title: Comparison of a waxy maize and a potato starch-based balanced hydroxyethyl starch for priming in patients undergoing coronary artery bypass grafting.
abstract: OBJECTIVE
  Concerns have been raised about differences in the safety profile of potato- versus waxy maize-derived hydroxyethyl starch (HES). The objective of this study was to compare 2 HES solutions derived from 2 different source materials (potato versus waxy maize) for their dose-related effects on hemostasis and organ function when used to prime the cardiopulmonary bypass circuit (CPB).
  
  
  METHODS
  A prospective, randomized, controlled study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB.
  
  
  METHODS
  For priming the CPB circuit, the HESPRL group received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500 mL of Ringer's lactate; the HESP group received 1,500 mL of potato-derived balanced 6% HES 130/0.42; the HESMRL group received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with 500 mL of Ringer's lactate, and the HESM group received 1500 mL of waxy maize-derived balanced 6% HES 130/0.4.
  
  
  RESULTS
  There were no significant differences in 24-hour mediastinal drainage, rate of re-exploration, blood product usage, coagulation parameters, and measures of pulmonary, renal, and hepatic function with respect to plant source of HES, when equivalent doses were used. Sonoclot activated clotting time (SonACT) was significantly higher and clot rate (CR) significantly lower at end of surgery (T1) and 24 hours after surgery (T2) in the HESP and HESM groups compared with the HESPRL and HESMRL groups. Compared with baseline, CR and platelet function were significantly lower at T1, PaO2/FIO2 ratio decreased significantly at T1 and T2, and serum bilirubin and transaminases increased significantly at T2 in all 4 groups.
  
  
  CONCLUSIONS
  There was no significant difference in cumulative 24-hour mediastinal drainage when potato-derived balanced 6% HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to prime the CPB circuit in patients undergoing CABG. In equal doses, both starches exerted the same effect on blood coagulation and pulmonary, renal, and hepatic function.
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. Electronic address: drbssethi72@gmail.com.
authors.forename: Brijindera Singh
authors.initials: BS
authors.lastname: Sethi
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Chauhan
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Akshay Kumar
authors.initials: AK
authors.lastname: Bisoi
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Randhir Singh
authors.initials: RS
authors.lastname: Rajput
mesh_terms: D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011300:Preoperative Care; D011446:Prospective Studies; D011198:Solanum tuberosum / Q000737:chemistry*; D016896:Treatment Outcome; D003313:Zea mays / Q000737:chemistry*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
keywords: cardiopulmonary bypass; coagulation; hemodilution; hydroxyethyl starch; outcome; priming