CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
AFRICA
431
and the oxygenation of organs.
11
HES also had an effect on
inflammation. Reduction of macrophage inflammatory protein
(
MIP-2), IL-1
β
and TNF-
α
levels was found to be a mechanism
for reduction of inflammation after the use of HES.
12
The most dangerous complication after CABG is kidney
damage and some researchers demonstrated kidney damage after
the use of HES but found gelatin (4%) to be safer.
8
Others have
shown little reduction in glomerular filtration rate (GFR) after
the use of high-molecular weight HES.
13
Boldt
et al. r
eported a
lower inflammation rate and better GFR with HES.
4
In our study there was better haemodynamic stability with
lower volumes of HES. Renal function was good after its use
in the first two days after CABG, which indicates that renal
function can be maintained after use of 6% HES. Other reporters
have shown less renal damage after the use of HES than with
gelatin, albumin and Ringer’s solutions.
4
In our study we used less volumes of HES than Ringer’s
solution and gelatin and this produced a better volume-expanding
effect with HES than with gelatin and Ringer’s solutions. Better
oxygenation and lower serum lactate concentration were shown
after the use of HES than with gelatin.
15
There were no differences
between the three groups as far as mortality rate is concerned.
There were some limitations to the study. Because of the
systemic inflammatory response after CPB, it would have been
advisable to compare inflammatory biomarkers in the three
groups but this was not done. It has been reported that HES had
an effect on the acid–base balance in some studies, but this was
not determined in our study.
Conclusion
Our study showed that HES (6%) had a better volume-expanding
effect than gelatin (4%) and Ringer’s solution, and its short-term
effects on renal function were also better than with gelatin and
Ringer’s solution.
We thank Farzan Science, Research and Technology Institute for technical
assistance.
References
1.
Yatin M, Ajay D, Sujatha Z, Meharwal, Naresh T. Comparison of new
Hes (130.0.4) and Hes (200.0.5) in OPCAB surgery.
J Anesth Clin
Pharmacol
2007;
23
: 273–278.
2.
Karanko MS. Effects of thre colloid solutions on plasma volume and
hemodynamics after coronary bypass surgery.
Crit Care Med
1987;
15
:
1015–1022.
3.
Toraman F, Evrenkaya S, Yuce M,
et al
.
lactic acidosis after cardiac
surgery is associated with adverse outcome.
Heart Surg Forum
2004;
17
: 155–159.
4.
Boldt J, Brosch CH, Rohm K, Papsdorf M, Mengistu A. comparison of
the effects of gelatin and modern hydroxyethyl starch solution on renal
function and inflamnatory response in elderly cardiac surgery patients.
Br J Anaesth
2008; 1–8.
5.
Walcher F, Bauer C, Paxian M, Holanda M, Larsen R, Marzi I. The
influence of resuscitation on hemodynamics & oxygen radical induced
reperfusion injury after arterialized liver transplantation in the rat.
J
Surg Res
1996;
65
: 9–14.
6.
Rehm M, Orth V, Scheingraber S, Kreimeier U, Brechtel Sbauer H,
Finsterer U. Acid–base changes caused by 5% albumin versus 6%
hydroxyethyl starch solution in patients undergoing acute normo-
volemic hemodilution.
Anesthesiology
2000;
93
: 1174–1183.
7.
Niemi T, schramko A, kuitnnen A, Kukkonen S, Suojaranta R. Hemo-
dynamic and acid–base equilibrium after cardiac surgery: comparison
of rapidly degradable hydroxyethyl starch solution and albumin
.
Scand
J Surg
2008;
97
: 259–265.
8.
Bnunkhorst FM, Engel C, Bloos F,
et al
.
Intensive insulin therapy and
pentastarch resuscitation in severe sepsis.
N Engl J Med
2008;
358
:
125–139.
9.
Dieterich HJ, Weissinmuller T, Rosenberger P, Eltzschig HK. Effect of
hydroxyethyl starch on vascular leak syndrome and neutrophil accumu-
lation during hypoxia.
Crit Care Med
2006;
34
: 1775–1782.
10.
Yeh JR, Tigh D, Moss RF,
et al
.
limiting edema in neonatal cardio-
pulmonary bypass with narrow range molecular weight Hydroxyethyl
starch.
Circ Shock
1992;
36
: 93–96.
11.
Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and
tissue oxygen tension in patients undergoing major abdominal surgery.
Anesth Analg
2001;
93
: 405–409.
12.
Feng X, Yan W, Wang Z,
et al
.
Hydroxyethyl starch, but not modi-
fied fluid gelatin, affects inflammatory response in a rat model of
polymicrobial sepsis with capillary leakage.
Anesth Analg
2007;
104
:
624–630.
13.
Winkelmayer WC, Glynn RJ, Levin R, Avorn J. Hydroxyethyl starch
and change in renal function in patients undergoing coronary artery
bypass graft surgery.
Kidney Int
2003;
64
: 1046–1049.
14.
Halmaja K, Bishop G, Bristow P. The crystalloid versus colloid contro-
versy: present status.
Balleres Clin Anaesth
1997;
11
: 1–13.
15.
SU F, wang Z, Cai Y, Rogiers P, Vincent JL. Fluid resuscitation in
severe sepsis and septic shock: albumin, hydroxyethyl starch, gelatin
or Ringer’s lactate – does it really makes a difference?
Shock
2007;
27
: 520–526.
