Hydroxyethyl starch 130/0.4 versus crystalloid co-loading during general anesthesia induction: a randomized controlled trial

J Anesth. 2017 Dec;31(6):878-884. doi: 10.1007/s00540-017-2416-1. Epub 2017 Oct 25.


Purpose: Hypotension and decreased cardiac output (CO) are common adverse effects during anesthesia induction depending on the patient's pre-anesthetic cardiac condition. The aim of this study was to assess the ability of hydroxyethyl starch (HES) 130/0.4 to prevent hypotension and decreased CO during the induction of general anesthesia.

Methods: Ninety patients undergoing laparoscopic surgery were randomly divided into a HES group and a crystalloid group. Following the insertion of an intravenous line, fluid was administered to each patient at a rate of 25 ml/min using either crystalloid or HES 130/0.4. Five minutes after the initiation of fluid loading, anesthesia was induced using propofol (1.5 mg/kg), rocuronium (0.9 mg/kg), and remifentanil (0.3 mcg/kg/min). Tracheal intubation was performed 5 min after the induction of anesthesia. Following tracheal intubation, general anesthesia was maintained using remifentanil and sevoflurane. Non-invasive blood pressure (BP) level was measured at 1-min intervals and CO was measured continuously using electrical cardiometry from the start of fluid loading until 5 min after tracheal intubation.

Results: The number of patients with hypotension (systolic BP < 90 mmHg or 80% of baseline) was significantly lower in the HES group (p < 0.001) than in the crystalloid group. Patients in the HES group showed smaller CO decreases than did patients in the crystalloid group (p < 0.001). The Kaplan-Meier method showed a lower incidence and significantly slower onset of hypotension in the HES group (p = 0.009). Multivariate logistic regression models indicated that the use of HES is an independent factor for the prevention of both hypotension and decreased CO (below 85% of baseline; p < 0.005 for both).

Conclusions: Co-loading using HES 130/0.4 prevented hypotension and decreased CO during general anesthesia induction.

Keywords: Cardiac output; Hydroxyethyl starch 130/0.4; Hypotension.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, General / adverse effects
  • Anesthesia, General / methods*
  • Anesthesia, Spinal / methods
  • Blood Pressure / drug effects
  • Crystalloid Solutions
  • Female
  • Humans
  • Hydroxyethyl Starch Derivatives / administration & dosage*
  • Hypotension / etiology
  • Hypotension / prevention & control*
  • Isotonic Solutions / administration & dosage*
  • Male
  • Middle Aged
  • Plasma Substitutes / therapeutic use


  • Crystalloid Solutions
  • Hydroxyethyl Starch Derivatives
  • Isotonic Solutions
  • Plasma Substitutes