Anesth Pain Med.  2023 Apr;18(2):139-147. 10.17085/apm.22246.

The effect of 6% hydroxyethyl starch 130/0.4 preloading on the blood glucose levels in diabetic patients undergoing orthopedic surgery with spinal anesthesia: a randomized pilot study

• Cho SY
• An TH
• Shim SB
• Lee M
• Jung KT

• KMID: 2543655
• DOI: http://doi.org/10.17085/apm.22246

Abstract

Background
Perioperative hyperglycemia can occur in surgical patients and may increase postoperative morbidity and mortality, especially in patients with diabetes. Therefore, we conducted the present study to evaluate whether the administration of 6% hydroxyethyl starch (HES)-130/0.4 increases blood glucose levels in patients with diabetes.
Methods
Forty patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into two groups according to the fluids administered 20 min before spinal anesthesia (Group L, lactated Ringer’s solution; Group H, 6% HES-130/0.4). Patient characteristics, intraoperative variables, blood glucose levels, mean blood pressure (MBP), and heart rate (HR) were recorded at five time-points (0, 20, 60, 120, and 240 min).
Results
A total of 39 patients were analyzed (Group L, n = 20; Group H, n = 19). The amount of intraoperative fluid was significantly higher in Group L than in Group H (718.2 ml vs. 530.0 ml, P = 0.010). There were no significant differences in the changes in blood glucose levels, HR, or MBP between the two groups (P = 0.737, P = 0.896, and P = 0.141, respectively). Serial changes in mean blood glucose levels from baseline also showed no significant differences between the groups (P = 0.764).
Conclusions
There were no significant changes in blood glucose levels when lactated Ringer’s solution or 6% HES-130 was used. When compared to the lactated Ringer’s solution, no evidence that 6% HES-130/0.4 produces hyperglycemia in diabetic patients could be found. Further evaluation of larger populations is needed.

Keyword

Blood glucose; Colloid; Diabetes mellitus; Hydroxyethyl starch derivative; Hyperglycemia; Ringer’s lactate.

Figure

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  Fig. 1. Consort flow diagram for the study. Group L was preloaded with lactated Ringer’s solution (15 ml/kg) as the control group. Group H was preloaded with 6% hydroxyethyl starch 130/0.4 (7.5 ml/kg).

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  Fig. 2. Changes in the mean blood glucose levels (mean ± SD). The numbers represent the changes in mean blood glucose levels from the baseline values (T0) at certain time points (mean ± SD). Group L was preloaded with lactated Ringer’s solution (15 ml/kg) as the control group, whereas Group H was preloaded with 6% hydroxyethyl starch 130/0.4 (7.5 ml/kg). T0: baseline before administration of the designated fluid, T1: 30 minutes after administration of the designated fluid, T2: 1 hour after administration of the designated fluid, T3: 2 hours after administration of the designated fluid, T4: 3 hours after administration of the designated fluid.

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  Fig. 3. Changes in mean blood pressure and heart rate (mean ± SD). (A) Mean blood pressure and (B) heart rate. Group L was preloaded with lactated Ringer’s solution (15 ml/kg) as the control group, whereas Group H was preloaded with 6% hydroxyethyl starch 130/0.4 (7.5 ml/kg). T0: baseline before administration of the designated fluid, T1: 30 minutes after administration of the designated fluid, T2: 1 hour after administration of the designated fluid, T3: 2 hours after administration of the designated fluid, T4: 3 hours after administration of the designated fluid.

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