title: Safety of modern starches used during surgery.
abstract: Various hydroxyethyl starch (HES) preparations have been used for decades to augment blood volume. There has been concern recently regarding possible adverse outcomes when using HES in the intensive care setting, especially in patients with septic shock. However, the pharmacokinetic and pharmacodynamic properties of HES preparations depend on their chemical composition and source material. Thus, different clinical conditions could result in differing effectiveness and safety for these preparations. Consequently, we assessed the safety of tetrastarches when used during surgery, using a formal search, that yielded 59 primary full publications of studies that met a priori inclusion criteria and randomly allocated 4529 patients with 2139 patients treated with tetrastarch compared with 2390 patients treated with a comparator. There were no indications that the use of tetrastarches during surgery induces adverse renal effects as assessed by change or absolute concentrations of serum creatinine or need for renal replacement therapy (39 trials, 3389 patients), increased blood loss (38 trials, 3280 patients), allogeneic erythrocyte transfusion (20 trials, 2151 patients; odds ratio for HES transfusion 0.73 [95% confidence interval = 0.61-0.87], P = 0.0005), or increased mortality (odds ratio for HES mortality = 0.51 [0.24-1.05], P = 0.079).
authors.affiliation: Service D’Anésthesiologie–Réanimation, CHU Brugmann, Bruxelles, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Van Der Linden
authors.forename: Michael
authors.initials: M
authors.lastname: James
authors.forename: Michael
authors.initials: M
authors.lastname: Mythen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Weiskopf
mesh_terms: D001777:Blood Coagulation; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016001:Confidence Intervals; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000627:therapeutic use; D007430:Intraoperative Care; D016017:Odds Ratio; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes