title: Hydroxyethyl starches: different products--different effects.
abstract: With the development of a new generation of hydroxyethyl starches (HES), there has been renewed interest in their clinical potential. High doses of first- and second-generation HES were associated with adverse effects on renal function, coagulation, and tissue storage, thereby limiting their clinical applicability. Newer HES products have lower molar substitution and in vivo molecular weight, resulting in more rapid metabolism and clearance. In this review article, the differences between HES generations are highlighted, with particular emphasis on the improved safety profile of the third generation products. These improvements have been achieved with no loss of efficacy, and they contradict the assumption that efficacy of HES solutions is directly linked to plasma concentration. The impact of source material on structure and pharmacokinetics is highlighted, and the role of the carrier solution is critically assessed.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Muenster, Germany. martin.westphal@gmx.net
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
authors.forename: Michael F M
authors.initials: MF
authors.lastname: James
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kozek-Langenecker
authors.forename: Reto
authors.initials: R
authors.lastname: Stocker
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
mesh_terms: D000818:Animals; D002626:Chemistry, Pharmaceutical; D017558:Elective Surgical Procedures / Q000379:methods; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000737:chemistry* / Q000493:pharmacokinetics*; D011183:Postoperative Complications / Q000378:metabolism / Q000517:prevention & control
chemical_list: D006895:Hydroxyethyl Starch Derivatives