Colloids for vegetarians

Abstract

In a secondary level rural mission hospital in Central India a 72-year-old man (55 kg) was scheduled to undergo revision hip surgery. His pre-operative evaluations, including haemoglobin 13.5 g.dl−1, were within acceptable limits. He was a strict vegetarian and requested that no animal products or derivatives be used during his surgery and anaesthesia. He underwent a revision total hip replacement under a general anaesthetic combined with an epidural. The surgery lasted 4 h and was uneventful with an estimated blood loss of 1600 ml. He received 6% Voluven®; (Hydroxyl ethyl starch 130/0.4, Frasenius Kabi, India) 1000 ml, along with crystalloids to maintain a normal CVP, and a unit of whole blood. He remained stable throughout the procedure. In the first 24 h postoperatively he required in addition to maintenance crystalloids, 6% Haes Steril®; (Hydroxyl ethyl starch 200/0.5 Frasenius Kabi, India) 500 ml and another unit of whole blood to replace the loss through the surgical drains. He made a satisfactory recovery and was discharged on the fifth day postoperatively. This case highlights important religious considerations when choosing colloids. Gelatin is derived from degradation of bovine or porcine bone [1], whereas hydroxyl ethyl starch is derived from cornstarch [2]. Anaesthetists who choose to administer them in the peri-operative period often overlook these differences in origin, and may violate patients' religious beliefs. Hindus do not allow bovine products and Muslims avoid porcine products.