The role of tetrastarches for volume replacement in the perioperative setting

Current opinion in perioperative fluid therapy suggests that the use of colloids to achieve haemodynamic optimization may result in improved clinical outcomes. This has focused interest on the colloid solutions, particularly on the newest of these, the tetrastarches. This review will address the advantages and disadvantages of the starch solutions with particular emphasis on the advantages offered by the tetrastarches, as these products, which have been widely used in Europe for a number of years, have recently been released in the United States.

The tetrastarches have a molar substitution of 0.4, compared with the older hetastarches that had a molar substitution of 0.7. This results in a lower in-vivo molecular weight leading to more rapid clearance of the starch particles and a reduced incidence of adverse effects such as coagulation disorders and skin itching. It is probable that the more rapidly degradable tetrastarch also decreases, or possibly eliminates, the risk of renal dysfunction that has been associated with some of the earlier starch products.

Tetrastarch represents a substantial advance in colloid therapy, offering good volume effectiveness with a very low risk of adverse effects.