Intensive Care Medicine

, Volume 21, Issue 7, pp 577–583

Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxethy starch (HES 200/0.62, 6%)

Authors

  • A. C. Degrémont
    • Départment d'Anesthésie-RéanimationHôpial Tenon
  • M. Ismaïl
    • Départment d'Anesthésie-RéanimationHôpial Pitié-Salpétrière
  • M. Arthaud
    • Laboratoire des UrgencesHôpital Pitié-Salpétrière
  • B. Oulare
    • Laboratoire Central de BiochimieHôpital Broussais
  • O. Mundler
    • Laboratoire de Médecine NucléaireHôpital Lariboisière
  • M. Paris
    • Laboratoire Central de BiochimieHôpital Broussais
  • J. F. Baron
    • Départment d'Anesthésie-RéanimationHôpital Broussais
Original

DOI: 10.1007/BF01700163

Cite this article as:
Degrémont, A.C., Ismaïl, M., Arthaud, M. et al. Intensive Care Med (1995) 21: 577. doi:10.1007/BF01700163

Abstract

Objective

To define the mechanisms of the stable and prolonged post-operative plasma volume expansion observed with Hydroxyethyl Starches (HES) and to determine whether a partial intravascular hydrolysis of large molecules contribute to reinforce the colloid-osmotic effect.

Design

Prospective, pharmacologic study using single dose of drug.

Setting

University-based, post-anesthesia care unit.

Patients

The protocol was performed during the post-operative period, in 10 patients after stable recovery from general anesthesia for carotid endarterectomy.

Interventions

HES 200/0.62 (500 ml) was infused over 30 min. Standard hemodynamic and biological variables, HES concentration and colloid osmotic pressure were obtained at each measurement. Plasma volume was calculated using51Cr-labelled RBCs. Patterns of changes in number average molecular weight (MWn) and weight average MW (MWw) were measured using gel permeation chromatography. Measurements were obtained at control, end of infusion, 1 h, 3 h, 6 h and 24 h after infusion.

Measurements and main results

Plasma volume increased by 693 ml (+21%) after the infusion of HES and remained constant over 24 h. HES concentration progressively decreased to reach a value of 35% of the peak at 24 h. MWn and MWw, initially decreased when compared with the dose solution and changed little in the 24 h study period. Diuresis significantly decreased at 3 h up to 24 h. Plasma albumin decreased after infusion and then progressively increased to reach a significantly higher value at 24 h than after infusion.

Conclusion

Initial plasma volume expansion and decrease in HES concentration agree with previously-published data. Maintenance of plasma volume expansion over 24 h was not related to a partial intravascular hydrolysis. Low elimination rate of HES, extravascular mobilization of albumin and post-operative renal adaptations were possibly the 3 main mechanisms to explain a prolonged plasma volume expansion with HES 200/0.62, 6%.

Key words

Plasma volume Hydroxyethyl-starch Pharmacokinetics

Copyright information

© Springer-Verlag 1995