Preoperative Acute Hypervolemic Hemodilution with Hydroxyethylstarch

Abstract

Acute normovolemic hemodilution (ANH) may help to reduce demand for homologous blood but requires extra time and apparatus. A more simple procedure is acute hypervolemic hemodilution (HHD), where hydroxyethylstarch is administered preoperatively without removal of blood. In a prospectively randomized study we compared ANH (preoperatively 15 mL/kg autologous blood removal and replacement with 15 mL/kg of hydroxyethylstarch with HHD (15 mL/kg of hydroxyethylstarch administered preoperatively) in 49 patients undergoing hip arthroplasty. To avoid excessive intravascular volume, we used the vasodilating effect of isoflurane. No significant differences were found between groups (ANH, n = 23; HHD, n = 26) for intraoperative blood loss (ANH versus HHD, median [minimum-maximum]); 545 [295-785] mL versus 520 [315-825] mL) and postoperative blood loss (730 [525-945] mL versus 780 [495-895] mL), postoperative hemoglobin, hemotocrit, platelet count or coagulation variables, and transfusion requirements (ANH 43% versus HHD 35% of patients received homologous blood) (P > 0.05). Heart rate did not change significantly in either group. In the ANH group mean arterial blood pressure (MAP) decreased after hemodilution (P < 0.05) while in the HHD group MAP did not change over time. Mean time required to perform ANH was 58 (46-62) min versus HHD 16 (12-19) min (P < 0.05). Costs for ANH were $63.60 USD and for HHD $32.75 USD (labor costs not included). In orthopedic patients undergoing hip replacement with a predicted blood loss of about 1000 mL, HHD seems to be a simple as well as time- and cost-saving alternative for ANH.

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

“…With respect to hypervolaemic haemodilution (HHD), comparable data in the literature are very rare. Besides one clinical study on a small number of patients comparing HHD versus ANH [16], those data mainly refer to case reports [17,18]. The very few MM on HHD versus no-HHD published differ from each other in both mathematical description of the model itself [13,19] and the degree of hypervolaemia assumed [13,20,21].…”

Hypervolemic Hemodilution: An Alternative to Acute Normovolemic Hemodilution? A Mathematical Analysis

“…However, ANH is sometimes accused of being a timeand equipment-consuming technique [3]. Instead of simultaneously exchanging the patient's blood versus a cell-free solution as seen in ANH, some studies used acute preoperative volume expansion without any blood removal and considered this technique hypervolemic hemodilution (HHD) [4,5].…”

“…Instead of simultaneously exchanging the patient's blood versus a cell-free solution as seen in ANH, some studies used acute preoperative volume expansion without any blood removal and considered this technique hypervolemic hemodilution (HHD) [4,5]. Based on those reports some authors even suggested replacing ANH with HHD, which they thought to be easier to handle [3]. So far, very little is known about the efficacy of HHD compared to ANH and further clarification is required.…”

“…A previously published trial by Mielke et al [3] looked at the efficacy of HHD and ANH in patients undergoing hip arthroplasty. From their results they concluded that HHD is a time-and cost-saving alternative to ANH.…”

Estudo prospectivo randomizado comparando duas técnicas de expansão volêmica em cirurgia de artroplastia total de quadril: hidroxietilamido (130/0,4) e Ringer lactato

“…Na cirurgia de artroplastia de quadril sob anestesia geral com isofluorane, hemodiluição hipervolêmica com volume de 15ml/kg se mostrou uma técnica atrativa, com queda de custos, facilidade de uso, menor taxa de transfusão (43%x35%), quando comparada à hemodiluição normovolêmica aguda com sangramento acima de 1000 ml (Mielke et al, 1997), e com valores de hemodiluição normovolêmica aguda = 40% x hiperdiluição hipervolêmica = 20% (Saricaoglu et al, 2005).…”