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Postoperative Blood Loss and Coagulation Changes After Balanced 6% Hydroxyethyl Starch 130/0.4 Administration During Spine Surgery: A Retrospective Study. Clin Spine Surg 2019; 32:E65-E70. [PMID: 30334822 DOI: 10.1097/bsd.0000000000000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The objective of this study was to investigate the effects of intraoperative balanced 6% hydroxyethyl starch (HES) 130/0.4 on postoperative blood loss and the coagulation profile. SUMMARY OF BACKGROUND DATA The safety of colloid versus crystalloid transfusion for bleeding and coagulation during major spine surgery remains controversial and only a few studies exist. Thus, we compared the effects of balanced 6% HES 130/0.4 and crystalloid on postoperative bleeding and coagulation. METHODS Patients undergoing spine surgery between February 1, 2015 and February 28, 2017 were divided into 2 groups: patients receiving intraoperative balanced 6% HES 130/0.4 and patients receiving crystalloid. We compared the postoperative bleeding volume with changes in the coagulation profile and length of hospital stay between these 2 groups. Propensity score (PS)-matching and multivariate stepwise linear regression were performed. RESULTS A total of 169 patients who met the inclusion criteria were analyzed. The quantity of total colloid per patient was 10-15 mL/kg. A significant difference was observed in the total intraoperative transfused crystalloid volume between the 2 groups (colloid group, 1.394.6±1.414.0 mL; crystalloid group, 2.027.3±1.114.1 mL; P<0.001). Postoperative blood loss and coagulation profile changes were not significantly different in the 60 PS-matched paired patients. Furthermore, no differences in either postoperative transfusion requirement or length of hospital stay were observed between the groups. Multivariate stepwise linear regression revealed that operation time (β=0.549; P<0.001) and intraoperative transfusion of packed red blood cells (β=0.466; P=0.003) or fresh frozen plasma (β=-0.263; P=0.041) were independently associated with postoperative blood loss. However, intraoperative colloid administration was not a predictive factor. CONCLUSIONS Intraoperative infusion of balanced 6% HES 130/0.4 in patients undergoing spine surgery presented clinically insignificant changes in postoperative blood loss and coagulation compared to crystalloid. LEVEL OF EVIDENCE Level III.
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Blanco Amil CL, Gallego Ferreiroa C, Fraga Muñoz E, Encisa de Sá JM. Post-traumatic femoropopliteal pseudo-aneurysm in a patient allergic to heparins. ANGIOLOGIA E CIRURGIA VASCULAR 2016. [DOI: 10.1016/j.ancv.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bern MM, Hazel D, Deeran E, Richmond JR, Ward DM, Spitz DJ, Mattingly DA, Bono JV, Berezin RH, Hou L, Miley GB, Bierbaum BE. Low dose compared to variable dose Warfarin and to Fondaparinux as prophylaxis for thromboembolism after elective hip or knee replacement surgery; a randomized, prospective study. Thromb J 2015; 13:32. [PMID: 26448724 PMCID: PMC4596510 DOI: 10.1186/s12959-015-0062-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background Deep vein thrombosis (DVT) and pulmonary emboli (PE), known together as venous thromboembolic (VTE) disease remain major complications following elective hip and knee surgery. This study compares three chemoprophylactic regimens for VTE following elective primary unilateral hip or knee replacement, one of which was designed to minimize risk of post-operative bleeding. Methods Patients were randomized and stratified for hip vs. knee to receive A: variable dose warfarin (first dose on the night preceding surgery with subsequent target INR 2.0–2.5), B: 2.5 mg fondaparinux daily starting 6–18 h postoperatively, or C: fixed 1.0 mg dose warfarin daily starting 7 days preoperatively. All treatments continued until bilateral leg venous ultrasound day 28 ± 2 or earlier upon a VTE event. The study examined primary endpoints including leg DVT, PE or death due to VTE and secondary endpoints including effects on D-dimer, estimated blood loss (EBL) at surgery and hemorrhagic complications. Results Three hundred fifty-five patients were randomized. None was lost to follow-up. Taking 1.0 mg warfarin for seven days preoperatively did not prolong the prothrombin time (PT). Two patients in Arm C had asymptomatic distal DVT. One major bleed occurred in Arm B and one in Arm C (ischemic colitis). Elevated d-dimer did not predict delayed VTE for one year. Conclusions Fixed low dose warfarin started preoperatively is equivalent to two other standards of care under study (95 % CI: -0.0428, 0.0067 for both) as VTE prophylaxis for the patients having elective major joint replacement surgery. Trial registration ClinicalTrials.gov identifier # NCT00767559 FDA IND: 103,716
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Affiliation(s)
- Murray M Bern
- Departments of Medicine, New England Baptist Hospital, Boston, MA USA ; Research, New England Baptist Hospital, Boston, MA USA ; Harvard Medical School, Boston, MA USA ; University of New Mexico Cancer Center, 1201 Camino de Salud, Albuquerque, NM 87131 USA
| | - Diane Hazel
- Research, New England Baptist Hospital, Boston, MA USA
| | | | - John R Richmond
- Orthopedic Surgery, New England Baptist Hospital, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA
| | - Daniel M Ward
- Orthopedic Surgery, New England Baptist Hospital, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA
| | - Damon J Spitz
- Diagnostic Radiology, New England Baptist Hospital, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA
| | - David A Mattingly
- Orthopedic Surgery, New England Baptist Hospital, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA
| | - James V Bono
- Orthopedic Surgery, New England Baptist Hospital, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA
| | | | - Laura Hou
- Research, New England Baptist Hospital, Boston, MA USA
| | - Gerald B Miley
- Departments of Medicine, New England Baptist Hospital, Boston, MA USA ; Harvard Medical School, Boston, MA USA
| | - Benjamin E Bierbaum
- Orthopedic Surgery, New England Baptist Hospital, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA
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Gu YJ, Boonstra PW. Selection of priming solutions for cardiopulmonary bypass in adults. Multimed Man Cardiothorac Surg 2014; 2006:mmcts.2005.001198. [PMID: 24415398 DOI: 10.1510/mmcts.2005.001198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The issue of choosing the right priming solution for adult cardiopulmonary bypass patients has been studied and argued for at least three decades. However, there is still no general consensus with regard to making the right choice. Basically, priming solutions can be classified into two categories, i.e. crystalloids and colloids. The former consists of dextrose, balanced crystalloid fluids, and mannitol, and the latter consists of albumin, dextrans, gelatins, and hydroxyethyl starch. In general, crystalloids are simple volume expanding solutions that mimic the normal plasma electrolyte concentrations. They can be used as clear priming solutions resulting in effective hemodilution but they lack oncotic activity. On the contrary, colloids have the advantage in maintaining the colloid oncotic pressure and reducing tissue oedema. However, colloids have been associated with increased incidence of anaphylactoid reactions and clinical coagulopathy. In this paper, we will describe the basic characteristics, the clinical efficiency and the safety of different types of priming fluids and make an overview on how to select the ideal priming solution for cardiopulmonary bypass in adults.
