Journal of Anesthesia

, Volume 24, Issue 3, pp 418–425 | Cite as

Fluid therapy with hydroxyethyl starch for massive blood loss during surgery

  • Toshinari Suzuki
  • Hideki Miyao
  • Katsuo Terui
  • Kaoru Koyama
  • Michio Shiibashi
Original Article

Abstract

Purpose

This clinical trial reports the use of hydroxyethyl starch (HES70/0.55/4) at very high dosages during surgery. HES70/0.55/4 has the lowest molecular weight among all HES products, and thus may have the least side effects. This observational retrospective study clarified the effects of high-dose HES70/0.55/4 on coagulation and renal function up to 1 month after massive bleeding during surgery.

Methods

Of 20875 patients on our surgical database, 31 patients were identified who had lost more than 5000 ml of blood during surgery and had survived for more than 1 month. The fluid balance, and pre- and postoperative laboratory data were analyzed. Patients were assessed using acute kidney injury (AKI) criteria. AKI and non-AKI groups were compared regarding volume of HES70/0.55/4 infused and serum creatinine (Cr) levels before surgery and until 1 month after surgery.

Results

The mean volumes of blood loss, total transfusions, HES70/0.55/4, and urine output during surgery were 8051 ml; 5765 ml; 3085 ml (54 ml/kg); and 1338 ml (2.7 ml/kg/h), respectively. Cr increased, and activated partial thromboplastin time, prothrombin time and international normalized ratio were prolonged postoperatively (0.77–0.9 mg/dl, 34–52 s, and 1.1–1.7, respectively). Of the 31 patients, 13 developed AKI, and 10 of the 13 had recovered at 1 month. Renal impairment due to HES70/0.55/4 was not evident, as shown by the finding that the HES70/0.55/4 amount infused in the AKI patients (53 ml/kg) did not differ from that in the nonAKI patients (55 ml/kg), and there was no relationship between the amount of HES infused and Cr changes.

Conclusion

High-dose HES70/0.55/4 could be safely used in massive bleeding during surgery. HES70/0.55/4 may affect coagulation, but renal impairment was not evident 1 month after surgery.

Keywords

HES70/0.55/4 Massive bleeding Adverse effects Renal complications Coagulation disorders 

Notes

Conflict of interest

HES70 is a product of Fresenius Kabi Inc. As we found that the second author, Dr. Miyao, had been the medical consultant of this company, we changed the COI form to a new version.

References

  1. 1.
    Adcock WL, MacGregor A, Davies JR, Hattarki M, Anderson DA, Goss NH. Chromatographic removal and heat inactivation of hepatitis A virus during manufacture of human albumin. Biotechnol Appl Biochem. 1998;28:85–94.PubMedGoogle Scholar
  2. 2.
    Blümel J, Schmidt I, Willkommen H, Löwer J. Inactivation of parvovirus B19 during pasteurization of human serum albumin. Transfusion. 2002;42:1011–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Thyer J, Unal A, Thomas P, Eaton B, Bhashyam R, Ortenburg J, Uren E, Middleton D, Selleck P, Maher D. Prion-removal capacity of chromatographic and ethanol precipitation steps used in the production of albumin and immunoglobulins. Vox Sang. 2006;91:292–300.Google Scholar
  4. 4.
    Roberts I. (Cochrane Injuries Group Albumin Reviewers) Human albumin administration in critically ill patients: systematic review of randomized controlled trials. Br Med J. 1998;317:235–9.Google Scholar
  5. 5.
    The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.CrossRefGoogle Scholar
  6. 6.
    Johnson ML, Gordon HS, Petersen NJ, Wray NP, Shroyer AL, Grover FL, Geraci JM. Effect of definition of mortality on hospital profiles. Med Care. 2002;40:7–16.Google Scholar
  7. 7.
    Molitoris BA, Levin A, Warnock DG, Joannidis M, Mehta RL, Kellum JA, Ronco C, Shah SV. Improving outcomes of acute kidney injury: report of an Initiative. Nat Clin Pract Nephrol. 2007;3:439–42.Google Scholar
  8. 8.
    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:31.Google Scholar
  9. 9.
    Gan T, Bennett GE, Phillips BB, Wakeling H, Moskowitz DM, Olufolabi Y, Konstadt SN, Bradford C, Glass PS, Machin SJ, Mythen MG. Hextend®, a physiologically balanced plasma expander for large volume use in major surgery: a randomized Phase III clinical trial. Anesth Analg. 1999;88:992–8.Google Scholar
  10. 10.
    Gallandat HRCG, Siemons AW, Bauss D, Rooyen-Butijn WT, Haagenaars JAM, Oeveren W, Bepperling F. A novel hydroxyethyl starch (Voluven®) for effective perioperative plasma volume substitution in cardiac surgery. Can J Anaesth. 2000;47:1207–15.Google Scholar
  11. 11.
    Westphal M, Jame MFM, Kozek-Langenecker S, Stocker R, Guidet B, Aken HV. Hydoroxyethyl starches. Anesthesiology. 2009;111:187–202.CrossRefPubMedGoogle Scholar
  12. 12.
    Yamazaki H. Effects of low-molecular weight HES on kidney—comparison with low-molecular weight dextran (in Japanese with English abstract). Jpn J Anesthesiol. 1975;24:26–43.Google Scholar
  13. 13.
    Mishler JM. Synthetic plasma volume expanders—their pharmacology, safety and clinical efficacy. Clin Haematol. 1984;13:75–92.PubMedGoogle Scholar
  14. 14.
    Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39.Google Scholar
  15. 15.
    Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire F, Brochard L. Effects of hydroxyethyl starch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet. 2001;357:911–6.Google Scholar
  16. 16.
    Boldt J, Brosch C, Rohm K, Lehmann A, Mengistu A, Suttner S. Is albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function? Anesth Analg. 2008;107:1496–503.CrossRefPubMedGoogle Scholar
  17. 17.
    Treib J, Haass A, Pindur G. Coagulation disorder caused by hydroxyethyl starch. Thromb Haemost. 1997;78:974–83.PubMedGoogle Scholar
  18. 18.
    Yamakage M, Sato J, Namiki A. Further potential of hydroxyethyl starch-based plasma substitute (in Japanese with English abstract). J Clin Anesth (Japan). 2005;29:61–73.Google Scholar
  19. 19.
    Yuasa H, Koga Y. Effects of hydroxyethyl starch on hemostasis system (in Japanese with English abstract). J Clin Anesth (Japan). 1998;22:204–8.Google Scholar
  20. 20.
    Dalrymple-Hay M, Aitchison R, Collins P, Sekhar M, Colvin B. Hydroxyethylstarch induced acquired von Willebrand’s disease. Cin Lab Haematol. 1992;14:209–11.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2010

Authors and Affiliations

  • Toshinari Suzuki
    • 1
  • Hideki Miyao
    • 1
  • Katsuo Terui
    • 1
  • Kaoru Koyama
    • 1
  • Michio Shiibashi
    • 2
  1. 1.Department of Anesthesiology, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
  2. 2.Information Technology CenterSaitama Medical UniversitySaitamaJapan

Personalised recommendations