Spinal anesthesia is an important and commonly used method for surgical anesthetic in operating rooms. However, even with identical drug dosage and administration mode, the extent of drug distribution in vivo is highly variable and difficult to control. Preanesthetic administration of fluids immediately before spinal anesthesia (preload) is normal practice. The choice of fluid type may affect drug distribution as well as the duration and level of the block.. We examined whether preloads of normal saline, Ringer, or hydroxyethyl starch has different effects on the time it takes to reach maximum block, and the distribution and duration of spinal block level..Patients and This was a randomized trial and the 150 patients selected were evenly divided into three groups and given; normal saline, Ringer, or hydroxyethyl starch 130/0.4fluids. Preload was given at 10 mL/kg for the normal saline and Ringer groups, and 5 mL/kg for the hydroxyethyl starch group, 10 min before the spinal anesthesia. Sensory block levels were recorded every 5 min until 30 min after spinal anesthesia and then at 60 and 90min. Time taken to reach maximum and median sensory block, maximum and median level of block, duration of block, and hemodynamic status were recorded.. There were no statistically significant differences in the demographic characteristics between the three groups. Maximum block was higher in normal saline compared to Ringer (P = 0.029). Time taken to reach maximum block was greater in Ringer compared to both normal saline (P = 0.001) and hydroxyethyl starch (P = 0.003). Normal saline had a longer duration of sensory block T10 compared to Ringer and hydroxyethyl starch (P = 0.03).. Preload fluids have an impact on the level, distribution and duration of sensory block in spinal block. Of the three fluids, normal saline produced the greatest maximum and longest duration of block, whereas time taken to reach maximum block was longer in the Ringer group..

Different processing methods are being used to improve the quality of hematopoietic stem cell transplantation. Using hydroxyethyl starch, simple centrifugation and Sepax automation, this study was aimed to compare these three conventional methods. 90 cord blood samples were taken and processed by hydroxyethyl starch, simple centrifugation and Sepax automation methods. Then they were subjected to total nucleated cell (TNC) counting and CD34 positive counting as well as colony assay. Finally, all data were analyzed using one-way analysis of variance (ANOVA) and ps less than 0.05 were considered statistically significant. The TNC recoveries in hydroxyethyl starch, simple centrifugation and Sepax automation methods were 76%, 71% and 80%, respectively (p> 0.05). The CD34+ cell recoveries in the Sepax automation and in the other two methods were 91% and 85%, respectively (p> 0.05). Also, the colony assay recoveries were not significantly different among the three methods (p> 0.05). No significant difference was seen in TNC number, CD34 positive counting and colony formation among the three different methods.

Given the fact that various studies have reported the positive effects of hydroxyethyl starch therapy in controlling shock, this study aimed to compare the effects of hydroxyethyl starch on modifying acidosis and treating patients with aluminum phosphide poisoning.
This was a randomized clinical trial that was conducted on 60 patients with aluminum phosphide poisoning. We compared the two groups of patients treated with hydroxyethyl starch and normal saline. Base excess and serum pH of arterial blood gases (ABG) were measured before and after the treatment and compared by t-test.
Results showed that arterial pH in the starch group and normal saline group increased by 0.13 and 0.18, respectively, and the difference between the two groups was not statistically significant. The difference in the base excess before and after treatment in the starch group and normal saline group was 6.41 and 5.39, respectively, and the difference between the two groups was not statistically significant. Changes in mean values of arterial pH after the intervention in comparison with before treatment were statistically significant (p<0.05).
Overall, the results of the present study show that starch is at least as effective as normal saline in treating acidosis in patients poisoned with aluminum phosphide and can be used instead of normal saline, and both of the two treatments could be equally effective.

Hemorrhagic shock remains one of the leading causes of death following multiple organ ischemic injuries in dogs. The aim of this study was to compare tissue perfusion and electrocardiographic parameters in experimentally induced acute hemorrhagic shock in dogs before and after resuscitation with the lactated ringer and hydroxyethyl starch 6% solutions. The parameters of tissue perfusion included the gingival mucosal color, CRT, peripheral pulse quality, appendage temperature, serum lactate concentration, heart rate, mean arterial blood pressure and urine output plus ECG were evaluated in ten male adult healthy mongrel dogs which instrumented, and anesthetized (control measurement). Hemorrhage was performed with removal of up to 60% of blood volume to keep MAP between 40 and 50 mm Hg (second set of measurements). After a 30- minute stabilization period in hemorrhagic shock condition, the third set of measurements was performed. The dogs were randomly assigned to two study groups which received lactated ringer or hydroxyethyl starch solutions, 20 or 5 ml/kg respectively in four consecutive 15 –min periods (fourth to seventh measurements). One hour after the last resuscitation stage, the dogs were monitored and at the end of this time, an eighth evaluation step was carried out. Time induced a significant effect on heart rate, mean arterial blood pressure, appendage temperature, urine output, serum lactate concentration, R wave amplitude and Q-T interval. While solution type had a significant effect on serum lactate concentration, urine output and P wave amplitude. The results of this study showed that each of lactated ringer and hydroxyethyl starch solutions, has no significant effect in the short term on tissue perfusion and electrocardiogram parameters in hemorrhagic shock resuscitated dogs.