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Affiliation(s)
- Y John Gu
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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Hamaji A, Hajjar L, Caiero M, Almeida J, Nakamura RE, Osawa EA, Fukushima J, Galas FR, Auler JOC. Volume replacement therapy during hip arthroplasty using hydroxyethyl starch (130/0.4) compared to lactated Ringer decreases allogeneic blood transfusion and postoperative infection. Braz J Anesthesiol 2013; 63:27-35. [PMID: 24565088 DOI: 10.1016/j.bjane.2012.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 03/15/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes. METHODS In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15 mL.kg(-1) of HES 130/0.4 and 24 patients received a preload of 30 mL.kg(-1) lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications. RESULTS Red blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p = .029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p = .037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection. CONCLUSIONS During hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.
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Affiliation(s)
- Adilson Hamaji
- Anesthesia Division, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil
| | - Ludhmila Hajjar
- PhD; Anesthesia Division, Heart Institute, HC-FM-USP, Brazil.
| | - Marcelo Caiero
- Department of Orthopedic, FMUSP; Instituto de Ortopedia e Traumatologia, HC-FMUSP, Brazil
| | - Juliano Almeida
- MD, Anesthesia Division, Cancer Institute, HC-FM-USP, Brazil
| | | | - Eduardo A Osawa
- MD, Anesthesia Division, Cancer Institute, HC-FM-USP, Brazil
| | - Julia Fukushima
- MSc; MD, Anesthesia Division, Heart Institute, HC-FM-USP, Brazil
| | | | - Jose Otavio Costa Auler
- PhD; Full Professor, Anesthesiology, HC-FM-USP, Brazil; Laboratory of Medical Investigation (LIM/08), FMUSP, Brazil
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Lee JJ, Kim JH. Plasma volume expanders: classification and characteristics of colloids. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.10.924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jae-Jin Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4) Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection. Braz J Anesthesiol 2013; 63:27-35. [DOI: 10.1016/s0034-7094(13)70196-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 03/15/2012] [Indexed: 11/22/2022] Open
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Gattas DJ, Dan A, Myburgh J, Billot L, Lo S, Finfer S. Fluid resuscitation with 6% hydroxyethyl starch (130/0.4) in acutely ill patients: an updated systematic review and meta-analysis. Anesth Analg 2012; 114:159-69. [PMID: 22184610 DOI: 10.1213/ane.0b013e318236b4d6] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recent research suggests that 6% hydroxyethyl starch (HES) 130/0.4 is one of the most frequently used resuscitation fluids worldwide. The retraction of studies evaluating its use necessitates a reevaluation of available evidence regarding its safety and efficacy. METHODS We performed a systematic review and meta-analysis of unretracted randomized controlled trials comparing the effects of 6% HES 130/0.4 with other colloid or crystalloid solutions on mortality, acute kidney injury/failure, and bleeding in acutely ill or perioperative patients. A sensitivity analysis including the data from retracted studies was also conducted. RESULTS Overall, 36 studies reporting 2149 participants met the inclusion criteria, of which 11 (n = 541) have been retracted. Of the remaining 25 studies, there was a high risk of bias in 17 studies; 19 studies (n = 1246) were conducted in perioperative patients and 6 (n = 362) in critically ill patients. Sixteen studies reported mortality: 104 deaths in 1184 participants. The relative risk of death was 0.95 (95% confidence interval 0.64-1.42, I(2) = 0%, P = 0.73); including the retracted studies added a further 14 deaths and the relative risk was 0.92 (95% confidence interval 0.63-1.34, I(2) = 0%, P = 0.95). The data reporting acute kidney injury, red blood cell transfusion, and bleeding were of insufficient quantity and quality and not amenable to meta-analysis. CONCLUSIONS Published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. This same conclusion is reached with or without the retracted studies. Given the widespread use of 6% HES 130/0.4, high-quality trials reporting a large number of events are urgently required.
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Affiliation(s)
- David J Gattas
- Critical Care & Trauma Division, The George Institute for Global Health, University of Sydney, Australia.
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Abstract
BACKGROUND Colloids are widely used in the replacement of fluid volume. However, doubts remain as to which colloid is best. Different colloids vary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this, and their other characteristics, they may differ in their safety and efficacy. OBJECTIVES To compare the effects of different colloid solutions in patients thought to need volume replacement. SEARCH METHODS We searched the Cochrane Injuries Specialised Register (searched 1 December 2011), the Cochrane Central Register of Controlled Trials 2011, issue 4 (The Cochrane Library); MEDLINE (Ovid) (1948 to November Week 3 2011); EMBASE (Ovid) (1974 to 2011 Week 47); ISI Web of Science: Science Citation Index Expanded (1970 to 1 December 2011); ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to 1 December 2011); CINAHL (EBSCO) (1982 to 1 December 2011); National Research Register (2007, Issue 1) and PubMed (searched 1 December 2011). Bibliographies of trials retrieved were searched, and for the initial version of the review drug companies manufacturing colloids were contacted for information (1999). SELECTION CRITERIA Randomised controlled trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and assessed the quality of the trials. The outcomes sought were death, amount of whole blood transfused, and incidence of adverse reactions. MAIN RESULTS Eighty-six trials, with a total of 5,484 participants, met the inclusion criteria. Quality of allocation concealment was judged to be adequate in 33 trials and poor or uncertain in the rest.Deaths were reported in 57 trials. For albumin or plasma protein fraction (PPF) versus hydroxyethyl starch (HES) 31 trials (n = 1719) reported mortality. The pooled relative risk (RR) was 1.06 (95% confidence interval (CI) 0.86 to 1.31). When the trials by Boldt were removed from the analysis the pooled RR was 0.90 (95% CI 0.68 to 1.20). For albumin or PPF versus gelatin, nine trials (n = 824) reported mortality. The RR was 0.89 (95% CI 0.65 to 1.21). Removing the study by Boldt from the analysis did not change the RR or CIs. For albumin or PPF versus dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). For gelatin versus HES 22 trials (n = 1612) reported mortality and the RR was 1.02 (95% CI 0.84 to 1.26). When the trials by Boldt were removed from the analysis the pooled RR was 1.03 (95% CI 0.84 to 1.27). RR was not estimable in the gelatin versus dextran and HES versus dextran groups.Forty-one trials recorded the amount of blood transfused; however, quantitative analysis was not possible due to skewness and variable reporting. Twenty-four trials recorded adverse reactions, with two studies reporting possible adverse reactions to gel and one to HES. AUTHORS' CONCLUSIONS From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the CIs were wide and do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significant differences in mortality are to be detected or excluded.