively and returned to preoperative levels after 40 days in both groups. Conclusion HES did not increase renal biomarkers following open hysterectomy compared to RL. Moreover, HES provided better hemodynamic parameters using less volume, and reduced postoperative fluid balance and fluid overload.

Preventive effects of hydroxyethyl starch combined with methoxyamine on complications of combined spinal and epidural anesthesia in older adult patients and its influence on hemodynamics / 中国基层医药

Objective:To investigate the preventive effects of hydroxyethyl starch and methoxamine on complications of combined spinal and epidural anesthesia in older adult patients and its influence on hemodynamics.Methods:The clinical data of 120 older adult patients who underwent combined spinal and epidural anesthesia in General Hospital of Armed Police and Marine Police between February 2017 and April 2019 were retrospectively analyzed. The included patients were divided into two groups according to the adverse reactions of drugs used to induce anesthesia: control group (methoxamine injection, n = 55) and observation group (methoxamine + hydroxyethyl starch, n = 65). The changes in hemodynamic index, complications and cognitive function were analyzed in each group. Results:Systolic blood pressures measured at 5, 15 and 30 minutes after anesthesia were (127.53 ± 10.63) mmHg, (119.85 ± 10.86) mmHg, (125.45 ± 10.74) mmHg, respectively in the observation group, which were significantly higher than (118.23 ± 11.32) mmHg, (114.34 ± 10.32) mmHg, (119.01 ± 10.34) mmHg in the control group ( t = 3.66, 2.24, 2.63, all P < 0.05). Diastolic blood pressures measured at 5, 15 and 30 minutes after anesthesia were (76.65 ± 9.07) mmHg, (78.43 ± 9.32) mmHg, (80.19 ± 9.43) mmHg, respectively in the observation group, which were significantly higher than (63.30 ± 9.43) mmHg, (65.98 ± 9.26) mmHg, (70.38 ± 9.17) mmHg in the control group ( t = 6.24, 5.78, 4.55, all P < 0.05). Heart rates measured at 5, 15 and 30 minutes after anesthesia were (73.65 ± 7.67) beats/min, (83.27 ± 9.57) beats/min, (84.10 ± 9.67) beats/min respectively in the observation group, which were significantly higher than (69.76 ± 7.82) beats/min, (64.70 ± 9.38) beats/min, (65.80 ± 9.43) beats/min in the control group ( t = 2.17, 8.46, 8.27, all P < 0.05). The incidences of hypotension and bradycardia in the observation group were 3.08% (2/65) and 3.08% (2/65), respectively, which were significantly lower than 25.45% (14/55) and 21.82% (12/55) in the control group ( χ2 = 12.91, 10.15, both P < 0.05). The Mini Mental State Examination scores measured at 1, 6 and 24 hours after surgery were (26.69 ± 2.51) points, (26.74 ± 2.75) points, and (26.99 ± 2.36) points, respectively in the observation group, which were significantly higher than (23.17 ± 2.41) points, (23.43 ± 2.36) points, and (24.18 ± 2.12) points in the control group ( t = 6.17, 5.55, 5.39, all P < 0.05). Conclusion:Hydroxyethyl starch combined with methoxamine for combined spinal and epidural anesthesia in older adult patients can effectively reduce the hemodynamic fluctuations, decrease the incidences of hypotension and bradycardia, and does not produce a remarkable effect on postoperative cognitive function.

Effect of acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/0.4 on pharmacodynamics of propofol during successful laryngeal mask airway implantation / 中华麻醉学杂志

