[Effect of volume replacement with hydroxyethyl starch solution for blood loss on splanchnic oxygenation in patients undergoing cytoreductive surgery for ovarian carcinoma].

OBJECTIVE

To investigate the effect of medium molecular weight hydroxyethyl starch solution (HES) administered as replacement for estimated blood losses (EBL) during cytoreductive surgery for ovarian carcinoma on splanchnic oxygenation.

METHODS

Cytoreductive surgery was operated upon forty-two patients with ovarian carcinoma. As soon as the EBL was higher than 10% but less than 20% of the estimated blood volume, the patients were randomly assigned to receive a volume of lactated Ringer's solution (LRS) equal to three times the EBL (LRS group, n = 22) or a volume of 6% HES equal to the EBL (HES group, n = 20). Tissue oxygenation was assessed indirectly by measuring the tonometric parameters of stomach, including difference between gastric intramucosal PsCO(2) and arterial PaCO(2) (Ps-aCO(2) gap), gastric intramucosal pH (pHi) and arterial lactate acid concentration 30 min after induction of anesthesia (baseline value), 1 h and 2 h after skin incision, and at the end of surgery.

RESULTS

At the end of surgery, the Ps-aCO(2) gap was 8.7 mm Hg +/- 1.6 mm Hg in the HES group, significantly lower than that in the LRS group (18.74 mm Hg +/- 4.4 mm Hg, P < 0.01), while the pHi in the HES group was 7.30 +/- 0.05, significantly higher than that in the LRS group (7.21 +/- 0.07, P < 0.01). There was no significant difference in arterial lactate acid concentration between the two groups.

CONCLUSION

In patients undergoing major surgery, volume resuscitation with medium molecular weight HES improves the splanchnic blood flow and tissue oxygenation.