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BJA Advance Access published online on December 10, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen350
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Initial administration of hydroxyethyl starch vs lactated Ringer after liver trauma in the pig

M. Zaar1,*, B. Lauritzen3, N. H. Secher1, T. Krantz1, H. B. Nielsen1, P. L. Madsen3 and P. I. Johansson2

1 Department of Anaesthesia
2 Department of Clinical Immunology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Denmark
3 Haemostasis Pharmacology, Novo Nordisk A/S, Måløv, Denmark

* Corresponding author. E-mail: morten.zaar{at}biology.au.dk

Background: This study tested the circulatory effectiveness of post-trauma administration of a large intravascular volume expander, hydroxyethyl starch 130/0.4 (HES), vs standard lactated Ringer's solution (RL).

Methods: Liver injury was inflicted in 14 pigs [31 (4) kg; mean (SD)] and treatment simulated an acute pre-hospital event: after a standard first-respond delay (7 min), volume administration was provided in three phases to simulate increasing intravascular access. In the first two phases, the fluid was administered either by HES or by RL and, during the last phase, all animals received HES to stabilize the intravascular volume.

Results: The liver trauma severed an equal number of 1–3 mm diameter blood vessels [1.4 (0.6)] and after 7 min, the blood loss was 184 (127) ml and mean arterial pressure had decreased by 19 (13) mm Hg (P<0.01). The intravascular volume expansion effect was 115 (25)% for HES and 76 (21)% for RL (P<0.05), yet oxygen uptake was maintained in zero of seven vs three of seven pigs and the survival was three of seven vs seven of seven, respectively (P<0.05). In these animals, the initial administration of HES provoked uncontrolled bleeding, whereas the administration of RL was associated with attenuated bleeding: total blood loss 2455 (1919) vs 311 (208) ml, respectively (P<0.01), reflecting that bleeding ceased in six of the pigs administered RL.

Conclusions: After injury, the intravascular volume expanding effect of HES was larger than that for RL. However, initial administration of HES provoked uncontrolled haemorrhage, suggesting that prioritizing intravascular volume expansion did not result in stabilization of the circulation after haemorrhage.

Keywords: blood, loss; blood, haemodilution; fluids, i.v.; research, animal


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This article has been cited by other articles:


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 Br J AnaesthHome page
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[Abstract] [Full Text] [PDF]

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Initial administration of hydroxyethyl starch vs lactated Ringer after liver trauma in the pig
James Geoghegan
British Journal of Anaesthesia, 2 Feb 2009 [Full text]
Hydroxyethyl starch vs lactated Ringer after liver trauma
R Jonathan T Wilson
British Journal of Anaesthesia, 2 Feb 2009 [Full text]
Initial administration of hydroxyl starch vs lactated Ringer after liver trauma in the pig
Morten Zaar, et al.
British Journal of Anaesthesia, 2 Mar 2009 [Full text]

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