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A randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6%
Matthias Paul1, Michael Dueck, H Joachim Herrmann
1Department of Anaesthesia and Intensive Care, University of Cologne, Cologne, Germany.
Insights
Hydroxyethyl starch (HES) showed more effective plasma expansion than lactated Ringer's solution in pediatric surgery patients. This study suggests HES is a viable volume expander for infants and toddlers.
Area of Science:
- Pediatric Anesthesiology
- Fluid Resuscitation
- Colloid Solutions
Background:
- Hydroxyethyl starch (HES) is a widely used synthetic colloid for volume replacement in adults.
- Limited data exist on HES use in pediatric populations.
- This study investigates a low molecular weight HES (HES 70/0.5) in infants and toddlers.
Purpose of the Study:
- To assess the plasma expansion efficacy of HES 70/0.5 compared to lactated Ringer's (LR) solution in pediatric patients.
- To evaluate the perioperative safety of HES 70/0.5 in this age group.
Main Methods:
- A randomized controlled trial involving 64 patients aged 1-38 months undergoing urological surgery.
- Patients received either HES 70/0.5 or LR (20 ml/kg) during the first hour of surgery.
- Hemoglobin levels, fluid volumes, blood loss, body weight changes, and postoperative edema were monitored.
Main Results:
- A significantly greater decrease in hemoglobin levels was observed with HES 70/0.5 compared to LR, indicating superior plasma expansion.
- No significant differences were found in administered fluid volumes, postoperative body weight changes, or edema incidence between groups.
- No adverse events, including anaphylactoid reactions or pruritus, were reported.
Conclusions:
- The greater hemoglobin decrease with HES 70/0.5 suggests more effective plasma expansion in pediatric patients.
- HES 70/0.5 may be considered a suitable volume expander for infants and toddlers undergoing surgery.
Background:
Volume replacement with hydroxyethyl starch (HES), a synthetic colloid, is widely accepted in adults, but only few data exist regarding its use in children. The aim of this study was to assess the effect of a low molecular weight HES solution (HES 70/0.5) compared with lactated Ringer's solution (LR) on haemoglobin levels as an indirect measure of plasma expansion in infants and toddlers, and its perioperative safety.
Methods:
Sixty-four patients, aged 1-38 months, were allocated randomly to receive 20 ml x kg-1 body weight of either HES 70/0.5 or LR during the first hour of urological surgery lasting >2 h. Thereafter, only LR was infused to maintain haemodynamic stability. Intraoperative blood loss and administered fluid volumes were analysed. Haemoglobin levels were determined perioperatively and intraoperatively at completion of volume loading. Changes in body weight and the incidence of postoperative oedema were assessed 24 and 48 h after surgery. For the safety analysis, patients were monitored for 72 h.
Results:
Intraoperative haemoglobin levels decreased significantly more with HES 70/0.5 (30 +/- 10 g.l-1) compared with LR (21 +/- 12 g.l-1) (P < 0.01). The overall administered fluid volumes during surgery did not differ between groups. The postoperative changes in body weight and incidence of postoperative oedema did not differ between groups. No anaphylactoid reactions, pruritus or adverse effects were observed during the study period.
Conclusions:
A larger decrease in haemoglobin levels in infants and toddlers after HES 70/0.5 (20 ml.kg-1) compared with LR indicates a more effective plasma expansion. HES might be considered as a volume expander in the paediatric population.