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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Navickis RJ, Haynes GR, Wilkes MM. Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass: A meta-analysis of randomized trials. J Thorac Cardiovasc Surg 2012; 144:223-30. [DOI: 10.1016/j.jtcvs.2012.04.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/19/2012] [Accepted: 04/04/2012] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Colloids are widely used in the replacement of fluid volume. However doubts remain as to which colloid is best. Different colloids vary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this and their other characteristics, they may differ in their safety and efficacy. OBJECTIVES To compare the effects of different colloid solutions in patients thought to need volume replacement. SEARCH METHODS We searched the Cochrane Injuries Specialised Register (searched 1 Dec 2011), Cochrane Central Register of Controlled Trials 2011, issue 4 (The Cochrane Library); MEDLINE (Ovid) (1948 to November Week 3 2011); EMBASE (Ovid) (1974 to 2011 Week 47); ISI Web of Science: Science Citation Index Expanded (1970 to 1 Dec 2011); ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to 1 Dec 2011); CINAHL (EBSCO) (1982 to 1 Dec 2011); National Research Register (2007, Issue 1) and PubMed (searched 1 Dec 2011). Bibliographies of trials retrieved were searched, and for the initial version of the review drug companies manufacturing colloids were contacted for information (1999). SELECTION CRITERIA Randomised controlled trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the quality of the trials. The outcomes sought were death, amount of whole blood transfused, and incidence of adverse reactions. MAIN RESULTS Ninety trials, with a total of 5678 participants, met the inclusion criteria. Quality of allocation concealment was judged to be adequate in 35 trials and poor or uncertain in the rest.Deaths were obtained in 61 trials. For albumin or PPF versus hydroxyethyl starch (HES) 32 trials (n = 1769) reported mortality. The pooled relative risk (RR) was 1.07 (95% CI 0.87 to 1.32). When the trials by Boldt were removed from the analysis the pooled RR was 0.90 (95% CI 0.68 to 1.20). For albumin or PPF versus gelatin, nine trials (n = 824) reported mortality. The RR was 0.89 (95% CI 0.65 to 1.21). Removing the study by Boldt from the analysis did not change the RR or confidence intervals. For albumin or PPF versus Dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). For gelatin versus HES 25 trials (n = 1756) reported mortality and the RR was 1.03 (95% CI 0.84 to 1.26). When the trials by Boldt were removed from the analysis the pooled RR was 1.04 (95% CI 0.85 to 1.27). RR was not estimable in the gelatin versus dextran and HES versus dextran groups.Forty five trials recorded the amount of blood transfused, however quantitative analysis was not possible due to skewness and variable reporting. Twenty-four trials recorded adverse reactions, with two studies reporting possible adverse reactions to Gel and one to HES. AUTHORS' CONCLUSIONS From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the confidence intervals are wide and do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significant differences in mortality are to be detected or excluded.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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Oh CS, Sung TY, Kim SH, Kim DK, Lim JA, Woo NS. Assessment of coagulation with 6% hydroxyethyl starch 130/0.4 in cesarean section. Korean J Anesthesiol 2012; 62:337-42. [PMID: 22558500 PMCID: PMC3337380 DOI: 10.4097/kjae.2012.62.4.337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/28/2011] [Accepted: 09/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Third-generation hydroxyethyl starch (HES) solutions have been developed to minimize negative effects on hemostasis. In normal pregnancy, the coagulation activity increases, reaching a maximum around term. This study examined the effects of hemodilution with HES 130/0.4 (6%) on blood coagulation in parturients in vivo and in vitro. METHODS Forty parturients scheduled for cesarean sections were assigned randomly to receive either 500 or 1,000 ml of HES 130/0.4 (6%). Rotation thromboelastometry (ROTEM®) measurements were performed before and after administering HES 130/0.4 (6%). In addition, blood samples obtained from 20 randomly selected parturients were diluted 10% to 40% using HES 130/0.4 (6%), and ROTEM® measurements were performed before and after dilution. The changes from baseline and the effects of dilution were analyzed by ROTEM® parameters. RESULTS Infusions of 500 or 1,000 ml of HES 130/0.4 (6%) in the parturients altered the clot formation time, α angle, and maximal clot firmness, although all remained within normal ranges. HES 130/0.4 (6%) affected in vitro blood coagulation in parturients' blood containing 10, 20, 30, and 40% HES. The clotting time was prolonged at each dilution percentage, but remained within the normal range. Other parameters showed an impairment of the coagulation system. CONCLUSIONS Blood coagulation in parturients may be compromised at high dilution ratios of HES 130/0.4 (6%) to blood. Nevertheless, the infusion of 1,000 ml of HES 130/0.4 (6%) in normal parturients did not significantly affect blood coagulation.
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Affiliation(s)
- Chung-Sik Oh
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Muralidhar K, Garg R, Mohanty S, Banakal S. Influence of colloid infusion on coagulation during off-pump coronary artery bypass grafting. Indian J Anaesth 2011; 54:147-53. [PMID: 20661354 PMCID: PMC2900740 DOI: 10.4103/0019-5049.63653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study was conducted to determine the influence of colloid infusion on coagulation in patients undergoing off-pump coronary artery bypass grafting (OP-CABG). Thirty patients undergoing elective OP-CABG received medium molecular weight hydroxyethyl starch group I (MMW-HES 200/0.5), low molecular weight hydroxyethyl starch group II (LMW-HES 130/0.4) or gelatin group III (GEL) in a prospective randomized trial. Blood samples were assessed for hemoglobin (Hb), activated coagulation time (ACT), prothrombin time (PT), activated partial thromboplastin time (aPPT), platelet count, fibrinogen and von Willebrand factor (vWF) at specified intervals. Total volume of the colloid infused and postoperative chest-time drainage was also measured. There was a significant decrease in Hb, platelet count, fibrinogen levels in all these groups, which did not warrant blood transfusion. After the colloid infusion, vWF decreased significantly to 67% from baseline in group I as compared to 85 and 79% in group II and group III, respectively. vWF levels remained lower than the baseline value in the first 24 hours in group I, whereas this factor level increased above the baseline values in groups II and III, 6 hours postoperatively. Postoperative chest tube drainage in 24 hours was significantly higher in group I (856 ± 131 ml) as compared to group II (550 ± 124 ml) and group III (582 ± 159 ml). LMW-HES 130/0.4 was superior to MMW-HES 200/0.5 and gelatin in patients undergoing OP-CABG, in terms of better preservation of coagulation associated with enhanced volume effect.
