Fluid replacement therapy using 6% hydroxyethyl starch 130 0.4 modulates the inflammatory response in patients undergoing major orthopedic surgery without compromising coagulation

الملخص EN

Objectives To evaluate the effect of perioperative fluid therapy using either 6% hydroxyethyl starch (HES) 130/0.4 or gelatin (GEL) on patients’ hemodynamics, platelet function, and inflammatory response to major orthopedic surgery.

Patients and methods Sixty patients were randomly divided into two equal groups: group A received 6% HES 130/0.4 (Voluven) and group B received GEL (Hemagel) for perioperative fluid replacement.

Ten patients received only crystalloid and gave blood samples as control for analysis of serum cytokine levels.

Fluid replacement was started after induction of anesthesia and continued for 48 h until the morning of the second postoperative day (POD2) to maintain central venous pressure between 5 and 9 mmHg.

Hemodynamic variables, total fluid input, urine output, and blood losses were recorded.

Blood samples were obtained for determination of platelet aggregation percentage and estimation of serum levels of interleukin-1b and interleukin-10 and soluble intercellular adhesion molecule-1.

Results Designed fluid therapy regimens allowed hemodynamic stability throughout the observation period with nonsignificant differences between both groups.

HES significantly maintained intravascular blood volume manifested as significantly lower volumes of HES infused compared with GEL, and also led to significantly higher volumes of urine output.

GEL fluid therapy significantly affected platelet aggregation compared with baseline percentage and with those who received HES.

The effect continued until POD2.

In contrast, platelet aggregation in patients who received HES was significantly lower at POD1 compared with baseline percentage, but returned to near normal percentage at POD2.

Postoperatively estimated serum cytokine levels were significantly higher compared with baseline levels; however, HES significantly reduced serum levels of estimated parameters compared with both control and GEL groups, with nonsignificant difference between control and GEL groups.

Conclusion Perioperative fluid therapy using 6% HES 130/0.4 properly maintained adjusted hemodynamic state and attenuated the proinflammatory response to surgery with reduction of adhesion molecules and minimal affection of platelet function