The Effects of Colloid Pre-Loading on Thromboelastography Prior to Caesarean Delivery: Hydroxyethyl Starch 130/0.4 versus Succinylated Gelatine

Abstract

This prospective, randomized, double-blind study compared the effects on thromboelastography (TEG) of pre-loading with two different colloid fluids prior to spinal anaesthesia for caesarean section. Healthy full-term parturients received either 500 ml 6% hydroxyethyl starch 130/0.4 (HES, n = 25) or 500 ml 4% succinylated gelatine (GEL, n = 25) prior to spinal anaesthesia. TEG parameters including reaction time (r-time), clot formation time (k-time), clot formation rate (α-angle) and maximum amplitude (MA) were measured immediately before and after pre-loading. Both groups had significantly shorter r-time and lower MA after pre-loading. The α-angle was significantly decreased after pre-loading with HES but not with GEL. No significant differences in k-time were induced pre-loading. In conclusion, pre-loading with HES or GEL was associated with a mild hypocoagulable effect in healthy parturients presenting for elective caesarean section; however, all TEG parameters in both groups remained within or very close to the normal range after pre-loading.

6% Hydroxyethyl starch (130/0.4) vs Ringer's lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial

“…Our results also indicated that the use of HES was not associated with any increased propensity to bleeding and standard coagulation parameters were unaltered; this lack of clinically significant bleeding is likely due to the very mild coagulation impairment produced by 500 ml 6% HES (130/0.4) preloading, only detectable by thromboelastography. 23 There was no postoperative renal dysfunction in any patient, and no differences between the two groups regarding plasma creatinine variation from day 0 to day 1. This is also in accordance with recent studies showing the safety of this third-generation HES on renal function, 24 25 particularly when used in an acute trauma setting with hypovolaemic risk.…”

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

“…This is particularly important since previous studies of pregnant patients undergoing cesarean delivery receiving HES showed impairment in viscoelastic testing despite the rise in coagulation factors during pregnancy. In these patients, thromboelastometry demonstrated impairment in clot formation and clot firmness [12] and thromboelastography showed a mild hypocoagulable state [11, 13]. …”

“…Fibrinogen is vital for the development of a firm clot and achieving hemostasis. Furthermore, in healthy term patients, functional coagulation profiles measured with thromboelastography and thromboelastometry showed changes in various viscoelastic parameters with infusion of HES at the time of cesarean delivery [11–13]. However, it is not known whether HES administration to patients undergoing cesarean delivery increases the risk of clinical bleeding.…”

Anesthesia for Cesarean Section

“…About 500 -1000 ml of fluid (10-15 ml/kg crystalloid over 20 minutes) or colloid (such as 6% hydroxyethyl starch, 4% succinylated gelatin (Turker et al, 2011)) is used. Crystalloid rapidly moves into the interstitial space and therefore, the increase in central blood volume garnered from an intravenous bolus of crystalloid (no matter how much) is fleeting.…”