Hydroxyethyl Starch In Patients Research Articles

Comparison of bromocriptine and hydroxyethyl starch in the prevention of ovarian hyperstimulation syndrome.

To evaluate the effectiveness of bromocriptine for prevention of ovarian hyperstimulation syndrome (OHSS). The retrospective study included women at risk of OHSS who were receiving gonadotropin-releasing hormone antagonist protocols, including 52 women given 2.5mg bromocriptine by rectal insertion, 52 women given 500 ml intravenous hydroxyethyl starch (HES), and 40 women who received no intervention. Treatments were administered daily for 5 days beginning on the day of oocyte retrieval. Baseline information and data related to OHSS were compared. No significant differences were found among groups in estradiol concentration on the day of trigger or in number of retrieved oocytes. Incidence of mild OHSS was not significantly different among groups, respectively 13.5%, 15.4%, and 17.5% (P> 0.05). The incidence of moderate to severe OHSS was significantly lower in the bromocriptine and HES groups compared with the control group, respectively 7.7%, 5.8%, and 22.5% (P< 0.05). D-dimer levels were significantly lower in the bromocriptine and HES groups compared with the control group on Day 5 after oocyte retrieval (P< 0.05). No differences in liver or renal function were found in the three groups. Bromocriptine was apparently as effective as intravenous HES in patients with high risk of OHSS.

Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial.

Background:The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate.Objectives:In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients.Patients and Methods:Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU.Results:GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group.Conclusions:Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

Balanced Hydroxyethylstarch (HES 130/0.4) Impairs Kidney Function In-Vivo without Inflammation.

Volume therapy is a standard procedure in daily perioperative care, and there is an ongoing discussion about the benefits of colloid resuscitation with hydroxyethylstarch (HES). In sepsis HES should be avoided due to a higher risk for acute kidney injury (AKI). Results of the usage of HES in patients without sepsis are controversial. Therefore we conducted an animal study to evaluate the impact of 6% HES 130/0.4 on kidney integrity with sepsis or under healthy conditions Sepsis was induced by standardized Colon Ascendens Stent Peritonitis (sCASP). sCASP-group as well as control group (C) remained untreated for 24 h. After 18 h sCASP+HES group (sCASP+VOL) and control+HES (C+VOL) received 50 ml/KG balanced 6% HES (VOL) 130/0.4 over 6h. After 24h kidney function was measured via Inulin- and PAH-Clearance in re-anesthetized rats, and serum urea, creatinine (crea), cystatin C and Neutrophil gelatinase-associated lipocalin (NGAL) as well as histopathology were analysed. In vitro human proximal tubule cells (PTC) were cultured +/- lipopolysaccharid (LPS) and with 0.1–4.0% VOL. Cell viability was measured with XTT-, cell toxicity with LDH-test. sCASP induced severe septic AKI demonstrated divergent results regarding renal function by clearance or creatinine measure focusing on VOL. Soleley HES (C+VOL) deteriorated renal function without sCASP. Histopathology revealed significantly derangements in all HES groups compared to control. In vitro LPS did not worsen the HES induced reduction of cell viability in PTC cells. For the first time, we demonstrated, that application of 50 ml/KG 6% HES 130/0.4 over 6 hours induced AKI without inflammation in vivo. Severity of sCASP induced septic AKI might be no longer susceptible to the way of volume expansion.

Coagulation effects of mannitol in combination with 0.9% normal saline or hydroxyethyl starch in patients undergoing supratentorial craniotomy: A preliminary report

Abstract Background: Neurosurgical patients often require administration of both, mannitol and hydroxyethyl starch (HES). A recent in vitro study demonstrated that HES in combination with mannitol could disturb coagulation parameters and should be avoided in neurosurgical practice. The aim of our study was to evaluate coagulation abnormalities due to mannitol when administered alone and in combination with HES in patients undergoing craniotomy for various intracranial brain tumours. Materials and Methods: We enrolled 30 adult patients undergoing craniotomy. Patients were randomised into two groups using a computer generated randomisation chart. Interventions: Group A: Patients received 10 ml/kg 0.9% normal saline and 1 g/kg mannitol and Group B: Patients received 10 ml/kg, HES 130/0.4, and 1 gm/kg mannitol; immediately after induction of general anaesthesia. Rotational thromboelastography was done immediately after induction of general anaesthesia and 5 min after administration of mannitol. Measured parameters of blood coagulation were clotting time (CT) and clot formation time (CFT) with EXTEM and maximum clot firmness (MCF) with EXTEM and (FIBTEM). Results: Fourteen patients in each group completed the study. Insignificant change was noted in CT; CFT altered significantly from the baseline in both the groups (P &lt; 0.05). MCF with FIBTEM did not change significantly from baseline (P &gt; 0.05), but significantly differed between groups (P = 0.001). However, all values were in normal range. Conclusion: Mannitol 1 g/kg and HES 10 ml/kg can be safely administered in patients undergoing craniotomy for supratentorial tumours, without clinically significant changes in coagulation parameters.

