Safety of Modern Starches Used During Surgery

Abstract

Various hydroxyethyl starch (HES) preparations have been used for decades to augment blood volume. There has been concern recently regarding possible adverse outcomes when using HES in the intensive care setting, especially in patients with septic shock. However, the pharmacokinetic and pharmacodynamic properties of HES preparations depend on their chemical composition and source material. Thus, different clinical conditions could result in differing effectiveness and safety for these preparations. Consequently, we assessed the safety of tetrastarches when used during surgery, using a formal search, that yielded 59 primary full publications of studies that met a priori inclusion criteria and randomly allocated 4529 patients with 2139 patients treated with tetrastarch compared with 2390 patients treated with a comparator. There were no indications that the use of tetrastarches during surgery induces adverse renal effects as assessed by change or absolute concentrations of serum creatinine or need for renal replacement therapy (39 trials, 3389 patients), increased blood loss (38 trials, 3280 patients), allogeneic erythrocyte transfusion (20 trials, 2151 patients; odds ratio for HES transfusion 0.73 [95% confidence interval = 0.61-0.87], P = 0.0005), or increased mortality (odds ratio for HES mortality = 0.51 [0.24-1.05], P = 0.079).

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

“…69 The key likely lies in the context -in the context of perioperative surgical patients with an intact glycocalyx, when renal injury is much less common than in the ICU, there is no current evidence that HES is associated with harm. 70 Nevertheless, it seems prudent to avoid HES (and gelatins) when there is pre-existing renal injury.…”

Maksillofasial Travmalar

“…Perioperatif Sıvı Yönetimi miktarda HES (pentastarch ve tetrastarch) verilmesi hemostaz üzerine minimal klinik etki yapar [2,4] .…”

A reply

“…The incidence of renal failure was similar between the groups (10.4% and 9.2% of patients, p = 0.12). Several recent meta-analyes have shown 6% hydroxyethyl starch not to be associated with renal morbidity in the peri-operative setting [4,5].…”