title: A randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6% (HES 70/0.5) vs lactated Ringer's solution.
abstract: 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.
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Cologne, Cologne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Paul
authors.forename: Michael
authors.initials: M
authors.lastname: Dueck
authors.forename: H
authors.initials: H
authors.lastname: Joachim Herrmann
authors.forename: Josef
authors.initials: J
authors.lastname: Holzki
mesh_terms: D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D001826:Body Fluids / Q000187:drug effects* / Q000502:physiology; D001835:Body Weight / Q000187:drug effects / Q000502:physiology; D002675:Child, Preschool; D004487:Edema / Q000209:etiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006454:Hemoglobins / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D010952:Plasma Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D000077325:Ringer's Lactate; D018709:Statistics, Nonparametric; D013997:Time Factors; D013520:Urologic Surgical Procedures
chemical_list: D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate