A randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6% (HES 70/0.5) vs lactated Ringer's solution1

Abstract

A larger decrease in haemoglobin levels in infants and toddlers after HES 70/0.5 (20 ml.kg-1) compared with LR indicates a more effective plasma expansion. HES might be considered as a volume expander in the paediatric population.

L’hydroxyéthylamidon 130/0,4 atténue les dommages hépatiques précoces causés par les lésions d’ischémie/reperfusion

“…[14][15][16][17][18][24][25][26][27][28][29] We shared the commonly held perception that both volume effect and molecule characteristics are among the most important factors in organ protection; however, the current study demonstrated that the HES molecule plays a role in hepatoprotection against reperfusion injury. The infused volume of HES solution (13 mLÁkg -1 ) adjusted to the weight of the rats was within the doses reported for volume repletion in clinical studies.…”

“…There is evidence of a better safety profile with HES 130/04 compared with the older colloids, and it is often preferred over pure crystalloid regimens because of its prolonged intravascular half-life and positive impact on blood rheology and tissue oxygenation. [24][25][26][27][28][29] Moreover, Lang et al 18 showed a significant attenuation of inflammatory markers, such as interleukins 6 and 8 and soluble Fig. 1 Alanine aminotransferase (ALT) levels in animals that were subjected to one hour of 70% warm ischemia and two hours of reperfusion and in sham-operated controls.…”

“…The infused volume of HES solution (13 mLÁkg -1 ) adjusted to the weight of the rats was within the doses reported for volume repletion in clinical studies. 25,26,32,33 An equivalent volume of 7.5% saline solution was used as an appropriate control of volume effect. First, although we are far from finding an ideal volume control for HES, theoretically, the osmotic and volume-expanding properties of the 7.5% saline solution make it the best alternative.…”

Hydroxyethyl Starches and Pruritus: A Real Problem?

“…In addition, the observation period was short in the study of Paul et al (72 h). 15 Therefore, the incidence of pruritus was low (0% and 11%, respectively) and no difference to the control groups (Ringer' s lactate) was observed. This is not a surprise since pruritus following HES administration frequently develops tardily and is generally observed only with higher cumulative doses exceeding 200 g. 10,12,13,[16][17][18][19] However, other studies, which were not prospective and randomized, have assessed a possible link between the administration of HES and the development of pruritus.…”

“…Among these, there are only two prospective randomized studies 14,15 in which relatively small amounts of HES (7 and 20 mL/kg, 6% solution) were given. In addition, the observation period was short in the study of Paul et al (72 h).…”