A prospective, comparative and random study was performed on 75 cases of partial and total gastrectomy, gall duct operation and splenectomia, the post operation transfusion of 500ml Haes Steril 6% solution, Gelafundin, Ringerlactat solution had restored and improved the hemodynamic state. After the transfusion the central venous pressure index, blood expelling volume and heart output volume had been restored, reached to high and stable values in a longer duration, versus 500ml gelafunding solution. The least improvement and restoration of hemodynamic activities were observed with the transfusion of 500ml og Ringer lactat solution.
Hetastarch ; Surgery ; Therapeutics ; Blood

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and it may induce some degree of coagulation impairment. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution with several solutions. METHODS: Sixty healthy patients were randomly allocated to six groups according to experimental solution, and each group contained 10 patients. Whole blood was diluted by 0%, 10%, 25%, 50% with 0.9% normal saline, 4% modified fluid gelatin, 10% pentastarch, 10% dextran 40 and two brands of 6% hydroxyethyl starchs (Salinehes(R) , HAES-steril(R) ). At each dilution, thromboelastographic parameters {(r, k, alpha angle, maximum amplitude (MA)} were measured using thromboelastography (TEG) and were compared with those of an undiluted specimen obtained concurrently from the same patients. RESULTS: Hemodilutions of 25% and 50% with 0.9% normal saline decreased r and k times, and increased alpha angle but there was no difference in MA. Hemodilutions of 10% and 25% with modified gelatin solution did not change the parameters. However, 50% hemodilution of the gelatin solution decreased the k time and increased alpha angle. Hemodilutions of more than 10% with 10% pentastarch increased the k time, decreased alpha angle and MA. Hemodilutions of more than 10% with 10% dextran 40 increased r and k times, and decreased alpha angles and MA according to the quantities of this dilutional solution. Hemodilutions of more than 25% with 10% dextran 40 increased k times above 400%. Hemodilutions of more than 10% of 6% HES (Salinehes(R) , M.W: 70,000 dalton) decreased MA. Hemodilutions of more than 10% of 6% HES (HAES-steril(R) , M.W: 200,000 dalton) decreased the alpha angle. CONCLUSIONS: 25% and 50% hemodilutions of 0.9% normal saline induce a hypercoagulable state, but hemodilutions of more than 10% with each colloid solution decreased coagulability of whole blood according to the degree of dilution, except in the case of modified fluid gelatin solution. Hemodilutions of more than 25% with 10% dextran 40 induce a severe coagulation impairment.
Colloids ; Dextrans ; Gelatin ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Starch ; Thrombelastography*

BACKGROUND: Acute normovolemic hemodilution (ANH) entails collecting patients blood immediately before surgery with concurrent fluid infusion to maintain intravascular volume. This reduces the red cells mass (RCM) lost during surgery by lowering the hematocrit at which surgical blood loss occurs. Blood collected from ANH is transfused back to the patient at the end of surgery METHODS: 40 ASA I patients scheduled to elective surgery under lumbar epidural anesthesia were randomly divided into two groups, the ANH group where a pre-computed amount of blood was withdrawn just prior to induction of anesthesia with simultaneous infusion of equal amount of hydroxyethyl starch (HAES-STERIL) and the non-ANH group where no blood was withdrawn nor colloid infused. All patients were monitored based on the following parameters: mean arterial pressure, cardiac rate, central venous pressure, hematocrit, prothrombin activity, platelet count, arterial blood pH and hemoglobin oxygen saturation during the five phases of the study: before hemodilution, during hemodilution, surgery proper, immediate post-op and 24 hours after the surgery. Intraoperative blood loss was likewise monitored RESULTS: Comparative studies of the mean values were curried using one-way ANOVA with Complement Scheffes test and Paired T-test with a p value of 0.05 considered significant. The perioperative changes in the hemodynamic and hematologic parameters were not clinical significant CONCLUSION: The higher final hematotocrit level and the non-requirement for homologous transfusion in the hemodiluted group prove that ANH effective as a blood conservation technique. (Author)
Human ; Adult ; Young Adult ; Adolescent ; BLOOD TRANSFUSION ; HETASTARCH ; SURGERY ; ANESTHESIA

Humans ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Sepsis ; mortality ; therapy

Humans ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Sepsis ; mortality ; therapy