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Affiliation(s)
- K Muralidhar
- Senior Consultant and Professor Anaesthesiology and Director (Academic), Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
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Raja SG, Akhtar S, Shahbaz Y, Masood A. In cardiac surgery patients does Voluven(R) impair coagulation less than other colloids? Interact Cardiovasc Thorac Surg 2011; 12:1022-1027. [DOI: 10.1510/icvts.2010.263939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
BACKGROUND Colloids are widely used in the replacement of fluid volume. However doubts remain as to which colloid is best. Different colloids vary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this and their other characteristics, they may differ in their safety and efficacy. OBJECTIVES To compare the effects of different colloid solutions in patients thought to need volume replacement. SEARCH STRATEGY We searched the Cochrane Injuries Group's specialised register, CENTRAL (2007, Issue 1), MEDLINE (1994 to March 2007), EMBASE (1974 to March 2007), and the National Research Register (2007, Issue 1). Bibliographies of trials retrieved were searched, and drug companies manufacturing colloids were contacted for information. The search was last updated in March 2007. SELECTION CRITERIA Randomised and quasi-randomised trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement. The outcomes measured were death, amount of whole blood transfused, and incidence of adverse reactions. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the quality of the trials. MAIN RESULTS Seventy trials, with a total of 4375 participants, met the inclusion criteria. Quality of allocation concealment was judged to be adequate in 24 trials and poor or uncertain in the rest.Deaths were obtained in 46 trials. For albumin or PPF versus hydroxyethyl starch (HES) 25 trials (n = 1234) reported mortality. The pooled relative risk (RR) was 1.14 (95% CI 0.91 to 1.43). When the trials by Boldt are removed from the analysis the pooled RR was 0.97 (95% CI 0.70 to 1.35). For albumin or PPF versus gelatin, seven trials (n = 636) reported mortality. The RR was 0.97 (95% CI 0.68 to 1.39). For albumin or PPF versus Dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). For gelatin versus HES 18 trials (n = 1337) reported mortality and RR was 1.00 (95% CI 0.80 to 1.25). RR was not estimable in the gelatin versus dextran and HES versus dextran groups.Thirty-seven trials recorded the amount of blood transfused, however quantitative analysis was not possible due to skewness and variable reporting. Nineteen trials recorded adverse reactions, but none occurred. AUTHORS' CONCLUSIONS From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the confidence intervals are wide and do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significant differences in mortality are to be detected or excluded.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, UK, AL10 9AB
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Hydroxyethyl starch for cardiovascular surgery: a systematic review of randomized controlled trials. Eur J Clin Pharmacol 2011; 67:767-82. [DOI: 10.1007/s00228-011-1008-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 01/27/2011] [Indexed: 11/26/2022]
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Hartog CS, Kohl M, Reinhart K. A systematic review of third-generation hydroxyethyl starch (HES 130/0.4) in resuscitation: safety not adequately addressed. Anesth Analg 2011; 112:635-45. [PMID: 21304149 DOI: 10.1213/ane.0b013e31820ad607] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hydroxyethyl starches (HES) are widely used for intravascular volume therapy in surgical, emergency, and intensive care patients. There are safety concerns with regard to coagulopathy, renal failure, pruritus, tissue storage, and mortality. Third-generation HES 130/0.4 is considered to have an improved risk profile. A common rationale for the use of HES is the belief that 3 to 4 times more crystalloid than colloid volume is needed to achieve similar hemodynamic end points. Our goal was to assess whether published studies on HES 130/0.4 resuscitation are sufficiently well designed to draw conclusions about the safety of this compound. In addition, we wanted to assess crystalloid-to-colloid fluid ratios in studies with goal-directed fluid regimen. METHODS Systematic review of randomized controlled trials in which HES 130/0.4 is used for resuscitation. RESULTS We identified 56 randomized controlled trials (RCTs) with HES 130/0.4 in. acute hypovolemia, mainly from the elective surgical setting (n = 45). Surgical studies were small-sized (median 25 patients in the HES groups, range 10 to 90) and of short duration (median 12 hours, range 0.5 to 144 hours). The median cumulative HES dose was 2465 mL (range 328 to 6229 mL), corresponding to 35 mL/kg in a 70-kg patient, the daily dose limit being 50 mL/kg. End points mostly addressed variable surrogate outcomes. Sixty percent of control fluids were other HES solutions, gelatins, or dextran, which have a similar risk profile. Without exception, these studies were not designed for clinically important safety outcomes, primarily because they were too small, used mostly inadequate control fluids, and had inappropriately short observation periods. Therefore, and also because of heterogeneity of patient groups and outcome definitions, results from these studies cannot be pooled. These studies do not allow any conclusion about the safety of HES 130/0.4. There is a common belief that 3 to 4 times more crystalloid than colloid volume is necessary to achieve similar hemodynamic effects. We found a considerably lower ratio in surgical studies (mean 1.8, SD 0.1). CONCLUSIONS In summary, the extent of fluid load reduction that can be achieved by HES 130/0.4 is overestimated. Use of older HES solutions may be associated with serious side effects, and clinicians should be aware that there is no convincing evidence that third-generation HES 130/0.4 is safe in surgical, emergency, or intensive care patients despite publication of numerous clinical studies.
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Affiliation(s)
- Christiane S Hartog
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, Erlanger Allee 101, D-07747 Jena, Germany
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Turker G, Yilmazlar T, Mogol EB, Gurbet A, Dizman S, Gunay H. The Effects of Colloid Pre-Loading on Thromboelastography Prior to Caesarean Delivery: Hydroxyethyl Starch 130/0.4 versus Succinylated Gelatine. J Int Med Res 2011; 39:143-9. [DOI: 10.1177/147323001103900115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This prospective, randomized, double-blind study compared the effects on thromboelastography (TEG) of preloading with two different colloid fluids prior to spinal anaesthesia for caesarean section. Healthy full-term parturients received either 500 ml 6% hydroxyethyl starch 130/0.4 (HES, n = 25) or 500 ml 4% succinylated gelatine (GEL, n = 25) prior to spinal anaesthesia. TEG parameters including reaction time (r-time), clot formation time (k-time), clot formation rate (α-angle) and maximum amplitude (MA) were measured immediately before and after pre-loading. Both groups had significantly shorter r-time and lower MA after pre-loading. The α-angle was significantly decreased after pre-loading with HES but not with GEL. No significant differences in k-time were induced pre-loading. In conclusion, preloading with HES or GEL was associated with a mild hypocoagulable effect in healthy parturients presenting for elective caesarean section; however, all TEG parameters in both groups remained within or very close to the normal range after pre-loading.
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Affiliation(s)
- G Turker
- Department of Anaesthesiology, Uludag University Medical Faculty, Bursa, Turkey
| | - T Yilmazlar
- Department of Anaesthesiology, Uludag University Medical Faculty, Bursa, Turkey
| | - E Basagan Mogol
- Department of Anaesthesiology, Uludag University Medical Faculty, Bursa, Turkey
| | - A Gurbet
- Department of Anaesthesiology, Uludag University Medical Faculty, Bursa, Turkey
| | - S Dizman
- Department of Anaesthesiology, Uludag University Medical Faculty, Bursa, Turkey
| | - H Gunay
- Department of Anaesthesiology, Uludag University Medical Faculty, Bursa, Turkey
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Appelman MH, van Barneveld LJM, Romijn JWA, Vonk ABA, Boer C. The impact of balanced hydroxylethyl starch cardiopulmonary bypass priming solution on the fibrin part of clot formation: ex vivo rotation thromboelastometry. Perfusion 2010; 26:175-80. [DOI: 10.1177/0267659110394711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Balanced colloidal priming solutions are supposed to further minimize the effects of cardiopulmonary bypass (CPB) on haemostasis as compared to gelatin-based preparations. This exploratory study investigated whether clot formation, in particular the fibrin part of the clot, is less altered by a modern balanced HES solution as compared to a gelatin-based priming solution. Methods: CPB priming solutions containing 60% gelatin (Gelofusin®) or balanced HES starch (100% or 60% Tetraspan®) were mixed with blood samples from healthy volunteers and compared with respect to their impact on clotting time (CT), alpha angle, maximum clot firmness (MCF), and fibrinogen, using thromboelastometry. Results: The 100% and 60% HES priming solutions significantly increased the EXTEM CT from 66 ± 9 s to 82 ± 19 and 83 ± 13, respectively (both P<0.05 vs. baseline). The speed of solid clot formation decreased significantly for all priming solutions compared with baseline values. The INTEM MCF decreased from 59 ± 4 mm to 47 ± 4, 44 ± 4 and 43 ± 3 mm, whereas the EXTEM MCF decreased from 57 ± 4 mm to 51 ± 4, 51 ± 4 and 50 ± 4 mm after dilution with 60% gelatin, 100% HES or 60% HES priming solution, respectively (all P<0.01 vs. baseline). The priming solutions containing HES induced the largest decrease in MCF attributed to fibrinogen from 12 ± 3 mm to 4 ± 4 mm and 3 ± 2 mm (both P<0.05) for the 100% and mixed priming solution, respectively. Conclusions: Ex vivo rotation thromboelastometry did not reveal the expected preservation of coagulation parameters, in particular the fibrin part of clot formation, by a balanced HES priming solution.
