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BJA Advance Access originally published online on November 26, 2006
British Journal of Anaesthesia 2007 98(1):29-37; doi:10.1093/bja/ael312
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Hydroxyethyl starch is superior to lactated Ringer as a replacement fluid in a pig model of acute normovolaemic haemodilution

D. A. Otsuki1, D. T. Fantoni2, C. B. Margarido3, C. K. Marumo3, T. Intelizano2, C. A. Pasqualucci4 and J. O. Costa Auler, Jr3,*

1 Laboratory of Medical Investigation LIM08, School of Medicine Brazil
2 Department of Surgery, School of Veterinary Medicine Brazil
3 Department of Surgery, School of Medicine Brazil
4 Department of Pathology, School of Medicine, University of São Paulo Brazil

*Corresponding author: Instituto do Coração (Incor)—Hospital das Clínicas da FMUSP Avenida Dr Enéas Carvalho Aguiar 44, CEP O5403-000 São Paulo, Brazil. E-mail: auler.junior{at}incor.usp.br

Background. Tissue tolerance to oxygen privation during acute normovolaemic haemodilution with different fluids remains unclear. We tested the hypothesis that hydroxyethyl starch (HES) is superior to lactated Ringer's solution in pigs for preserving tissue perfusion during acute normovolaemic haemodilution.

Methods. Twenty-four animals were randomized into control, lactated Ringer's solution and HES groups. All groups, except the control, underwent acute normovolaemic haemodilution. Haemodynamics, oxygen parameter indices, global anaerobic metabolic markers, echocardiographic parameters, gastric tonometry and serum osmolarity were monitored at baseline, immediately after (0 min) and 60 and 120 min after the end of haemodilution. Myocardial, liver, stomach and intestine samples were collected for further evaluation.

Results. Cardiac and oxygen parameter index responses to acute normovolaemic haemodilution were comparable. However, the increment in cardiac index, stroke volume index, and left ventricular stroke work index were more sustained in the starch group. In the lactated Ringer's group, gastric pH decreased significantly and was accompanied by a significant increase in lactate. Myocardial ultrastructure was better preserved in the starch group. The other tissue samples presented no change.

Conclusions. In this model of ANH, the starch group had a superior haemodynamic response. Minor loss of myocardial cellular integrity and preserved gastric pHi reinforce these findings.


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Hydroxyethyl starch is superior to lactated Ringer as replacement fluid in acute normovolaemic haemo
Olumuyiwa A Bamgbade, et al.
British Journal of Anaesthesia, 16 Feb 2007 [Full text]
Response to Bamgbade OA letter
Jose Otavio C. Auler Jr., et al.
British Journal of Anaesthesia, 13 Mar 2007 [Full text]

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