title: Volume replacement therapy during hip arthroplasty using hydroxyethyl starch (130/0.4) compared to lactated Ringer decreases allogeneic blood transfusion and postoperative infection.
abstract: OBJECTIVE
  Hydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes.
  
  
  METHODS
  In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15 mL.kg(-1) of HES 130/0.4 and 24 patients received a preload of 30 mL.kg(-1) lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications.
  
  
  RESULTS
  Red blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p = .029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p = .037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection.
  
  
  CONCLUSIONS
  During hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.
authors.affiliation: Anesthesia Division, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil.
authors.forename: Adilson
authors.initials: A
authors.lastname: Hamaji
authors.affiliation: PhD; Anesthesia Division, Heart Institute, HC-FM-USP, Brazil. Electronic address: pc.anestesiologia@incor.usp.br.
authors.forename: Ludhmila
authors.initials: L
authors.lastname: Hajjar
authors.affiliation: Department of Orthopedic, FMUSP; Instituto de Ortopedia e Traumatologia, HC-FMUSP, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Caiero
authors.affiliation: MD, Anesthesia Division, Cancer Institute, HC-FM-USP, Brazil.
authors.forename: Juliano
authors.initials: J
authors.lastname: Almeida
authors.affiliation: MD, Anesthesia Division, Cancer Institute, HC-FM-USP, Brazil.
authors.forename: Rosana Ely
authors.initials: RE
authors.lastname: Nakamura
authors.affiliation: MD, Anesthesia Division, Cancer Institute, HC-FM-USP, Brazil.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Osawa
authors.affiliation: MSc; MD, Anesthesia Division, Heart Institute, HC-FM-USP, Brazil.
authors.forename: Julia
authors.initials: J
authors.lastname: Fukushima
authors.affiliation: PhD; Anesthesia Division, Heart Institute, HC-FM-USP, Brazil.
authors.forename: Filomena R
authors.initials: FR
authors.lastname: Galas
authors.affiliation: PhD; Full Professor, Anesthesiology, HC-FM-USP, Brazil; Laboratory of Medical Investigation (LIM/08), FMUSP, Brazil.
authors.forename: Jose Otavio Costa
authors.initials: JO
authors.lastname: Auler
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001810:Blood Volume / Q000187:drug effects; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D000077325:Ringer's Lactate
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate
keywords: Anesthesia; Arthroplasty; Blood Transfusion; Hemodilution; Hetastarch; Hip; Replacement; Spinal