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Affiliation(s)
- Marly H Appelman
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Lerau J M van Barneveld
- Department of Cardio-thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes W A Romijn
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Alexander B A Vonk
- Department of Cardio-thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Christa Boer
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands,
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Winterhalter M, Malinski P, Danzeisen O, Sixt S, Monaca E, Jüttner T, Peiper M, Kienbaum P, Koester A, Rahe-Meyer N. Prospective observational study for perioperative volume replacement with 6% HES 130/0,42, 4% gelatin and 6% HES 200/0,5 in cardiac surgery. Eur J Med Res 2010; 15:383-9. [PMID: 20952347 PMCID: PMC3351905 DOI: 10.1186/2047-783x-15-9-383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The constantly growing amount of different kinds of colloid fluids necessitates comparative investigations with regards to the safety and effectivity in clinical use of these preparations. Hence we compared three colloid fluids in an observational study. The objective was the exploration of the influence of these three colloids on blood coagulation, hemodynamics and renal function of the cardiac surgical patient. Methods We included 90 patients undergoing an elective open-heart surgery with the use of the heart-lung machine and observed them consecutively. Group 1 [gelatin 4% (n = 30)], Group 2 [HES 200/0,5 (n = 30)] and Group 3 [HES 130/0,42 (n = 30)]. We measured the perioperative volume replacement, the administration of blood- and coagulation-products, the application of catecholamines, the renal function, blood gas and the platelet aggregation using multiplate electrode analyzer (Multiplate®, Dynabyte medical, Munich, Germany). Results The gelatin-group needed significantly more norepinephrine than the HES 130/0.42 group. The responsible surgeon considered the blood coagulation in the HES 200/0.5 group most frequently as impaired. Furthermore we saw a significant decrease in platelet function in the HES 200/0.5 group when performing the multiplate®-analysis (ADP-and COL-test). HES 130/0.4 as well as gelatin 4% showed no significant change in platelet function. The gelatin-group and the HES 200/0.5 needed significantly more aprotinine than the HES 130/0.4 group. We saw no significant difference with regards to administration of blood and coagulation products between the three groups. The urinary excretion during the intervention was significantly higher in the HES 200/0.5 group and in the gelatin group than in the HES 130/0.4 group. Conclusions Our results confirm the lower stabilizing effect of gelatin on circulation during fluid resuscitation. The blood coagulation was mostly impaired due to HES 200/0.5 confirmed by the multiplate®-analysis as well as by different clinical findings.
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Affiliation(s)
- Michael Winterhalter
- University of Düsseldorf, Department of Anaesthesiology, Moorenstr.5, 40225 Düsseldorf, Germany.
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Niemi TT, Miyashita R, Yamakage M. Colloid solutions: a clinical update. J Anesth 2010; 24:913-25. [DOI: 10.1007/s00540-010-1034-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 09/23/2010] [Indexed: 01/17/2023]
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Rozec B, Blanloeil Y, Fernandez M, Cinotti R, Videcoq M, Lejus C. Nature du priming de la circulation extracorporelle en chirurgie cardiaque adulte et pédiatrique. Ing Rech Biomed 2010. [DOI: 10.1016/s1959-0318(10)70004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schramko AA, Suojaranta-Ylinen RT, Kuitunen AH, Raivio PM, Kukkonen SI, Niemi TT. Comparison of the effect of 6% hydroxyethyl starch and gelatine on cardiac and stroke volume index: a randomized, controlled trial after cardiac surgery. Perfusion 2010; 25:283-91. [PMID: 20630920 DOI: 10.1177/0267659110377819] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The objective of this study was to find out the effect of various doses of hydroxyethyl starch (HES), gelatine or Ringer's acetate on cardiac and stroke volume index after cardiac surgery. MATERIAL AND METHODS Three consecutive boluses (each 7 mL·kg(-1)) of either 6% HES 130/0.4, 4% gelatine, or Ringer's acetate solutions were administered to 45 patients postoperatively. The rate of infusions was adjusted according to haemodynamic measurements. Thereafter, infusion of the study solution (7 mL·kg(-1)) was continued for the following 12 hours. The total dose of study solution was 28 mL·kg(-1). RESULTS AND CONCLUSION Mean (SD) cardiac and stroke volume indices were greater in the HES group [2.8 L·min(-1)·m(-2) (0.7), 34.1 (6.7) ml·m( -2)] than in the gelatine group [2.2 L·min(-1)·m( -2) (0.6), 25.8 (7.2) ml·m(-2)] after completion of 7 mL·kg(-1) of study solution. At this stage, the effect of gelatine did not differ from Ringer's acetate. After completion of 14 mL·kg(-1) and 21 mL·kg(-1) of colloids, similar cardiac and stroke volume indices were observed and the haemodynamic response was better in both colloid groups than in the Ringer's acetate group. No differences between groups were detected on the first postoperative morning. In the early postoperative phase after cardiac surgery, the effect of a single dose of HES solution on the haemodynamics was superior to the effect of gelatine or Ringer's acetate. However, after repeated administration of the study solutions, the haemodynamics in the two colloid groups appeared to be similar, but superior to the Ringer's acetate group.
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Affiliation(s)
- Alexey A Schramko
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Meilahti Hospital, Helsinki, Finland.
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Murphy GS, Greenberg SB. The new-generation hydroxyethyl starch solutions: the Holy Grail of fluid therapy or just another starch? J Cardiothorac Vasc Anesth 2010; 24:389-93. [PMID: 20399119 DOI: 10.1053/j.jvca.2010.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Indexed: 11/11/2022]
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Balanced hydroxyethylstarch preparations: are they all the same? In-vitro thrombelastometry and whole blood aggregometry. Eur J Anaesthesiol 2010; 26:1020-5. [PMID: 19606044 DOI: 10.1097/eja.0b013e32832f5a90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Haemostasis appears to be less altered with balanced than with unbalanced hydroxyethylstarch (HES) preparations. In a blinded in-vitro coagulation study, the effects of two HESs dissolved in different balanced solutions were measured. METHODS Blood from 12 healthy young male volunteers was diluted by 10, 30 and 50% by using either a balanced 6% HES 130/0.42 or a balanced 6% HES 130/0.4. Composition of the solvent of the two HES preparations differed. An unbalanced gelatin solution was used as a control. Rotation thrombelastometry was used to assess changes in coagulation, and whole blood aggregometry using three different inductors was used to assess the effects of dilution on platelet function. RESULTS Dilutions of 10 and 30% showed no significant changes in thrombelastometry data and platelet aggregation in all three groups. Fifty per cent haemodilution was associated with significantly more pronounced deterioration in clotting time, clot formation time and clot firmness, with the balanced HES 130/0.42 containing calcium than with the balanced HES without calcium. Platelet function was also more impaired by HES not containing calcium than by HES containing calcium. Extreme dilution with gelatin showed similar results to those of balanced HES 130/0.4. CONCLUSION Our in-vitro studies showed that extreme haemodilution with HES 130/0.42 dissolved in a balanced solution containing calcium was associated with less negative effects on thrombelastometry and platelet aggregation than HES 130/0.4 prepared in a balanced solution without calcium. Gelatin prepared in a nonbalanced solution showed similar effects on coagulation to balanced HES without calcium.
