Background: What is the effect of preoperative acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch (HES) 130/0.4 (Voluven) on blood volume?
Methods: In 10 patients undergoing radical hysterectomy, ANH was performed to a hematocrit of 21% using 6% HES 130/0.4 (Voluven) whereby a replacement of blood with 115% of colloid was planned. Plasma volume (indocyanine green dilution technique) and hematocrit were determined before, 30 and 60 min after ANH. Red cell volume (labelling erythrocytes with fluorescein) was determined before and 30 min after ANH.
Results: After removal of 1,431+/-388 ml of blood and simultaneous replacement with 1,686+/-437 ml of colloid, blood volumes were 218+/-174 ml higher than before (at 105+/-4%). The volume effect was 98+/-12%, 30 min after ANH. Even 60 min after ANH, mean blood volumes were with 4,228+/-986 ml slightly higher than before ANH (102+/-5%). The hematocrit decreased disproportionally in relation to the residual intravascular volume. Consequently, estimating the volume effect from the changes in hematocrit led to an overestimation (about +30%).
Conclusion: Double label measurements of blood volume demonstrated that the volume effect of 6% HES 130/0.4 (Voluven) is about 100% in the course of ANH. The reason for the disproportionally large decrease in hematocrits could be the mobilization of a fraction of the plasma volume which was retained within the endothelial glycocalyx.
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[Voluven--third generation plasma expander].
Lijec Vjesn
September 2010
Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinicka bolnica Dubrava, Zagreb.
Crystalloid solutions are considered a good choice for lower scale blood loss (up to 20%). The usage of colloids facilitates faster and more durable blood volume substitution. Besides, some colloids (HES 130/04) are considered to have a beneficial effect on microcirculation, capillary membrane integrity, inflammatory response and endothelium integrity.
View Article and Find Full Text PDFThe results of using three infusion solutions, such as 6% hydroxyexyethyl starch (HES) 200/0.5 (HaesSteril), HES 130/0.4 (Voluven), and 4% modified gelatin solution (Gelofusin), were compared in 33 patients with neurosurgical diseases of the brain (supratentorial meningovascular tumors) and predictable massive intraoperative blood loss during acute isovolemic hemodilution and compensation for later blood loss.
View Article and Find Full Text PDFHydroxyethyl starch 130/0.4 versus modified fluid gelatin for cardiopulmonary bypass priming: the effects on postoperative bleeding and volume expansion needs after elective CABG.
Acta Anaesthesiol Belg
July 2009
UZ Gasthuisberg Dept. Anesthesia, Leuven, Belgium.
Unlabelled: Concerned about high dose starches and potential coagulopathy, we performed a double blinded randomised prospective study on the influence of gelatine or 6% HES 130/04 pump prime on postoperative blood loss and transfusion requirements after CABG surgery.
Methods: After informed consent, 157 electively scheduled patients were randomly allocated to 6% HES (n=85) or gelatine (n=72) CPB priming. Postoperatively, chest tube drainage was noted hourly during the first 24 hours and every unit of colloid, albumin, FFP or Packed Red Cells needed to maintain hemodynamic stability was carefully registered.
Aim: To investigate hemostasis disorders caused by massive blood transfusions of artificial plasma replacing solutions (PRS).
Material And Methods: Two groups of patients were examined: 7 healthy volunteers without blood loss (group 1) and 11 healthy donors of bone marrow with intraoperative blood loss 1-2 l (group 2). Five patients of group 1 received transfusion of 12 ml/kg hydroxyethyl starch (HES) 130/0.
Influence of different strategies of volume replacement on the activity of matrix metalloproteinases: an in vitro and in vivo study.
Anesthesiology
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Section of Anesthesia and Intensive Care, Multiple Sclerosis Center, Department of Neurology, Anna Hospital, University of Ferrara, Italy.
Background: Excessive production of matrix metalloproteinase 9 (MMP-9) is linked to tissue damage and anastomotic leakage after large bowel surgery. Hence, the aim of this study was to verify whether different strategies of fluids administration can reduce MMP-9 expression.
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