Some of studies suggest that hydroxyethyl starch (HES) and calcium Infusion may be beneficial for women with a high risk of developing ovarian hyperstimulation syndrome (OHSS). This study aimed to compare the effects of intravenous infusion of calcium or hydroxyethyl starch in preventing OHSS in high-risk women. This clinical trial study was carried out on 100 women considered at risk of developing OHSS were divided in two equal groups. The first group received 10 mg of 10% calcium gluconate in 100 mg normal saline within 2 hours, and the dose was repeated at the third day of oocyte retrieval. In the second group, in a time of oocyte retrieval, 500 cc hydroxyethyl starch was administered by infusion, and it was repeated at second and third days of oocyte removal. Finally, incidence and intensity of OHSS was measured and compared between the two groups. Findings: OHSS was found in 21 patients (42%) in each group; but intensity of OHSS in hydroxyethyl starch group was higher (P = 0.024). There was no sever OHSS in calcium group, whereas in hydroxyethyl starch group, 3 patients (14%) had sever form OHSS. Calcium or hydroxyethyl starch infusion strategies were both effective in preventing OHSS, but the intensity of OHSS in calcium infusion was lower. Therefore, probably calcium infusion is a better novel therapy that may be used effectively in prevention of OHSS

Cardiopulmonary bypass (CPB) can adversely affect coagulation and systemic inflammatory response. Given that the optimal strategy for priming CPB in cardiac surgery remains a matter of debate, this study aimed to investigate the effects of albumin 20% and hydroxyethyl starch 6% as priming solutions on bleeding and interleukin-6 (IL-6) levels during CPB.

This randomized clinical trial involved 40 patients undergoing coronary artery bypass surgery at Shahid Chamran Hospital between July 2021 and July 2022. Participants were assigned to 2 groups: the first group received 50 mL of albumin 20% as the priming solution for the CPB circuit, while the second group received 500 mL of hydroxyethyl starch 6%. Bleeding and IL-6 levels were assessed before and after the intervention.

The albumin group comprised 80.0% men and 20.0% women, with a mean age of 66.45±5.84 years. The hydroxyethyl starch 6% group consisted of 85.0% men and 15.0% women, with a mean age of 63.05±5.92 years (P>0.05). The findings revealed that 12 hours after CPB, the IL-6 level in the hydroxyethyl starch 6% group (mean: 171.6±77.71 pg/mL) was significantly higher than that in the albumin group (mean: 105.8±36.45 pg/mL; P=0.002). At 48 hours after CPB, the mean bleeding was not significantly different between the groups (P=0.950).

Albumin 20% was more effective than hydroxyethyl starch 6% concerning IL-6 levels. However, no significant differences in bleeding were observed between the groups at 48 hours post-CPB.

Colloids play an important role in fluid resuscitation. However, their unfavorable effects on the coagulation system have led to the limited usage of these solutions. Newer types of colloids are currently being claimed to have minimal effects on homeostasis. This study tried to evaluate such a claim. In a double blind clinical trial, 58 ASA (American Society of Anesthesiologists) I and II patients candidate for elective lower limbs or lower abdomen surgeries under spinal anesthesia were studied. Using thromboelastography, the coagulation system was evaluated before and 1 hour after an infusion of 15 cc/kg of hydroxyethyl starch (HES) 130 in the study group and HES 200 in the control group. Hemodynamics were monitored and recorded during the study and data was analyzed by chi-square test, analysis of variance (ANOVA) and Mann-Whitney test at a significance level of 0.05. Mean age in the study and control groups were 37.83 ± 16.1 and 44.07 ± 15.6 years, respectively. There were 23 males and 6 females in each group. Mean weight in the study and control groups were respectively 69.48 ± 8.7 and 69.72 ± 7.5 kg. The results of statistical analyses did not show any differences in these three variables. Repeated measures ANOVA only revealed P values less than 0.05 for heart rate and body temperature. However, the patients were not significantly different in blood pressure. Mean values of thromboelastography parameters, including R (reaction time),K (coagulation time), α (angle), MA (maximal amplitude), and LY30 (percentage lysis 30 minutes post-MA) did not have significant differences between the two groups after infusion of starches. The patients had similar hemodynamic indexes during the study. They did not show any significant differences in thromboelastography parameters (R, K, α, MA, and Ly30). Therefore,15 cc/kg of HES 130 does not have any priority over HES 200 for effects on coagulation.

