FLUID REPLACEMENT THERAPY USING 6% HYDROXYETHYL STARCH 130/0.4 MODULATES THE INFLAMMATORY RESPONSE IN PATIENTS UNDERGOING MAJOR ORTHOPEDIC SURGERY WITHOUT COMPROMISING COAGULATION

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 Methods: Sixty patients randomly divided into two equal groups: Group A received 6% HES 130/0.4 (Voluven) and Group B received Gelatin (Haemagel) for perioperative fluid replacement. Ten patients received only crystalloid and gave blood samples as control for serum cytokine levels. Fluid replacement was started after induction of anesthesia and continued for 48 hr until the morning of the second postoperative day (POD) to maintain central venous pressure (CVP) 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 (IL)-1ß and IL-10, and soluble intercellular adhesion molecule-1 (sICAM-1). Results: Designed fluid therapy regimens allowed hemodynamic stability throughout the observation period with non-significant differences between both groups. HES significantly maintained intravascular blood volume manifested as significantly lower volume of HES infused compared to GEL and significantly higher volumes of urine output. GEL fluid therapy significantly affected platelet aggregation compared both to baseline percentage and to those received HES and the effect was continued till POD2. On contrary, platelet aggregation in patients received HES was significantly lower at POD1 compared to baseline percentage, but returned to near normal percentage at POD2. Postoperative estimated serum cytokines levels were significantly higher compared to baseline levels; however, HES significantly reduced serum levels of estimated parameters compared to both control and GEL groups with non-significant difference between control and GEL groups. Conclusion: Perioperative fluid therapy using 6% HES 130/0.4 properly maintained adjusted hemodynamic state and attenuated the pro-inflammatory response to surgery with reduction of adhesion molecules and minimal affection of platelet function.