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Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg 2009; 110:375-90. [PMID: 19955503 DOI: 10.1213/ane.0b013e3181b6b3b5] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been more than 50 yr since the landmark article in which Holliday and Segar (Pediatrics 1957;19:823-32) proposed the rate and composition of parenteral maintenance fluids for hospitalized children. Much of our practice of fluid administration in the perioperative period is based on this article. The glucose, electrolyte, and intravascular volume requirements of the pediatric surgical patient may be quite different than the original population described, and consequently, use of traditional hypotonic fluids proposed by Holliday and Segar may cause complications, such as hyperglycemia and hyponatremia, in the postoperative surgical patient. There is significant controversy regarding the choice of isotonic versus hypotonic fluids in the postoperative period. We discuss the origins of perioperative fluid management in children, review the current options for crystalloid fluid management, and present information on colloid use in pediatric patients.
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Affiliation(s)
- Ann G Bailey
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA.
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Adam S, Karger R, Kretschmer V. Photo-Optical Methods Can Lead to Clinically Relevant Overestimation of Fibrinogen Concentration in Plasma Diluted With Hydroxyethyl Starch. Clin Appl Thromb Hemost 2009; 16:461-71. [DOI: 10.1177/1076029609342090] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Adequate fibrinogen concentration is a crucial component of sufficient perioperative/posttraumatic hemostasis. In major blood loss, large volumes of fluids are being administered, which have been shown to interfere with valid determination of fibrinogen concentration. This may lead to wrong treatment decisions. We studied the variables that cause the discrepancies between measured and true fibrinogen concentrations in samples diluted with volume replacement fluids. Methods: Citrated plasma samples of healthy volunteers were diluted by 30% and 50% with phosphate buffered saline (PBS), hydroxyethyl starch (HES) 10% (200/0.5), or gelatine (GEL). Fibrinogen concentrations of diluted samples were derived from the prothrombin time (PT) and the Clauss method (CLS) was applied. With the latter, several modifications and combinations of detection principles and thrombin reagents were investigated. Values were compared with ‘‘true,’’ that is, calculated values based on the results of undiluted samples for each method. Results: Photo-optical methods resulted in significant overestimation of the fibrinogen concentration in blood diluted with HES, depending on the thrombin reagent used. This was particularly true for modifications of the CLS aimed at measuring low fibrinogen concentrations. Use of another thrombin reagent gave satisfactory results for this modification. The validity of mechanical end point determination methods was considered sufficient and was not influenced by the use of different thrombin reagents. Conclusions: Fibrinogen determination methods used in situations of major blood loss need to be validated with samples containing significant amounts of volume replacement fluids, particularly colloids. Only some combinations of test principle, detection method, and reagents will give valid results.
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Affiliation(s)
- Susanne Adam
- Institute of Transfusion Medicine and Hemostaseology, University Hospital Marburg, Marburg, Germany,
| | - Ralf Karger
- Institute of Transfusion Medicine and Hemostaseology, University Hospital Marburg, Marburg, Germany
| | - Volker Kretschmer
- Institute of Transfusion Medicine and Hemostaseology, University Hospital Marburg, Marburg, Germany
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Min JOS, Ramzisham ARM, Zamrin MD. Is 6% Hydroxyethyl Starch 130/0.4 Safe in Coronary Artery Bypass Graft Surgery? Asian Cardiovasc Thorac Ann 2009; 17:368-72. [DOI: 10.1177/0218492309338101] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to compare 6% hydroxyethyl starch 130/0.4 with 4% succinylated gelatin for priming the cardiopulmonary bypass circuit and as volume replacement in patients undergoing coronary artery bypass, in terms of postoperative bleeding, blood transfusion requirements, renal function, and outcome after surgery. Forty-five patients received 6% hydroxyethyl starch 130/0.4 (Voluven) and another 45 were given 4% succinylated gelatin (Gelofusine) as the priming solution for the cardiopulmonary bypass circuit as well as for volume replacement. Postoperative bleeding was quantified from the hourly chest drainage in the first 4 h and at 24 h postoperatively. The baseline characteristics of both groups were similar. In the hydroxyethyl starch group, the total amount of colloid used was 1.9 ± 1.0 L, while the gelatin group had 2.0 ± 0.7 L. There was no significant difference in hourly chest drainage between groups. Blood transfusion requirements, estimated glomerular filtration rate, extubation time, intensive care unit and hospital stay were similar in both groups. It was concluded that 6% hydroxyethyl starch 130/0.4 is a safe alternative colloid for priming the cardiopulmonary bypass circuit and volume replacement in patients undergoing coronary artery bypass surgery.
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Affiliation(s)
| | - Abdul Rahman Mohd Ramzisham
- Division of Cardiothoracic Surgery Heart and Lung Centre, Hospital Universiti Kebangsaan Malaysia Kuala Lumpur, Malaysia
| | - Mohd Dimon Zamrin
- Division of Cardiothoracic Surgery Heart and Lung Centre, Hospital Universiti Kebangsaan Malaysia Kuala Lumpur, Malaysia
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Adam S, Karger R, Kretschmer V. Influence of different hydroxyethyl starch (HES) formulations on fibrinogen measurement in HES-diluted plasma. Clin Appl Thromb Hemost 2009; 16:454-60. [PMID: 19617247 DOI: 10.1177/1076029609336855] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fibrinogen is the first coagulation factor becoming critical in dilution coagulopathy. Volume replacement in major blood loss is performed with large volumes of crystalloid and colloid solutions. The latter has been shown to compromise accurate photo-optical measurement of fibrinogen. This study determined the influence of different hydroxyethyl starch (HES) formulations. METHODS Citrated plasma samples of 8 healthy volunteers were diluted by 30% or 50% with either HES 10% (200/0.5; HES-200), HES 6% (70/0.5; HES-70), or HES 6% (450/0.7; HES-450). Fibrinogen concentrations were determined by photo-optical measurement (Behring coagulation system [BCS]: derived fibrinogen, or Clauss fibrinogen, calibrated for high [CLS] or low fibrinogen concentrations [CLS-low]) as well as mechanical end point determinations (KC4: CLS-KC4). Measured values were compared with calculated values. RESULTS On average and across all photo-optical methods, fibrinogen concentrations were overestimated, particularly with HES-200. Hydroxyethyl starch-70 and HES-450 did not differ much from each other. Overestimation was relatively greater for 50% dilutions with all HES formulations. Surprisingly, overestimation was most prominent with CLS-low, the method supposed to most reliably measure low fibrinogen concentrations; overestimation amounted to 92% and 120% with HES-200, 54% and 73% with HES-70, and 51% and 79% with HES-450, for 30% and 50% dilutions, respectively. In contrast, CLS-KC4 always yielded sufficiently accurate results. CONCLUSIONS The study showed that all HES solutions more or less impaired the fibrinogen measurement with the photo-optical method. In particular, overestimation with CLS-low may prevent timely fibrinogen replacement in major blood loss. Hydroxyethyl starch concentration appears to be more relevant for this effect than its molecular size.
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Affiliation(s)
- Susanne Adam
- Institute of Transfusion Medicine and Hemostaseology, University Hospital Marburg, Marburg, Germany.
