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: 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*

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

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

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

Pulseless electrical activity refers to a heterogeneous group of cardiac rhythm disorders, all characterized by pulselessness in the presence of some type of electrical activity other than ventricular tachycardia or ventricular fibrillation. We experienced a case of sudden pulseless electrical activity and cardiac arrest during hetastarch infusion in general anesthesia in an adult who had total gastrectomy. We report this experience with a brief review of literature.
Adult ; Anesthesia, General ; Gastrectomy* ; Heart Arrest ; Humans ; Hydroxyethyl Starch Derivatives ; Tachycardia, Ventricular ; Ventricular Fibrillation

Based on the result of randomized controlled trials and meta-analysis recently, the infusion of hydroxyethyl starch (HES) was not shown to over match routine crystalline solution in exerting resuscitation effect against hypovolemia of patients with burn shock, severe systematic infection, or other critical conditions, on the other hand, it may induce renal toxicity and other toxic and side effects. Since the pathological mechanism underlying hypovolemia during shock phase after burn is similar to that of severe systemic infection, we propose to suspend the use of HES for fluid resuscitation during the shock phase of severe burn until further elucidation.
Burns ; therapy ; Contraindications ; Fluid Therapy ; Humans ; Hydroxyethyl Starch Derivatives ; Hypovolemia ; prevention & control ; Resuscitation ; Shock ; therapy

BACKGROUNDThis meta-analysis was to determine the association of the cumulative dose of 130/0.4 or 0.42 (hydroxyethyl starch [HES] 130/0.4*) or delta daily fluid balance (i.e., daily fluid balance in HES group over or below control group) with the heterogeneity of risk ratio (RR) for mortality in randomized control trials (RCTs).

METHODSThree databases (PubMed, EMBASE, Cochrane) were searched to identify prospective RCTs reporting mortality in adult patients with sepsis to compare HES130/0.4* with crystalloids or albumin. Meta-analysis was performed using random effects. Sensitivity and meta-regression analyses were used to examine the heterogeneity sources of RR for mortality.

RESULTSA total number of 4408 patients from 11 RCTs were included. The pooled RR showed no significant difference for overall mortality in patients with administration of HES130/0.4* compared with treatment of control fluids (RR: 1.02, 95% confidence interval: 0.90-1.17; P = 0.73). Heterogeneity was moderate across recruited trials (I2 = 34%, P = 0.13). But, a significant variation was demonstrated in subgroup with crystalloids as control fluids (I2 = 42%, P < 0.1). Sensitivity analysis revealed that trials with high risk of bias did not significantly impact the pooled estimates for mortality. Meta-regression analysis also did not determine a dose-effect relationship of HES130/0.4* with mortality (P = 0.298), but suggested daily delta fluid balance being likely associated with mortality in septic patients receiving HES130/130/0.4* (P = 0.079).

CONCLUSIONSInappropriate daily positive fluid balance was likely an important source of heterogeneity in these trials reporting HES130/0.4* associated with excess mortality in septic patients.

BACKGREOUND: Cerebral damage caused by hemorrhagic shock presents an important challenge for critical care medicine. The type of fluid to resuscitate hemorrhagic shock is important for the outcome of such patients. Pentastarch is low-molecular-weight hydroxyethyl starch, which increases cerebral blood flow (CBF) by plasma volume expansion and compensatory vasodilation, and improves the microcirculation in the ischemic brain area by reducing the blood viscosity. METHODS: The authors continuously determined CBF and CMRO2 in 10 mongrel dogs weighing 20.1 +/- 0.8 kg with posterior sagittal sinus outflow method. Dogs were subjected to the 20 minute-period of hemorrhagic shock to a mean arterial pressure of 40 mmHg. The shock phase was followed by resuscitation with the same volume of 10% pentastarch as blood loss. The authors assessed the changes of CBF, CMRO2, and CBF/CMRO2 ratio immediately and 30, 60, 90, 120 minutes after pentastarch infusion. Brain water content was assessed by the wet-dry weight method. RESULTS: CBF was increased above the control level, immediately and 30 minutes after 10% pentastarch infusion (p<0.05), and approximated to the control level for the remaining time. CMRO2 was increased, immediately and 30, 60, 90 minutes after 10% pentastarch infusion (p<0.05), and approximated to the control level at 120 minutes. CBF/CMRO2 ratio was recovered to the control level after 10% pentastarch infusion. Brain water content was not significantly different from the normal value of dogs. CONCLUSION: 10% pentastarch may be used with safety to resuscitate hemorrhagic shock because it recovers the balance between the cerebral oxygen supply and demand, and does not cause cerebral edema.
Animals ; Arterial Pressure ; Blood Viscosity ; Brain ; Brain Edema ; Critical Care ; Dogs ; Humans ; Hydroxyethyl Starch Derivatives* ; Microcirculation ; Oxygen* ; Plasma Volume ; Reference Values ; Resuscitation ; Shock ; Shock, Hemorrhagic* ; Starch ; Vasodilation