The Effect of 6% Hydroxyethyl Starch 130/0.4 on Hemostasis and Hemodynamic Efficacy in Off-pump Coronary Artery Bypass Surgery: a Comparison with 6% Hydroxyethyl Starch 200/0.5

Abstract

Background:This study was designed to compare the effect of low-molecular 6% hydroxyethyl starch (HES) 130/0.4 on hemostasis and hemodynamic efficacy with that of medium-molecular 6% HES 200/0.5 in patients undergoing off-pump coronary artery bypass surgery.Methods: Forty-eight patients were randomized to receive up to 33 ml/kg of either 6% HES 130/0.4 or 6% HES 200/0.5. Hemodynamic variables and blood tests including thromboelastography were measured 10 min after induction (baseline value, T0), 5 min after acute loading of HES 10 ml/kg (T1) in hypovolemic patients, after sternum closure (T2), and 16 hr after intensive care unit (ICU) arrival (T3). Chest tube drainage was recorded until 16 hours after ICU arrival.Results: Hemodynamic variables were similar in both groups. Chest tube drainage at 16 hr after surgery was higher in HES 200/0.5 group than that in HES 130/0.4 group. Maximum clot firmness was decreased in HES 200/0.5 group at sternal closure but not in HES 130/0.4 group.Conclusions: Both HES 200/0.5 and HES 130/0.4 were equally efficient in maintaining stable hemodynamics during off-pump coronary artery bypass surgery. However, HES 130/0.4 may reduce postoperative blood loss compared to that of HES 200/0.5 at the same dose of 33 ml/kg. (Korean J Anesthesiol 2007; 53: S 14～21)

A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery

“…[4] Though colloids such as hydroxyl ethyl starch (HES) are effectively used for intraoperative volume replacement and plasma volume expansion, they may cause coagulopathy and result in postoperative blood loss. [5,6] The search for the newer modes to facilitate reduction in perioperative blood loss continues, the use of fibrinolytic inhibitors such as TA may be an effective method to promote blood conservation; but, the possible complications of thrombosis of coronary artery graft, precludes their regular use in coronary artery bypass graft surgeries. [1,6,7] In this study we assessed the hemostatic effects of concomitant use of HES and TA.…”

Fluid Optimization With Hydroxyethyl Starch 130/0.4 Compared With Modified Fluid Gelatin Guided by Esophageal Doppler During Major Abdominal Surgeries

“…These results may be induced not only from hemodilution but also due to their pharmacological properties (Jin and Yu, 2010). Biochemical data representing liver and kidney function remained within normal limit after the off-pump coronary artery bypass surgery when using HES (Kim et al 2007). However, in meta-analysis conducted in 2012 concluded that the poor quality and small size of available studies don't allow the benefits and risks of HES 130/ 0.4 to be reliably estimated (Gattas et al, 2012).…”