title: Inhibition of platelet function by hydroxyethyl starch solutions in chronic pain patients undergoing peridural anesthesia.
abstract: The use of hydroxyethyl starch (HES) solutions as a fluid replacement before peridural blockade may compromise blood coagulation, thus increasing the risk of neuraxial bleeding. In this prospective, double-blind, placebo-controlled, crossover study, we compared the influence of HES 130 (molecular weight in kilodalton), HES 200, and lactated Ringer's solution on platelet function and hemodynamics in chronic low back pain patients scheduled for peridural blockades. Patients received 3 test infusions of 10 mL/kg each administered IV for 30 min. Collagen/epinephrine and collagen/adenosine diphosphate were used as agonists for assessment of platelet function analyzer-closure times. Arterial blood pressure, heart rate, platelet counts, and hemoglobin levels were documented. Platelet function analyzer-closure times remained stable after lactated Ringer's solution but were significantly prolonged after HES. The platelet-inhibiting effect of HES 200 was more than that of HES 130. Hemodynamic stability was sufficiently maintained by all test infusions. In contrast to previous observations, a relevant antiplatelet effect of both low and medium molecular weight HES solutions was found in this study in chronic pain patients undergoing peridural anesthesia. Because hemostasiological competence is a prerequisite for safe neuraxial blockade, the decision of HES for intravascular fluid administration before blockade should be critically made.
authors.affiliation: *Intensive Care Unit, Department of Internal Medicine I, †Department of Hospital Hygiene, and ‡Department of Medical Computer Sciences, University of Vienna, Vienna, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Rabitsch
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Köstler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fiebiger
authors.forename: Christoph
authors.initials: C
authors.lastname: Dielacher
authors.forename: Heidrun
authors.initials: H
authors.lastname: Losert
authors.forename: Camillo
authors.initials: C
authors.lastname: Sherif
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Edith
authors.initials: E
authors.lastname: Seper
authors.forename: Walter
authors.initials: W
authors.lastname: Koller
authors.forename: Florian
authors.initials: F
authors.lastname: Daxböck
authors.forename: Ernst
authors.initials: E
authors.lastname: Schuster
authors.forename: Paul
authors.initials: P
authors.lastname: Knöbl
authors.forename: Heinz
authors.initials: H
authors.lastname: Burgmann
authors.forename: Michael
authors.initials: M
authors.lastname: Frass
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology; D002908:Chronic Disease; D003102:Colloids; D018592:Cross-Over Studies; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D006438:Hemodilution; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007552:Isotonic Solutions; D008875:Middle Aged; D010146:Pain / Q000097:blood; D059408:Pain Management; D010952:Plasma Substitutes; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D011446:Prospective Studies
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D010975:Platelet Aggregation Inhibitors