title: Use of modified fluid gelatin and hydroxyethyl starch for colloidal volume replacement in major orthopaedic surgery.
abstract: We have compared 6% hydroxyethyl starch (HES 200/0.5) with 3% modified fluid gelatin (MFG) for volume replacement in major orthopaedic surgery and studied the effects on haemodynamic state, colloid osmotic pressure, blood clotting and plasma homeostasis. Using a controlled, randomized, single-blind clinical design, we studied 46 consecutive patients undergoing major elective orthopaedic hip surgery. The two groups were comparable in age, body weight and duration of surgery. Patients were maintained haemodynamically stable using both HES and MFG over the entire study. Fluid balance and colloidal replacement volumes were comparable in both groups (median perioperative infusion volume: HES 2500 ml, MFG 2400 ml). Laboratory variables were not clinically different. We conclude that both colloidal solutions were comparable in volume efficacy and effects on plasma oncotic pressure, clotting and plasma homeostasis. In the small number of patients studied, 6% HES 200/0.5 was found to be safe when administered in amounts corresponding to the currently accepted maximum daily dose in Germany and France of 33 ml/kg body weight and 2.0 g/kg body weight, respectively.
authors.affiliation: Department of Anaesthesiology, Emergency and Intensive Care Medicine, George-August-University of Göttingen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Beyer
authors.forename: U
authors.initials: U
authors.lastname: Harmening
authors.forename: O
authors.initials: O
authors.lastname: Rittmeyer
authors.forename: S
authors.initials: S
authors.lastname: Zielmann
authors.forename: F
authors.initials: F
authors.lastname: Mielck
authors.forename: S
authors.initials: S
authors.lastname: Kazmaier
authors.forename: D
authors.initials: D
authors.lastname: Kettler
mesh_terms: D000328:Adult; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D001809:Blood Viscosity / Q000187:drug effects; D005440:Fluid Therapy / Q000379:methods*; D005780:Gelatin / Q000627:therapeutic use*; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects; D006454:Hemoglobins / Q000378:metabolism; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007430:Intraoperative Care; D008875:Middle Aged; D009997:Osmotic Pressure / Q000187:drug effects; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011182:Postoperative Care; D016037:Single-Blind Method; D013386:Succinates / Q000627:therapeutic use*
chemical_list: D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D013386:Succinates; C060085:succinylated gelatin; D005780:Gelatin