Abstract
Aims and Objective: The present study was carried out with an objective to compare 4% succinylated gelatin with 6% hydroxyethyl starch 130/0.4 for preloading prior to cardiopulmonary bypass in coronary artery bypass grafting patients with respect to haemodynamics status, blood loss, transfusion requirement, ICU stay and complication. Methods: The study enrolling 60 patients of either sex, aged between 30-70 years undergoing elective coronary artery bypass grafting. These patients were randomly divided into two groups of 30 each. Group 1 received 500 ml 6% hydroxyethyl starch (HES) and group 2 received 500 ml 4% succinylated gelatins, on pump over a period of 25 minutes. Data were monitored included haemodynamic changes, postoperative blood loss, transfusion of PRBC and blood products, ICU stay and complications related to colloid usage. Results: We found statistically significant difference in pulse rate 5 minutes after starting colloid. Also found statistically significant difference in mean arterial pressure immediately after shifting patient to ICU but no significant difference found subsequently. There was gradual increase in CVP in both the groups but majority of patients in group 2 showed higher CVP values as compared to group 1 patients. Measured chest tube drain and output higher in starch group as compared to gelatin group, there was no need of reexploration or greater need for blood and blood products in starch group. There was no significant difference in postoperative renal parameter between two groups. Conclusions: Results of our study revealed that both the colloids i.e. 4% succinylated gelatin and 6% hydroxyethyl starch were comparable with respect to haemodynamics parameters, blood loss, transfusion requirement and complication.
Highlights
Controversy regarding the most suitable colloid for use as a plasma volume expander in cardiac surgery is unresolved, despite many ongoing studies
Gelatin based colloids have been used as they are free of adverse effects on hemostasis, cross matching and renal function and there is no limit to their use [2]
At 15 minutes after starting colloid mean arterial pressure (MAP) in both the group almost similar after which MAP continue to increase in group 1whereas it falls slightly in group 2
Summary
Controversy regarding the most suitable colloid for use as a plasma volume expander in cardiac surgery is unresolved, despite many ongoing studies. Colloid chosen for preloading and priming the cardiopulmonary bypass circuit and volume replacement must not interfere with the coagulation system or any other body system and incur minimal risk of adverse reaction. Gelatin based colloids have been used as they are free of adverse effects on hemostasis, cross matching and renal function and there is no limit to their use [2]. With large volume of hydroxyethyl starch infused perioperatively, inhibitory effects on hemostasis most notably on Von Willebrand factor have been reported. These effects are most pronounced with large and highly substituted hydroxyethyl starch molecules such as hetastarch which has an average molecular weight of 450,000 daltons and degree of substitution of 0.7 (HES 450/0.7), a new HES specification HES 130/0.4 offers a better pharmacokinetic and pharmacodynamic profile and can be safely used up to 50 ml/kg/day [3,4,5]. It has been suggested that correction of hypovolemia with HES is associated with increased risk of acute renal failure and interest has recently focused on the influence of HES solution on renal function [6]
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