title: A triple-blinded randomized trial comparing the hemostatic effects of large-dose 10% hydroxyethyl starch 264/0.45 versus 5% albumin during major reconstructive surgery.
abstract: In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. Fifty patients were randomized to receive HES 264/0.45 or 5% human albumin from the induction of anesthesia until 24 h thereafter. Both albumin and HES 264/0.45 effectively maintained physiologic variables in the perioperative and postoperative periods. The partial thromboplastin time and international normalized ratio were significantly increased in the HES 264/0.45 group compared with the albumin group after infusion of 30 mL/kg and 45 mL/kg (P < 0.05). Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.
authors.affiliation: Departments of Anesthesia, Surgery, Hematology, Otolaryngology, Biostatistics and Clinical Epidemiology. The Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada and St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Arellano
authors.forename: Bing Siang
authors.initials: BS
authors.lastname: Gan
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Salpeter
authors.forename: Erik
authors.initials: E
authors.lastname: Yeo
authors.forename: Stuart
authors.initials: S
authors.lastname: McCluskey
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Pinto
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Ross
authors.forename: D John
authors.initials: DJ
authors.lastname: Doyle
authors.forename: John
authors.initials: J
authors.lastname: Parkin
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.forename: Lorne
authors.initials: L
authors.lastname: Rotstein
authors.forename: Ian
authors.initials: I
authors.lastname: Witterick
authors.forename: Wayne
authors.initials: W
authors.lastname: Matthews
authors.forename: John
authors.initials: J
authors.lastname: Yoo
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
authors.forename: Pat
authors.initials: P
authors.lastname: Gullane
authors.forename: Howard
authors.initials: H
authors.lastname: Lampe
mesh_terms: D000758:Anesthesia; D001777:Blood Coagulation / Q000187:drug effects; D004311:Double-Blind Method; D006439:Hemodynamics; D006490:Hemostatics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D019934:International Normalized Ratio; D009959:Oropharyngeal Neoplasms / Q000601:surgery; D010314:Partial Thromboplastin Time; D019651:Plastic Surgery Procedures; D012709:Serum Albumin; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D006490:Hemostatics; D006895:Hydroxyethyl Starch Derivatives; D012709:Serum Albumin; D014841:von Willebrand Factor