Document Detail


Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4) Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection.
MedLine Citation:
PMID:  23438799     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Hydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes.
METHODS: In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15mL.kg(-1) of HES 130/0.4 and 24 patients received a preload of 30mL.kg(-1) lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications.
RESULTS: Red blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p=.029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p=.037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection.
CONCLUSIONS: During hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.
Authors:
Adilson Hamaji; Ludhmila Hajjar; Marcelo Caiero; Juliano Almeida; Rosana Ely Nakamura; Eduardo A Osawa; Julia Fukushima; Filomena R Galas; Jose Otavio Costa Auler Junior
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Revista brasileira de anestesiologia     Volume:  63     ISSN:  1806-907X     ISO Abbreviation:  Rev Bras Anestesiol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-02-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401316     Medline TA:  Rev Bras Anestesiol     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  27-44     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
Affiliation:
Anesthesia Division, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil.
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