Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxethy starch (HES 200/0.62, 6%)
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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.
Prospective, pharmacologic study using single dose of drug.
University-based, post-anesthesia care unit.
The protocol was performed during the post-operative period, in 10 patients after stable recovery from general anesthesia for carotid endarterectomy.
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.
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 wordsPlasma volume Hydroxyethyl-starch Pharmacokinetics
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- 1.Thompson WL (1980) Hydroxyethyl starch. Dev Biol Stand 44:259–266Google Scholar
- 2.Thompson WL, Britton JJ, Watton RP (1962) Persistence for starch derivative and dextran when infused after hermorrhage. J Pharmacol Exp 136:125–132Google Scholar
- 3.Lederer K, Huber C, Dunky M, Fink J, Ferber H, Nitsch E (1985) Studies on hydroxyethyl starch. Part I: Molecular characterization by size exclusion chromatography coupled with low angle laser light sattering. Arzneimittelforsch Drug Res 35:610–614Google Scholar
- 4.Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putman D (1983) Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch and saline solutions in patients with hypovolemic and septic shock. Crit Care Med 11:839–851PubMedGoogle Scholar
- 5.Damon L, Adams M, Stricker RB, Ries C (1987) Intracranial bleeding during treatment with hydroxyethyl starch. N Engl J Med 317:964–965Google Scholar
- 7.Iguchi K, Ikeda K (1971) Clinical investigations of a new plasma expander partially substituted HES. Med Consul N Rem 8:139–150Google Scholar
- 10.London MJ, Ho JS, Triedman JK, Verrier ED, Levin J, Merrick SH, Hanley FL, Browner WS, Mangano DT (1989) A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg 97:785–797PubMedGoogle Scholar
- 11.Rosencher N, Vassilieff N, Guigonis V, Toulon P, Conseiller C (1992) Effects of Elohes and albumin on haemostasis in orthopaedic surgery. Ann Fr Anesth Réanim 11:526–530Google Scholar
- 12.Mishler J, Ricketts C, Parkhouse E (1979) Changes in the molecular compostion of circulating hydroxyethyl starch following consecutive daily infusions in man. Br J Clin Pharm 7: 505–509Google Scholar
- 13.Ferber HP, Nitsch E, Förster H (1985) Studies on hydroxyethyl starch. Part II: changes of the molecular weight distribution of hydroxyethyl starch types 450/0.7, 450/0.5, 450/0.3, 300/0.4, 200/0.7, 200/0.5, 200/0.3, 200/0.1 after infusion in urine and serum of volonteers. Arzneimittelforschung 35: 615–622PubMedGoogle Scholar
- 14.Quon CY (1988) Clinical pharmacokinetics and pharmacodynamics of colloidal plasma volume expanders. J Cardiothorac Anesth 2:13–23Google Scholar
- 15.Kalhorn F, Yacob A, Sum C (1984) Billilary excretion of hydroxyethyl starch in man. Biomedic Mass Spectrometry 11:164–166Google Scholar
- 17.International Committee for standardization in Haermatology (ICSH) (1973) Standard techniques for the measurement of red cell and plasma volume. Br J Haematol 25:795–814Google Scholar
- 18.Najean Y, Deschryuer F (1984) The body venous haematocrit ratio and its use for calculating total blood volume from fractional volumes. Em J Nucl Med 9:558–560Google Scholar
- 22.Mizuta S, Keiichi I, Kiyoshi I (1971) Clinical investigation of HES in respect of circulatory movement, metabolism and excretion. Med Consul N Remed 8:2493–2497Google Scholar
- 23.Wiedler B, Von Bormann B, Sommermeyr K, Lohmann E, Peil J, Hempelmann G (1991) Pharmakokinetische Merkmale als Kriterien für den klinischen Einsatz von Hydroxyethylstärke. Arzneimittelforsch Drug Res 41:494–498Google Scholar
- 24.Hulse JD, Yacobi A (1983) Hetastarch: an over view of the colloid and its metabolism. Drug Intell Clin Pharmacol 17:334–341Google Scholar
- 27.Lundsgaard-Hansen P (1986) Physiology and pathophysiology of colloid osmotic pressure and albumin metabolism. Curr Stud Hematol Blood Transf 53:1–17Google Scholar
- 28.Wood GA, Lewitt SH (1965) Simultaneous red cell mass and plasma volume determination using 51 Cr tagged red cells and 125-l labelled albumin. J Nucl Med 6:433–440Google Scholar
- 29.Ferrant A, Lewis SA, Szur L (1982) The elution of 99 m Tc from red cells and its effect on red cells volume measurement. J Clin Pathol 27:373–380Google Scholar
- 30.Baron JF, De Kegel D, Prost AC, Mundler O, Maistre G, Carayon A, Landault C, Barré E, Viars P (1991) Hemodynamic and hormonal effects of normovolemic hemodilution using hydroxyethyl starch. Clin Intensive Care 2:22–26Google Scholar
- 31.Baron JF, De Kegel D, Prost AC, Mundler O, Arthaud M, Basset G, Maistre G, Masson F, Carrayon A, Landault C, Barre E, Viars P (1991) Low molecular weight hydroxyethyl starch 6% compared to albumin 4% during intentional hemodilution. Intensive Carc Med 17:141–148Google Scholar
- 33.Rackow EC, Mecher C, Astiz ME, Griffel M, Falk JL, Weil H (1989) Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med 17:396–398Google Scholar
- 34.Lijedahl SO, Rieger S (1967) Importance of thoracic duct lymph in restitution of plasma volume and plasma proteins after bleeding and immediate substitution in the splenectomized dog. Acta Chir Scand [Suppl] 379:39–51Google Scholar