Plasma substitution effects of a new hydroxyethyl starch HES 130/0.4 compared with HES 200/0.5 during and after extended acute normovolaemic haemodilution

Background. The volume expansion effect of a recently introducedhydroxyethyl starch, HES 130/0.4, was compared with the commonlyused HES 200/0.5 after rapid infusion of a single large dose(up to 2 litres) administered during acute normovolaemic haemodilution(ANH). Methods. This prospective, randomized, double-blind study included40 patients scheduled for major abdominal surgery with no contraindicationto ANH. Patients were randomized to undergo ANH with eitherHES 130/0.4 (n=20) or HES 200/0.5 (n=20). Blood was collectedto reach a target haemoglobin level of about 8.0 g dl^–1and simultaneously replaced by the same volume of colloid (HES130: 1825 [SD 245] ml; HES 200: 1925 [183] ml). Heart rate,mean arterial pressure, cardiac filling pressure, and cardiacoutput were measured before induction of anaesthesia (baseline),10 min after completion of ANH, before surgery, at the end ofsurgery and on the following morning (postoperative day 1; POD1).ANH blood was systematically retransfused during surgery orbefore POD1. Results. Exchange of about 40% of blood volume resulted in similarhaemodynamic changes in both groups. Filling pressures increasedsignificantly, while cardiac index remained unchanged (HES 130:from 3.3 [0.4] to 3.2 [0.7] litre min^–1 m^–2; HES200: from 3.0 [0.6] to 3.1 [0.7] litre min^–1 m^–2).Need for crystalloids and colloids was similar between the groupsduring surgery and on POD1. Total blood loss (HES 130: median2165 ml, range 660–2970 ml; HES 200: median 2464 ml, range640–19 380 ml) and amount of allogeneic red blood cellstransfused (HES 130: median 0, range 0–4 units; HES 200:median 0, range 0–18 units) were comparable in the twogroups. Conclusions. This study demonstrates a good immediate and medium-termplasma volume substitution effect of HES 130 compared with HES200. HES 130 could represent a suitable synthetic colloid forplasma volume substitution during extensive ANH. Br J Anaesth 2003; 91: 196–202