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BJA Advance Access published online on November 26, 2006
British Journal of Anaesthesia, 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
Accepted September 1, 2006

Laboratory Investigation

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

D. A. Otsuki 1, D. T. Fantoni 2, C. B. Margarido 3, C. K. Marumo 3, T. Intelizano 2, C. A. Pasqualucci 4, and J. O. Costa Auler Jr 3 *

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

* To whom correspondence should be addressed.
J. O. Costa Auler Jr, E-mail: auler.junior{at}incor.usp.br


  Abstract

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.

Keywords: blood, acute normovolaemic haemodilution; gastric tonometry; HES; lactated Ringer's; measurement techniques, echocardiography; myocardial ultrastructure; pigs.
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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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