Which Hydroxyethyl Starch for Which Indication?

  • G. Audibert
  • M. C. Laxenaire
Conference paper

Abstract

Plasma substitutes are widely used to maintain circulatory dynamics during various types of shock. Plasma volume can be expanded with several types of colloids, belonging to four pharmacological families: gelatins, dextrans, starches, and albumin. Rather than attempting to determine which type of solution is superior to others, we consider it appropriate to outline the proper role of each in the context of its specific indications and characteristics. This chapter defines advantages and side effects of the use of starches in treating hypovolemia. Factors that are discussed include blood volume expanding efficiency, hemostasis impairment, allergic reactions, and the effect on microcirculation. Finally, indications are suggested for various clinical situations.

Keywords

Permeability Starch Dioxide Albumin Urea 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Arfors KE, Buckley PB (1997) Pharmacological characteristics of artificial colloids. Clin Anaesthesiol 11 (1):15–47Google Scholar
  2. 2.
    Haljamae H, Dahlquist M, Walentin F (1997) Artificial colloids in clinical practice: pros and cons. Clin Anaesthesiol 11 (1):49–79Google Scholar
  3. 3.
    Treib J, Haass A, Pindur G, Seyfert UT, Treib W, Grauer MT, Jung F, Wenzel E, Schimrigk K (1995) HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethylstarch (HES) on hemorheology coagulation and elimination kinetics. Thromb Haemost 74:1452–1456PubMedGoogle Scholar
  4. 4.
    Kohler H, Zschiedrich H, Linfante A (1982) The elimination of HES 200/ 0.5, dextran 40 and oxypolygelatine. Klin Wochenschr 60:293–301PubMedCrossRefGoogle Scholar
  5. 5.
    Sirtl C, Hubner G, Jesch F (1988) Zur Speicherung von hoch und mittelmolekularer Hydroxyäthylstärke (HÄS) in meuschlichen Gewebe. Beitr Anaesthesiol Intens Med 26:74–97Google Scholar
  6. 6.
    Spittal MJ, Findlay GP (1995) The seven year itch. Anaesthesia 50:913–914PubMedCrossRefGoogle Scholar
  7. 7.
    Boldt J, Knothe C, Zickmann B, Andres P, Dopper F, Hempelmann G (1993) Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg 76:1185–1190PubMedGoogle Scholar
  8. 8.
    Treib J, Haass A, Pindur G, Grauer MT, Wenzel E, Schimrigk K (1996) All medium starches are not the same: influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions and coagulation. Transfusion 36:450–455PubMedCrossRefGoogle Scholar
  9. 9.
    Mortelmans YJ, Kermant G, Verbruggen AM, Arnout JM, Vermylen J, van Aken H, Mortelmans LA (1995) Effects of 6% hydroxyethylstarch and 3% modified fluid gelatin on intravascular volume and coagulation during intraoperative hemodilution. Anesth Analg 81:1235–1242PubMedGoogle Scholar
  10. 10.
    Laxenaire MC, Charpentier C, Feldman L (1994) Anaphylactoid reactions to colloid plasma substitutes: frequency, risk factors, mechanisms. A French prospective multicentre inquiry. Ann Fr Anesth Reanim 13:301–310PubMedGoogle Scholar
  11. 11.
    Ring J, Messmer K (1977) Incidence and severity of anaphylactoid reactions to colloid volume substituts. Lancet 1:466–469PubMedCrossRefGoogle Scholar
  12. 12.
    Goto Y, Sakakura S, Hatta M (1985) Hemorheological effects of colloid plasma substitutes infusion. A comparative study. Acta Anaesthesiol Scand 29:217–223PubMedCrossRefGoogle Scholar
  13. 13.
    Audibert G, Donner M, Lefevre JC, Stoltz JF, Laxenaire MC (1994) Rheologic effects of plasma substitutes used for preoperative hemodilution. Anesth Analg 78:740–745PubMedCrossRefGoogle Scholar
  14. 14.
    Baron JF, de Kegel D, Prost AC, Mundler PO, Arthaud M, Basset G (1991) Low molecular weight hydroethylstarch 6% compared to albumin 4% during intentional hemodilution. Intensive Care Med 17:141–148PubMedCrossRefGoogle Scholar
  15. 15.
    Gold MS, Russo J, Tissot M, Weinhouse G, Riles T (1990) Comparison of hetastarch to albumin for perioperative bleeding in patients undergoing abdominal aortic aneurysm surgery. A prospective, randomized study. Ann Surg 211:482–485PubMedCrossRefGoogle Scholar
  16. 16.
    Knippel RA, Hatangadi SB (1995) Acute hypotension related to hemorrhage in the obstetric patient. Obstet Gynecol Clin North Am 22:111–129Google Scholar
  17. 17.
    Zikria BA, Subbarto C, Oz MC, Shih ST, MacLeod PF, Sachdev R, Freeman HP, Hardy MA (1989) Macromolecules reduce abnormal microvascular permeability in rat limb ischemia-reperfusion injury. Crit Care Med 17:1306–1309PubMedGoogle Scholar
  18. 18.
    Collis RE, Collins PW, Gutteridge CN, Kaul A, Newland AC, Williams DM, Webb AR (1994) The effect of hydroxyethylstarch and other plasma substitutes on endothelial cell activation; an in vitro study. Intensive Care Med 20:37–41PubMedCrossRefGoogle Scholar
  19. 19.
    Schmand JF, Ayala A, Morrison MH, Chaudry IH (1995) Effects of hydroxyethylstarch after trauma-hemorrhagic shock: restoration of macrophage integrity and prevention of increased circulating interleukin 6 levels. Crit Care Med 23:806–814PubMedCrossRefGoogle Scholar
  20. 20.
    Beards SC, Watt T, Edwards JD, Nightingale P, Farragher EB (1994) Comparison of the hemodynamic and oxygen transport responses to modified fluid gelatin and hetastarch in critically ill patients: a prospective, randomized trial. Crit Care Med 22:600–605PubMedCrossRefGoogle Scholar
  21. 21.
    Boldt J, Heesen M, Müller M, Pabsdorf M, Hempelmann G (1996) The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory variables in critically ill patients. Anesth Analg 83:254–261PubMedGoogle Scholar
  22. 22.
    Boldt J, Müller M, Heesen M, Neumann K, Hempelmann G (1996) Influence of different volume therapies and pentoxifylline infusion on circulating soluble adhesion molecules variables in critically ill patients. Crit Care Med 24:385–391PubMedCrossRefGoogle Scholar
  23. 23.
    Ducey JP, Mozingo DW, Lamiell JM, Okerburg C, Gueller GE (1989) A comparison of the cerebral and cardiovascular resuscitation with isotonic and hypertonic saline, hetastarch and whole blood following hemorrhage. J Trauma 29:1510–1518PubMedCrossRefGoogle Scholar
  24. 24.
    Cittanova ML, Leblanc I, Legendre CH, Mouquet C, Riou B, Coriat P (1996) Effect of hydroxyethylstarch in brain dead kidney donors on renal function in kidney transplant recipients. Lancet 348:1620–162PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • G. Audibert
  • M. C. Laxenaire

There are no affiliations available

Personalised recommendations