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Schäfer ST, Neumann A, Lindemann J, Görlinger K, Peters J. Venous air embolism induces both platelet dysfunction and thrombocytopenia. Acta Anaesthesiol Scand 2009; 53:736-41. [PMID: 19426241 DOI: 10.1111/j.1399-6576.2009.01947.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In vitro, air bubbles can induce platelet activation and platelet to air bubble binding. We therefore tested in vivo the hypothesis that venous air embolism (VAE) induces (1) platelet dysfunction and (2) thrombocytopenia. METHODS Adult swine (60.8+/-3.9 kg; n=8) were anaesthetized, mechanically ventilated, and placed in a semi-upright position. Air boli (0.5-80 ml) were injected randomly via an ear vein, and arterial blood was sampled after cumulative air dosages of 0, 80, 160, and 240 ml. Coagulation was assessed by impedance aggregometry, rotational thrombelastometry, whole blood count, plasmatic coagulation variables, and fibrinogen, d-dimer, protein C, and antithrombin plasma concentrations, respectively. RESULTS VAE induced a 47% decrease in platelet count (303 vs. 160 nl(-1); P<0.001) over the dose range assessed, with haematocrit being unaltered. Furthermore, VAE-impaired platelet aggregation induced by adenosine diphosphate, arachidonic acid, collagen, and the thromboxan analogue U46619 over the dose range assessed independent of thrombocytopenia. (P<0.05 vs. baseline). In contrast, rotational thrombelastometry alone was quite insensitive in detecting VAE-induced coagulation changes, showing only at near lethal air dosages a prolonged clot formation time following activation with tissue factor, contact activator, and during spontaneous coagulation (P<0.05 vs. baseline). CONCLUSIONS VAE induces both a dose-dependent decrease in platelet count and a marked decrease in platelet aggregation, independent of thrombocytopenia (P<0.05 vs. baseline).
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Affiliation(s)
- S T Schäfer
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum Essen, Essen, Germany.
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Ertmer C, Rehberg S, Van Aken H, Westphal M. Relevance of non-albumin colloids in intensive care medicine. Best Pract Res Clin Anaesthesiol 2009; 23:193-212. [PMID: 19653439 DOI: 10.1016/j.bpa.2008.11.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Boldt J, Suttner S, Brosch C, Lehmann A, Mengistu A. RETRACTED: Influence on coagulation of a potato-derived hydroxethylstarch (HES 130/0.42) and a maize-derived hydroxethylstarch (HES 130/0.4) in patients undergoing cardiac surgery. Br J Anaesth 2009; 102:191-7. [DOI: 10.1093/bja/aen353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Adequate restoration of intravascular volume remains an important therapeutic maneuver in managing the surgical patient. Definition of the ideal volume replacement strategy still remains one of the burning problems. Firstly, the choice between colloid and crystalloid solutions continues to generate controversy. Secondly, the highly controversial crystalloid/colloid dispute has been enlarged to a colloid/colloid debate because of the increasing number of colloids that are available. And lastly, whether high or low volume replacement strategies are favorable for the surgical patient is an another issue for the anesthesiologists. Volume replacement has been hitherto often based on art, dogma and personal beliefs. It was the aim of this overview to present the different solutions and to facilitate the strategies for above three main issues in the field of intraoperative fluid therapy.
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Affiliation(s)
- Jaemin Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Hartog C, Brunkhorst FM, Reinhart K. Old versus New Starches: What do We Know about their Differences? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wenzel V, Raab H, Dünser MW. Arginine vasopressin: a promising rescue drug in the treatment of uncontrolled haemorrhagic shock. Best Pract Res Clin Anaesthesiol 2008; 22:299-316. [PMID: 18683476 DOI: 10.1016/j.bpa.2008.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Haemorrhagic shock is one of the most frequent types of shock. If haemorrhage cannot be controlled and fluid resuscitation as well as catecholamines are insufficient to stabilize cardiovascular function, uncontrolled haemorrhagic shock occurs. Several approaches have been suggested as promising alternatives to volume resuscitation. The rationale for the use of arginine vasopressin (AVP) is the pharmacologic amplification of the neuroendocrine stress response. AVP-mediated vasoconstriction is the first physiologic step to haemostasis and shifts blood away from the bleeding site towards the heart, lungs and brain. Particularly, when uncontrolled haemorrhage is accompanied by traumatic brain injury this may help to reduce secondary neurological damage. Since AVP can prevent acute death only transiently, it must comprehensively be combined with rapid hospital admission, immediate control of haemorrhage followed by aggressive fluid resuscitation and blood transfusion. This review article summarizes current experimental and clinical evidence on the use of AVP in uncontrolled haemorrhagic shock.
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Affiliation(s)
- Volker Wenzel
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, 6020 Innsbruck, Austria
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Kozek-Langenecker SA, Jungheinrich C, Sauermann W, Van der Linden P. The Effects of Hydroxyethyl Starch 130/0.4 (6%) on Blood Loss and Use of Blood Products in Major Surgery: A Pooled Analysis of Randomized Clinical Trials. Anesth Analg 2008; 107:382-90. [DOI: 10.1213/ane.0b013e31817e6eac] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tiryakioğlu O, Yildiz G, Vural H, Goncu T, Ozyazicioglu A, Yavuz S. Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial). J Cardiothorac Surg 2008; 3:45. [PMID: 18620591 PMCID: PMC2483980 DOI: 10.1186/1749-8090-3-45] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 07/12/2008] [Indexed: 11/26/2022] Open
Abstract
Background In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch) 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications. Methods 140 patients undergoing to CABG (Coronary Artery Bypass Graft surgery) were electively enrolled to the study. 1500 ml Ringer solution + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution to start cardiopulmonary by-pass in 70 patients which was defined as group 1. On the other hand, 1500 ml HES 130 - 0.4 + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution in 70 patients in group 2. Results INR (International Normalized Ratio), urea levels and blood platelet counts were significantly different between the groups. INR level was higher in group 1, while blood urea and creatinine levels and platelet count were higher in group 2 at the end of the 12th and 24nd hours postoperatively (p = 0.001). In this study, it was shown that the usage of HES 130-0.4 as a prime solution did not have negative effect on postoperative INR level, platelet count, the need for transfusion and the amount of drainage, despite the negative opinions that similar solutions caused coagulation disorders. Another interesting result of the study was that blood platelet count at 24th hour was statistically significantly higher in group 2 (p = 0.001). Conclusion HES 130-0.4 solution is an alternative colloidal solution which can be used as the prime solution or as a mixture with the crystalloids in cardio-pulmonary bypass applications.