Hydroxyethyl starch in patients undergoing craniotomy in sitting position

Hydroxyethyl starch in patients undergoing craniotomy in sitting position

The Effects of Hydroxyethyl Starch on Cultured Renal Epithelial Cells

The use of hydroxyethyl starch (HES) as a plasma expander in the critically ill is highly controversial.1,2 The controversy is also driven by claims that HES has properties beyond plasma expansion that are held to be beneficial in patients with sepsis, in particular, antiinflammatory properties or effects on microcirculation and oxygenation.3 The number of experimental studies supporting these claims and published by proponents of HES is growing rapidly,4–9 despite the fact that we have learned in recent years that these mechanisms are incredibly complex, and the course of sepsis is not reflected, let alone influenced, by the modulation of 1 or 2 single molecules. In addition, evidence from large-scale studies and metaanalyses with data derived from hundreds of patients consistently confirms that such added properties of HES are clinically irrelevant because they do not contribute to improved survival in this patient population. It is becoming increasingly obvious that administration of HES is not only ineffective10–12 compared with crystalloid or other synthetic colloids in these patients, but recent evidence also shows that HES increases the incidence of renal failure in patients with severe sepsis,11,13–15 increases bleeding complications in off-pump cardiac surgery,16 and may increase overall mortality,11,15,17 and that HES-associated toxicity is dose related. Adverse effects of HES are more evident in high-quality and multicenter studies,15 but despite more than 50 years of clinical use, there is still a lack of such studies on the safety of HES in patients at risk with higher cumulative doses and longer observation periods. Moreover, little is known about the cellular mechanism of renal failure. Renal dysfunction may result from uptake of HES into proximal renal epithelial cells, resulting in so-called “osmotic nephrosis-like lesions”18 or from tubular obstruction caused by the production of hyperviscous urine. Recently, it was also observed that interstitial inflammation resulted from administration of HES in a model of isolated perfused porcine kidneys19 and that HES 200/0.5 and 130/0.4 have proinflammatory effects on platelets.20 Therefore, well-designed in vitro studies investigating the possible pathophysiologic mechanisms of HES-related toxicity are of growing interest to clinicians. This issue of Anesthesia & Analgesia includes the report of an in vitro study by Wittlinger et al.21 who evaluated the direct effects of HES 130/0.42 and HES 200/0.5 on cultured human tubular epithelial cells after pretreatment with tumor necrosis factor (TNF)-α, by measuring secretion of the monocyte chemoattractant protein-1 as a marker for inflammatory response, as well as overall cell viability and TNF-induced cell death. Unfortunately, because coincubation controls with non-HES fluids are lacking, it is impossible to determine whether the observed effects are specific for HES. It is, however, interesting to note the increased intracellular uptake of fluorescein isothiocyanate–HES (both 200/0.5 and 130/0.4) after TNF stimulation, which complies with renal biopsy findings showing colloid-filled foam cells in kidneys of patients with chronic renal failure after liver transplantation,22 and in an acute hemorrhage model in pigs.23 The study by Wittlinger et al.21 highlights the need for well-designed experimental and clinical studies with relevant end points on the subject of colloid resuscitation and especially on the role of so-called third-generation starches. Therefore, it is good news that large-scale, multicenter, randomized, controlled trials about the safety of HES are ongoing in Scandinavia and Australia.

Fibrinogen substitution improves whole blood clot firmness after dilution with hydroxyethyl starch in bleeding patients undergoing radical cystectomy: a randomized, placebo-controlled clinical trial.

Infusion of artificial colloids such as hydroxyethyl starch (HES) induces coagulopathy to a greater extent than simple dilution. Several studies have suggested that the coagulopathy could be corrected by substitution with a fibrinogen concentrate. The aims of the present prospective, randomized, placebo-controlled trial were to investigate the hemostatic effect of a fibrinogen concentrate after coagulopathy induced by hydroxyethyl starch in patients experiencing sudden excessive bleeding during elective cystectomy. Twenty patients were included. Blood loss was substituted 1:1 with HES 130/0.4. At a dilution level of 30%, patients were randomly selected for intra-operative administration of a fibrinogen concentrate or placebo. The primary endpoint was maximum clot firmness (MCF), as assessed by thromboelastometry. Secondary endpoints were blood loss and transfusion requirements, other thromboelastometry parameters, thrombin generation and platelet function. Whole-blood MCF was significantly reduced after 30% dilution in vivo with HES. The placebo resulted in a further decline of the MCF, whereas randomized administration of fibrinogen significantly increased the MCF. Furthermore, only 2 out of 10 patients randomly chosen to receive fibrinogen substitution required postoperative red blood cell transfusions, compared with 8 out of 10 in the placebo group (P = 0.023). Platelet function and thrombin generation were reduced after 30% hemodilution in vivo, and fibrinogen administration caused no significant changes. During cystectomy, fluid resuscitation with HES 130/0.4 during sudden excessive bleeding induces coagulopathy that shows reduced whole-blood maximum clot firmness. Randomized administration of fibrinogen concentrate significantly improved maximum clot firmness and reduced the requirement for postoperative transfusion.

Haemodilution with medium molecular weight hydroxyethyl starch in patients with peripheral arterial occlusive disease stage IIb

The basic therapy of peripheral arterial occlusive disease stage IIb, according to Fontaine, is exercise. It should be determined whether a mild hypervolaemic haemodilution with hydroxyethyl starch or Ringer lactate can produce a further increase in walking distance. For this purpose, three groups of 25 patients each were formed. One group exercised three times weekly and the second group, in addition to exercise, underwent a mild hypervolaemic to isovolaemic dilution therapy with HES for a period of 6 weeks. In the final group the haematocrit was reduced to the same extent by venesections and volume substitution using Ringer lactate. The walking distance in the HES group increased from 216 m to 311 m (44%), in the Ringer lactate group from 214 m to 258 m (20%), and in the exercise group from 213 m to 242 m (14%). On comparison of the groups, the increase in pain-free walking distance in the HES group differs significantly (P less than 0.05) from that achieved in the other groups. It was demonstrated that haemodilution with HES in combination with exercise brings about a clinical effect three times that achieved by exercise alone. Venesection with subsequent administration of Ringer lactate and exercise is superior to exercise alone but markedly inferior to the combination therapy with HES.