Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery

Thy, Michaël; Montmayeur, Juliette; Julien-Marsollier, Florence; Michelet, D.; Brasher, Christopher; Dahmani, Souhayl; Orliaguet, Gilles

doi:10.1097/eja.0000000000000780

Cited by 18 publications

(12 citation statements)

References 78 publications

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“…We also decided not to use hydroxyethyl starch for priming the CPB circuit due to the lack of evidence and absence of high-quality randomized controlled trials showing the safety and efficacy of hydroxyethyl starch use in children. 16 In addition, an in vitro study showed a pronounced inhibitory effect on coagulation parameters detected by the ROTEM test when colloids were compared with crystalloids. 17 Second, in our study all the caregivers (except the perfusionist) were blinded to the study solution, which is an important aspect when it comes to deciding to transfuse.…”

Section: Discussionmentioning

confidence: 99%

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

et al. 2020

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Background: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods: In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml • kg −1 PlasmaLyte or 15 ml • kg −1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra-and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. results: Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml • kg −1 (5.1, 9.4) in the FFP group and 5.7 ml • kg −1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. conclusions: The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

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Section: Discussionmentioning

confidence: 99%

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

et al. 2020

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“…21,22 Most centers used albumin or the association of albumin and gela- supposed to provide a greater vascular feeling effect despite the fact that some evidences are not supporting this practice. [23][24][25] Mismatch of donor and recipient size and weights and the resulting divergent hemodynamic requirements is an issue specific to pediatric transplantation. 19 As such, the monitoring and hemodynamic management sections are probably the most interesting aspects of this survey, demonstrating significant variability between centers in hemodynamic monitoring and therapeutic responses.…”

Section: Discussionmentioning

confidence: 99%

“…Macromolecules are usually used in France when a vascular feeling is needed (either as a first‐line treatment or after crystalloid administration). Both albumin and gelatins are supposed to provide a greater vascular feeling effect despite the fact that some evidences are not supporting this practice …”

Section: Discussionmentioning

confidence: 99%

A survey of the anesthetic management of pediatric kidney transplantation in France

Marsac

Michelet

Sola

et al. 2019

Pediatric Transplantation

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Background Renal transplantation is the best available therapeutic option for end‐stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. Material and Methods The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). Results Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. Conclusions The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.

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“…A meta-analysis opined that intravascular volume expansion with low molecular weight 6% HES did not appear to modify renal function, blood loss or transfusion when administered to children during the peri-operative period. [37] However, since the quality of evidence was low, the authors recommended conduct of high-quality RCTs to study their effect in children.…”

Section: Introductionmentioning

confidence: 99%

Perioperative fluid therapy and intraoperative blood loss in children

Bhardwaj

2019

Indian J Anaesth

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Fluid and blood administration are required during surgery in children. The type, amount and tonicity of the intravenous fluids is an important aspect to be considered during anaesthesia management. The physiological differences between adults and children regarding the body water and blood volume needs to be understood. We performed a PUBMED search for English language articles using keywords including 'children', 'intravenous fluid therapy', 'crystalloids', 'colloids', 'fluid homeostasis', 'Starling equation', 'Donnan effect', 'blood loss', 'estimation of blood loss', 'blood management program'. This review discusses the physiological basis, historical background, risk of hyponatraemia, need of glucose in the intravenous fluids as well as the recent concepts in blood transfusion as related to children.

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Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery

Cited by 18 publications

References 78 publications

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

A survey of the anesthetic management of pediatric kidney transplantation in France

Perioperative fluid therapy and intraoperative blood loss in children

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