BACKGROUND: Hydroxyethyl starch (HES), a commonly used resuscitation fluid, has the property to induce hyperglycemia as it contains large ethyl starch, which can be metabolized to produce glucose. We evaluated the effect of 6% HES-130 on the blood glucose levels in non-diabetic patients undergoing surgery under spinal anesthesia. METHODS: Patients scheduled to undergo elective lower limb surgery were enrolled. Fifty-eight patients were divided into two groups according to the type of the main intravascular fluid used before spinal anesthesia (Group LR: lactated Ringer's solution, n = 30 vs. Group HES: 6% hydroxyethyl starch 130/0.4, n = 28). Blood glucose levels were measured at the following time points: 0 (baseline), 20 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), and 6 h (T6). RESULTS: Mean blood glucose levels at T5 in the LR group and T4, T5 in the HES group, increased significantly compared to baseline. There were no significant changes in the serial differences of mean blood glucose levels from baseline between the two groups. CONCLUSIONS: Administration of 6% HES-130 increased blood glucose levels within the physiologic limits, but the degree of glucose increase was not greater than that caused by administration of lactated Ringer's solution. In conclusion, we did not find evidence that 6% HES-130 induces hyperglycemia in non-diabetic patients.
Anesthesia, Spinal ; Blood Glucose* ; Colloids ; Glucose ; Humans ; Hydroxyethyl Starch Derivatives ; Hyperglycemia ; Lower Extremity ; Resuscitation ; Starch*

BACKGROUND: Hydroxyethylstarch (HES) solutions are commonly used for intravascular volume expansion with varying effect on coagulation depending on molecular weight and mode of hydroxyl substitution.Clopidogrel and aspirin have been shown to reduce cardiovascular complications in patients with coronaryartery occlusive disease which renders patients to higher risk of bleeding complications who require surgery.The purpose of this study was to evaluate the effect of HES 200/0.5, 130/0.4 and crystalloid on blood loss and transfusion requirement in patients with recent antiplatelet therapy undergoing off-pump coronary bypass surgery (OPCAB) in a prospective, randomized trial. METHODS: Sixty patients scheduled for OPCAB, who received clopidogrel and aspirin within 5 days of surgery were randomly allocated into 3 groups:HES 200/0.5 (n = 20), HES 150/0.4 (n = 20), and Crystalloid (n = 20).Routine coagulation profile were measured before and 2 days after the surgery.Amount of perioperative blood loss, transfusion requirement and fluids input and output were recorded until 2 days postoperatively. RESULTS: The 3 groups were similar with regard to patients and operative characteristics.There were no significant differences in the amount of perioperative blood loss and transfusion requirement among the 3 groups. CONCLUSIONS: Both HES solutions were safe to use in terms of blood loss and transfusion requirement in patients undergoing OPCAB who received antiplatelet agents within 5 days of surgery.
Aspirin ; Hemorrhage ; Hetastarch ; Humans ; Isotonic Solutions ; Molecular Weight ; Platelet Aggregation Inhibitors ; Prospective Studies ; Ticlopidine

BACKGROUND: Third-generation hydroxyethyl starch (HES) solutions have been developed to minimize negative effects on hemostasis. In normal pregnancy, the coagulation activity increases, reaching a maximum around term. This study examined the effects of hemodilution with HES 130/0.4 (6%) on blood coagulation in parturients in vivo and in vitro. METHODS: Forty parturients scheduled for cesarean sections were assigned randomly to receive either 500 or 1,000 ml of HES 130/0.4 (6%). Rotation thromboelastometry (ROTEM(R)) measurements were performed before and after administering HES 130/0.4 (6%). In addition, blood samples obtained from 20 randomly selected parturients were diluted 10% to 40% using HES 130/0.4 (6%), and ROTEM(R) measurements were performed before and after dilution. The changes from baseline and the effects of dilution were analyzed by ROTEM(R) parameters. RESULTS: Infusions of 500 or 1,000 ml of HES 130/0.4 (6%) in the parturients altered the clot formation time, alpha angle, and maximal clot firmness, although all remained within normal ranges. HES 130/0.4 (6%) affected in vitro blood coagulation in parturients' blood containing 10, 20, 30, and 40% HES. The clotting time was prolonged at each dilution percentage, but remained within the normal range. Other parameters showed an impairment of the coagulation system. CONCLUSIONS: Blood coagulation in parturients may be compromised at high dilution ratios of HES 130/0.4 (6%) to blood. Nevertheless, the infusion of 1,000 ml of HES 130/0.4 (6%) in normal parturients did not significantly affect blood coagulation.
Blood Coagulation ; Cesarean Section ; Female ; Hemodilution ; Hemostasis ; Hetastarch ; Pregnancy ; Reference Values

