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[Blood volume replacement and hemodilution with hydroxyethyl starch]
Infusionstherapie Und Klinische Ernahrung
|June 1, 1978
Summary
High molecular hydroxyethylstarch (HES) effectively replaces volume and aids hemodilution. However, HES can accumulate in tissues and cause hyperamylasemia, requiring careful consideration in clinical use.
Area of Science:
- Pharmacology
- Resuscitation Medicine
Context:
- Hydroxyethylstarch (HES) is a colloid used for volume replacement.
- High molecular weight HES (MW 450000, DS 0.7-0.8) has demonstrated efficacy.
- Low molecular weight HES shows inadequate volume effects.
Purpose:
- To evaluate the efficacy and safety of high molecular weight hydroxyethylstarch (HES) for volume replacement and hemodilution.
- To compare the effects of high vs. low molecular weight HES.
- To identify potential adverse effects and limitations of HES administration.
Summary:
- High molecular weight HES (MW 450000, DS 0.7-0.8) is suitable for primary volume replacement and preoperative normovolemic hemodilution.
- HES infusion can cause hyperamylasemia, which is generally non-pathogenic but relevant for differential diagnosis.
- Anaphylactoid reactions to HES are rare (0.08%) and similar to other colloids; their mechanism is unknown, precluding prophylaxis.
- A significant disadvantage of HES is its protracted elimination, leading to potential tissue accumulation after repeated infusions.
- Future starch preparations may offer adequate volume effects with rapid elimination.
Impact:
- High molecular weight HES is a viable option for volume resuscitation and hemodilution, despite potential side effects.
- Understanding HES-induced hyperamylasemia is crucial for postoperative differential diagnosis.
- The risk of tissue accumulation necessitates careful consideration of HES in patients requiring repeated infusions.
- The development of rapidly eliminated starch preparations is anticipated to overcome current HES limitations.