Objective:To investigate the effect of acute hypervolemic hemodilution (AHH) with 6% hydroxyethyl starch 130/0.4 on pharmacodynamics of propofol during successful laryngeal mask airway (LMA) implantation.Methods:American Society of Anesthesiology physical status Ⅰ or Ⅱ patients, aged 30-60 yr, with body mass index of 18.5-25.0 kg/m 2, undergoing elective extensive total hysterectomy under general anesthesia, were divided into 2 groups: AHH group (group A) and control group (group C). In group A, 6% hydroxyethyl starch 130/0.4 was infused at a rate of 20 ml/min for AHH, and the target hematocrit was 30%.In group C, lactated Ringer′s solution was infused according to the " 4-2-1" rule to supplement physiological requirements, and anesthesia induction was performed after 10 min of stabilization.Sufentanil was administered by target-controlled infusion using Bovil pharmacokinetic model with effect-site concentration (Ce) of 0.25 ng/ml, 3 min later propofol was given by target-controlled infusion using Schnider model.The Ce of propofol in the first patient was set at 5.0 μg/ml.Each time the concentration of propofol was increased/decreased by 0.5 μg/ml according to the sequential method.LMA was inserted following 1 min equilibration between plasma concentration and Ce of propofol.The trial was terminated when 8 consecutive inflection points of failed/successful LMA insertion occurred.The EC 5, EC 50, EC 95 and 95% confidence interval (95% CI) of propofol were calculated by probit regression analysis. Results:In group A, the EC 5 (95% CI), EC 50 (95% CI) and EC 95 (95% CI) of propofol when LMA was successfully placed were 4.237 (3.090-4.514) μg/ml, 4.802 (4.500-5.078) μg/ml and 5.443 (5.125-7.304) μg/ml, respectively.In group C, the EC 5 (95% CI), EC 50 (95% CI) and EC 95 (95% CI) of propofol when LMA was successfully placed were 2.408 (1.190-2.756) μg/ml, 3.120 (2.690-3.472) μg/ml and 4.042 (3.582-7.431) μg/ml, respectively.There was significant difference in EC 5, EC 50 and EC 95 between the two groups ( P<0.01). Conclusion:AHH with 6% hydroxyethyl starch 130/0.4 can decrease the efficacy of propofol when LMA is successfully implanted.

Effect of hydroxyethyl starch on blood glucose levels / 대한마취과학회지

BACKGROUND: Hydroxyethyl starch (HES), a commonly used resuscitation fluid, has the property to induce hyperglycemia as it contains large ethyl starch, which can be metabolized to produce glucose. We evaluated the effect of 6% HES-130 on the blood glucose levels in non-diabetic patients undergoing surgery under spinal anesthesia. METHODS: Patients scheduled to undergo elective lower limb surgery were enrolled. Fifty-eight patients were divided into two groups according to the type of the main intravascular fluid used before spinal anesthesia (Group LR: lactated Ringer's solution, n = 30 vs. Group HES: 6% hydroxyethyl starch 130/0.4, n = 28). Blood glucose levels were measured at the following time points: 0 (baseline), 20 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), and 6 h (T6). RESULTS: Mean blood glucose levels at T5 in the LR group and T4, T5 in the HES group, increased significantly compared to baseline. There were no significant changes in the serial differences of mean blood glucose levels from baseline between the two groups. CONCLUSIONS: Administration of 6% HES-130 increased blood glucose levels within the physiologic limits, but the degree of glucose increase was not greater than that caused by administration of lactated Ringer's solution. In conclusion, we did not find evidence that 6% HES-130 induces hyperglycemia in non-diabetic patients.

Effect of protective solutions and hydroxyethyl starch in the attenuation of the injuries of ischemia and reperfusion of splanchnic organs

PURPOSE: Vogt´s antioxidant solution (red blood cells, Ringer's solution, sodium bicarbonate, mannitol, allopurinol and 50% glucose) or its modification including hydroxyethyl starch (HES) were tested for the prevention of splanchnic artery occlusion shock. METHODS: Seventy rats were distributed in treatment (3), control (1), and sham (3) groups. Ischemia and reperfusion were induced by celiac, superior mesenteric and inferior mesenteric arteries occlusion for 40 min, followed by 60 min reperfusion or sham procedures. Controls received saline, both treatment and sham groups received the Vogt's solution, modified Vogt's solution (replacing Ringer's solution by HES), or HES. Mean arterial blood pressure (MABP), ileal malondialdehyde (MDA) and plasmatic MDA were determined, and a histologic grading system was used. RESULTS: At reperfusion, MABP dropped in all I/R groups. Only HES treatment was able to restore final MABP to the levels of sham groups. Plasmatic MDA did not show differences between groups. Ileum MDA was significantly higher in the control and treatment groups as compared to the sham group. Histology ranking was higher in the only in control group. CONCLUSIONS: Hydroxyethyl starch was able to prevent hemodynamic shock but not intestinal lesions. Both treatments with Vogt's solutions did not show any improvement. .