BACKGROUND: Hemodilution may increase cerebral blood flow (CBF) but the mechanism(s) remain controversal. Autoregulation is easily modified or disturbed by several conditions. The aim of this study was to evaluate the effects of isovolemic hemodilution on the autoregulation of cerebral blood flow in a rabbit model. METHODS: Stepwise hemodilution was accomplished by incrementally removing whole blood from the animals in amounts of 8-12 ml and replacing this with an equal volume of 6% hetastarch in saline. This procedure was continued until the target content values of approximately Hct -18% were achieved. To evaluate the influence of pressure changes on CBF, mean arterial pressure (MAP) was increased from a baseline pressure (approximately 78 mmHg) to 145 mmHg by infusing methoxamine, and cerebral blood flow was measured at each MAP level using the hydrogen clearence method after MAP had been stabilized for 15 min. RESULTS: Stepwise hespen replacement caused a sudden drop of Hct from 37.4% to 18.5% and a simultaneously a significant increase in local CBF of 161% in the hemodilution group. Hemodilution significantly reduced CaO2 in the hemodilution group (9.45 +/- 1.7 ml O2/dl) versus the control group (18.34 +/- 1.3 ml O2/dl). However, despite these decrease in CaO2, calculated cerebral oxygen delivery (DO2) was as well maintained in the hemodilution group (22.47 +/- 7.28 ml O2/100 gm/min) as in the control group (24.14 +/- 8.67 ml O2/100 gm/min). MAP increases from 78 mmHg to 145 mmHg produced a significant increase in CBF from 122.4 +/- 32.8 ml/100 gm/min to 170.9 +/- 23.7 ml/100 gm/min in control group (39.6%) and from 218.4 +/- 75.6 ml/100 gm/min to 268.4 +/- 106.5 ml/100 gm/min in the hemodilution group (44.6%) (P<0.001). These CBF increases were not significantly different in the two groups. CONCLUSIONS: The present study demonstrates that in the normal brain the decrease in CaO2 caused by hemodilution is well compensated for by an increase CBF, and that oxygen transport to the brain is also well maintained during at a Hct value of 20%. Although the present study did not show the tight CBF control within the MAP range from 78 mmHg to 145 mmHg, hemodilution did not alter the response of the cerebral circulation to increased MAP.
Animals ; Arterial Pressure ; Brain ; Hemodilution* ; Homeostasis* ; Hydrogen ; Hydroxyethyl Starch Derivatives ; Methoxamine ; Oxygen

PURPOSE: For separation of RBC from cord blood, it is important to minimize RBC contamination without significant loss of nucleated cells using sedimentation agent that is safe for human use. This study was performed to investigate the possibility of replacing 6% hydroxyethylstarch (HES) with 10% pentastarch (PS) which is a lower molecular weight hetastarch-analog that is cleared from the circulation rapidly. METHODS: After dilution of cord blood till hematocrit 25%, PS or HES were added by the ratio of 7:1 and 5:1 respectively. Sedimentation was performed for 2 hours by gravity. RESULTS: PS was used in 14 cases with volume of 72.4+/-22.3 mL (45~126 mL) and HES in 8 cases with volume of 58.4+/-8.0 mL (50~70 mL). Sedimentation rate has reached at plateau by 90 minutes in PS group and it was slightly faster than in HES group. Recovery rate of nucleated cells and residual RBC were 82.9+/-10.7%, 7.6+/-5.4% in PS group, and 84.0+/-4.7%, 10.7+/-2.3% in HES group. There were no significant differences between the two groups (P=0.657, 0.219). Cell viabilities were high in both groups; 92+/-3% before separation and 97+/-2% in PS group and 98+/-3% in HES group. CD34+ cells were 0.75+/-0.28% before separation and 0.64+/-0.21% in PS group and 0.60+/-0.30% in HES group (P=0.690). CFU-GM after 2 week culture were 27.4+/-20.0 per 1 105 mononuclear cells in PS group and 22.9+/-8.6 in HES group (P=0.856). CONCLUSION: These results demonstrated that PS has similar efficacy to HES for separation of RBC from umbilical cord blood. Considering its rapid clearance and faster sedimentation rate, PS can replace HES for RBC separation in cord blood banking.
Cell Survival ; Fetal Blood* ; Granulocyte-Macrophage Progenitor Cells ; Gravitation ; Hematocrit ; Humans ; Hydroxyethyl Starch Derivatives* ; Molecular Weight