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Affiliation(s)
- Osman Tiryakioğlu
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
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Green RS, Hall RI. Con: Starches Are Not Preferable to Albumin During Cardiac Surgery: A Contrary Opinion. J Cardiothorac Vasc Anesth 2008; 22:485-91. [DOI: 10.1053/j.jvca.2008.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Indexed: 11/11/2022]
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Affiliation(s)
- Dennis J. Cada
- Drug Information Center, Washington State University Spokane, WA
| | - Terri Levien
- Drug Information Center, Washington State University Spokane, WA
| | - Danial E. Baker
- Drug Information Center and College of Pharmacy, Washington State University Spokane, PO Box 1495, Spokane, WA 99210-1495
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Abstract
BACKGROUND Colloids are widely used in the replacement of fluid volume. However doubts remain as to which colloid is best. Different colloids vary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this and their other characteristics, they may differ in their safety and efficacy. OBJECTIVES To compare the effects of different colloid solutions in patients thought to need volume replacement. SEARCH STRATEGY We searched the Cochrane Injuries Group specialised register, CENTRAL (2007, Issue 1), MEDLINE (1994 to March 2007), EMBASE (1974 to March 2007), and the National Research Register (2007, issue 1). Bibliographies of trials retrieved were searched, and drug companies manufacturing colloids were contacted for information. The search was last updated in March 2007. SELECTION CRITERIA Randomised and quasi-randomised trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement. The outcomes measured were death, amount of whole blood transfused, and incidence of adverse reactions. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the quality of the trials. MAIN RESULTS Seventy trials, with a total of 4375 participants, met the inclusion criteria. Quality of allocation concealment was judged to be adequate in 24 trials and poor or uncertain in the rest. Deaths were obtained in 46 trials. For albumin or PPF versus hydroxyethyl starch (HES) 25 trials (n = 1234) reported mortality. The pooled relative risk (RR) was 1.14 (95% CI 0.91 to 1.43). For albumin or PPF versus gelatin, seven trials (n = 636) reported mortality. The RR was 0.97 (95% CI 0.68 to 1.39). For albumin or PPF versus Dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). For gelatin versus HES 18 trials (n = 1337) reported mortality and RR was 1.00 (95% CI 0.80 to 1.25). RR was not estimable in the gelatin versus dextran and HES versus dextran groups.Thirty-seven trials recorded the amount of blood transfused, however quantitative analysis was not possible due to skewness and variable reporting. Nineteen trials recorded adverse reactions, but none occurred. AUTHORS' CONCLUSIONS From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the confidence intervals are wide and do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significant differences in mortality are to be detected or excluded.
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Affiliation(s)
- F Bunn
- University of Hertfordshire, Centre for Research in Primary and Community Care (CRIPACC), College Lane, Hatfield, Hertfordshire, UK AL10 9PN.
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Ahn SW, Bang SO, Chun DH, Lee JH, Park KB, Kwak YL. The Effect of Hydroxyethyl Starch and Crystalloid Solutions on Blood Loss and Transfusion Requirement in Patients with Recent Antiplatelet Therapy Undergoing Off-pump Coronary Bypass Surgery. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.2.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- So Woon Ahn
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sou Ouk Bang
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Reserch Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Hee Chun
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Reserch Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bae Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Reserch Institute, Yonsei University College of Medicine, Seoul, Korea
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Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, Oswald E, Bach C, Schnapka-Koepf M, Innerhofer P. Hemostatic Changes After Crystalloid or Colloid Fluid Administration During Major Orthopedic Surgery: The Role of Fibrinogen Administration. Anesth Analg 2007; 105:905-17, table of contents. [PMID: 17898365 DOI: 10.1213/01.ane.0000280481.18570.27] [Citation(s) in RCA: 230] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND To explore whether disturbed fibrin polymerization is the main problem underlying dilutional coagulopathy and can be reversed by fibrinogen administration, we conducted a prospective study using modified thrombelastography (ROTEM). METHODS Sixty-six orthopedic patients randomly received modified gelatin solution, hydroxyethyl starch 130/0.4, or exclusively Ringer lactate solution. ROTEM analysis was performed, concentrations of coagulation factors and markers of thrombin generation were measured. Fibrinogen concentrate (Hemocomplettan) was administered (30 mg/kg) when thrombelastographically measured fibrinogen polymerization was critically decreased. RESULTS The alpha angle, clot firmness, and fibrinogen polymerization (median [min to max]) significantly decreased in the patients receiving hydroxyethyl starch (area under the curve minus baseline (-5 [-9 to -2]), followed by gelatin solution (-3 [-8 to 0]), with the least reductions seen for Ringer lactate solution (-2 [- 4 to 1]) (colloids versus Ringer lactate P < 0.0001). Thirteen patients in the colloid groups but none in the Ringer lactate group needed fibrinogen concentrate to maintain borderline clot firmness. Activity of FVII, FVIII, FIX, and von Willebrand ristocetin activity decreased significantly with colloids. Thrombelastographically measured coagulation time, molecular markers of thrombin generation, and activity of all other coagulation factors were comparable in all groups. CONCLUSION Disturbance of fibrinogen/fibrin polymerization is the primary problem triggering dilutional coagulopathy during major orthopedic surgery. The magnitude of clot firmness reduction is determined by the type of fluid used, with hydroxyethyl starch showing the most pronounced effects. These undesirable effects of intravascular volume therapy can be reversed by increasing fibrinogen concentration by administering fibrinogen concentrate, even during continuing blood loss and intravascular volume replacement.
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Affiliation(s)
- Markus Mittermayr
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
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JUNGHEINRICH CORNELIUS. The starch family: are they all equal? Pharmacokinetics and pharmacodynamics of hydroxyethyl starches. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1778-428x.2007.00070.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Joachim Boldt
- Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
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The effect of a novel hydroxyethyl starch solution (130/0.4) 6% on haemostasis in patients undergoing coronary artery bypass surgery - a comparative study with gelatin 3%. Eur J Anaesthesiol 2007. [DOI: 10.1097/00003643-200706003-00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boldt J, Schöllhorn T, Münchbach J, Pabsdorf M. A total balanced volume replacement strategy using a new balanced hydoxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery. Eur J Anaesthesiol 2007; 24:267-75. [PMID: 17054812 DOI: 10.1017/s0265021506001682] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The kind of fluid for correcting hypovolaemia is still a focus of debate. In a prospective, randomized, controlled and double-blind study in patients undergoing major abdominal surgery, a total balanced volume replacement strategy including a new balanced hydroxyethyl starch (HES) solution was compared with a conventional, non-balanced fluid regimen. METHODS In Group A (n = 15), a new balanced 6% HES 130/0.42 was given along with a balanced crystalloid solution; in Group B (n = 15), an unbalanced conventional HES 130/0.42 plus an unbalanced crystalloid (saline solution) were administered. Volume was given when mean arterial pressure (MAP) was <65 mmHg and central venous pressure (CVP) minus positive end-expiratoric pressure (PEEP) level was <10 mmHg. Haemodynamics, acid-base status, coagulation (thrombelastography (TEG)) and kidney function (including kidney-specific proteins, N-acetyl-beta-d-glucosaminidase (beta-NAG) and alpha-1-microglobulin) were measured after induction of anaesthesia, at the end of surgery, 5 and 24 h after surgery. RESULTS Group A received 3533 +/- 1302 mL of HES and 5333 +/- 1063 mL of crystalloids, in Group B, 3866 +/- 1674 mL of HES and 5966 +/- 1202 mL of crystalloids were given. Haemodynamics, laboratory data, TEG data and kidney function were without significant differences between the groups. Cl- concentration and base excess (-5 +/- 2.4 mmol L-1 vs. 0.4 +/- 2.4 mmol L-1) were significantly higher in patients of Group B than of Group A. CONCLUSIONS A complete balanced volume replacement strategy including a new balanced HES preparation resulted in significantly less derangement in acid-base status compared with a non-balanced volume replacement regimen. The new HES preparation showed no negative effects on coagulation and kidney function.
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Affiliation(s)
- J Boldt
- Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany.
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Kim JY, Lee JW, Kweon TD, Kwak YL, Kim JH, Bang SO. The Effect of 6% Hydroxyethyl Starch 130/0.4 on Hemostasis and Hemodynamic Efficacy in Off-pump Coronary Artery Bypass Surgery: a Comparison with 6% Hydroxyethyl Starch 200/0.5. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.3.s14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Jong Wha Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Dong Kweon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ho Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sou Ouk Bang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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