Intra-operative hydroxyethyl starch is not associated with post-craniotomy hemorrhage.

James A Feix,David L Mcdonagh,David S Warner,Ali Zomorodi,Michael L James,Tong J Gan,C Andrew Peery

doi:10.1186/s40064-015-1126-0

Abstract

BackgroundIntraoperative intravascular volume expansion with hydroxyethyl starch-based colloids is thought to be associated with an increased risk of post-craniotomy hemorrhage. Evidence for this association is limited. Associations between resuscitation with hydroxyethyl starch and risk of repeat craniotomy for hematoma evacuation were examined.MethodsUsing a retrospective cohort of neurosurgical patients at Duke University Medical Center between March 2005 and March 2012, patient characteristics were compared between those who developed post-craniotomy hemorrhage and those who did not.ResultsA total of 4,109 craniotomy procedures were analyzed with 61 patients having repeat craniotomy for post-operative hemorrhage (1.5%). The rate of reoperation in the group receiving 6% High Molecular Weight Hydroxyethyl Starch (Hextend®) was 2.6 vs. 1.3% for patients that did not receive hetastarch (P = 0.13). The reoperation rate for those receiving 6% hydroxyethyl Starch 130/0.4 (Voluven®) was 1.4 vs. 1.6% in patients not receiving Voluven (P = 0.85).ConclusionsIn this retrospective cohort, intra-operative hydroxyethyl starch was not associated with an increased risk of post-craniotomy hemorrhage.

Highlights

Intraoperative intravascular volume expansion with hydroxyethyl starch-based colloids is thought to be associated with an increased risk of post-craniotomy hemorrhage
Between March 2005 and March 2010, when Hextend® was in use, a total of 2,883 craniotomies were performed
There was no significant difference in the proportion of patients who received Hextend® among those who had a post-operative hemorrhage and those who did not (Table 1)

Summary

Introduction

Intraoperative intravascular volume expansion with hydroxyethyl starch-based colloids is thought to be associated with an increased risk of post-craniotomy hemorrhage. Hydroxyethyl starch (HES) based colloids have gained popularity in clinical anesthesia practice due to their effective intravascular volume expansion (Kozek-Langenecker 2005). We aimed to determine whether intraoperative HES administration, compared with no HES, was associated with post-craniotomy hemorrhage requiring reoperation in a large retrospective cohort

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