Anesth Analg 2005;100:1846-1853
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000152008.04333.53
GENERAL ARTICLES
A Triple-Blinded Randomized Trial Comparing the Hemostatic Effects of Large-Dose 10% Hydroxyethyl Starch 264/0.45 Versus 5% Albumin During Major Reconstructive Surgery
Ramiro Arellano, MD, MSc, FRCPC,
Bing Siang Gan, MD, PhD, FRCSC, FACS,
Mary Jane Salpeter, RN,
Erik Yeo, MD, PhD, FRCPC,
Stuart McCluskey, MD, PhD, FRCPC,
Ruxandra Pinto, PhD,
Jonathan Irish, MD, MSc, FRCSC,
Douglas C. Ross, MD, FRCSC,
D. John Doyle, MD, PhD, FRCPC,
John Parkin, MD, FRCPC,
Dale Brown, MD, FRCSC,
Lorne Rotstein, MD, FRCSC, FACS,
Ian Witterick, MD, FRCSC,
Wayne Matthews, MD, FRCSC,
John Yoo, MD, FRCSC,
Peter C. Neligan, MD, FRCSC, FACS,
Pat Gullane, MD, FRCSC, FACS, and
Howard Lampe, MD, FRCSC
Departments of Anesthesia, Surgery, Hematology, Otolaryngology, Biostatistics and Clinical Epidemiology. The Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada and St. Joseph’s Health Centre, University of Western Ontario, London, Ontario, Canada
Address correspondence and reprint requests to Ramiro Arellano, MD, MSc, FRCPC, Department of Anesthesia, Kingston General Hospital, 76 Stuart Street Kingston, Ontario, Canada K7L 2V7. Address e-mail to arel111{at}yahoo.com.
In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. Fifty patients were randomized to receive HES 264/0.45 or 5% human albumin from the induction of anesthesia until 24 h thereafter. Both albumin and HES 264/0.45 effectively maintained physiologic variables in the perioperative and postoperative periods. The partial thromboplastin time and international normalized ratio were significantly increased in the HES 264/0.45 group compared with the albumin group after infusion of 30 mL/kg and 45 mL/kg (P < 0.05). Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.
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