Posttraumatic intravasation of fat and debris can lead to a cascade of events. Hydroxyethyl starches (HES) markedly suppress neutrophil influx by decreasing pulmonary capillary permeability and facilitating tissue oxygenation by improving microcirculation. It was hypothesized that in hypoxemic femur injury patients undergoing operative stabilization, HES administration will prevent the deterioration of respiratory variables and facilitates recovery. This prospective, double-blind, randomized preliminary study, enrolled twenty posttraumatic hypoxemic patients (room air PaO2 < 70 mmHg, Schonfeld fat embolism index score (SS) > 5) scheduled for femur fracture stabilization under general anesthesia. Patients were allocated to receive either; 6% HES 130/0.42, 15mL/kg or 0.9% normal saline (NS) to maintain their central venous pressure (CVP) 12 + 2 mm Hg. Blood was transfused according to the maximum allowable blood loss and by serial hematocrit estimations. Perioperative Glasgow Coma Scale (GCS), physiological variables, arterial oxygen saturation (SpO2), arterial blood gas (ABG), SS and P/F ratios were recorded until recovery. The partial pressure of oxygen in arterial blood / fraction of inspired oxygen ratio (PaO2/FiO2) improved from a preoperative value of 273.33 ± 13.05 to 435.70 in the 6% Hydroxyethyl starch group (HES) and from 275.24 ± 15.34 to 302.25 ± 70.35 in the NS group over a period of six days (P values =0.970, 0.791, 0.345, 0.226, 0.855, 0.083, 0.221). Time taken to achieve a P/F ratio > 300 and for persistent reduction of Murray’s lung injury score (LIS) were comparable (P = 0.755 and 0.348, respectively). The number of; ventilator, intensive care unit (ICU) and hospital stay days, did not differ (P value = 0.234, 1.00, 0. 301, respectively). There were no adverse sequelae or mortalities. A trend showing relatively fast improvement in the P/F ratio and an early reduction in LIS values was observed in hypoxemic, femur injury patients receiving intraoperative colloid supplementation.

Providing and maintaining normovolemic condition during major surgeries is a major challenge, especially in children. In this respect, third-generation hydroxyethyl starches seem to be more cost-effective than human albumin. However, the efficacy of 6% hydroxyethyl starch (HES) 130/0.4 compared to other alternatives such as human albumin 5% remains uncertain in children. The present study aimed to assess the efficacy and safety of replacing human albumin 5% with 6% HES 130/0.4 for volume replacement therapy in children undergoing ive open cardiac surgery.
This randomized double-blinded clinical trial was performed on 59 children aged less than 2 years and ASA I-III who were candidated for ive open-heart surgery and referred to a children medical center in 2014. The patients were randomly assigned via the block randomization method to the case group (n = 30) receiving a solution of 6% HES 130/0.4 and the control group (n = 29) receiving 5% human albumin. There were no between-group differences in hemodynamic parameters—including pulse rate, systolic and diastolic blood pressures, and mean blood pressure—at the time points of before anesthesia induction, before and after pump ion, and 24 hours after surgery.
Comparisons of the laboratory indices indicated no differences between the 2 groups at the different time points. The volume of packed cell and colloid fluids infused in the case and control group was also similar.
Compared to human albumin 5%, 6% HES 130/0.4 is a safe alternative to fluid supply during cardiac surgery among children. (Iranian Heart Journal 2018; 19(1):37-43)

This study sought to assess the levels of cardiac troponin I, as a resuscitation end point, along with oxygen delivery (DO2) and oxygen consumption (VO2) during resuscitation of dogs with experimental hemorrhagic shock using lactated Ringer’s solution or 6% hydroxyethyl starch. After induction of anesthesia (control measurements), hemorrhagic shock was induced by rapid removal of blood to achieve a mean arterial pressure (MAP) of 40 to 50 mmHg within 30 minutes and then maintained in hypovolemic situation for additional 30 minutes (second and third stages of measurements). Afterward, the dogs were randomly assigned to two groups which received 20 ml/kg lactated Ringer’s solution or 5 ml/kg Hydroxyethyl starch, in four consecutive 15 minutes intervals (forth stage of measurements). One hour after the last resuscitation step, final measurements were performed. Hemorrhagic shock caused marked elevation in the levels of cTnI and reduction in DO2 and VO2 (p < 0.05). Following resuscitation, a significant reduction was observed in the levels of cTnI and VO2 but a significant elevation was seen in DO2 levels (p < 0.05), without significant differences between the groups (p > 0.05). The results of this study proved that cTnI can be evaluated for better monitoring during fluid therapy in hemorrhagic shock, as a novel resuscitation end point.