Volume replacement therapy during major orthopedic surgery using Voluven® (Hydroxyethyl starch 130/0.4) or hetastarch

Sweeta D. Gandhi, Richard B. Weiskopf, Cornelius Jungheinrich, Robert Koorn, Diane Miller, Robert Shangraw, Donald S. Prough, Daniela Baus, Frank Bepperling, David C. Warltier

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

BACKGROUND: The purpose of this study was to test the equivalence of efficacy and compare the safety of the 6% hydroxyethyl starches (HES) Voluven® (HES 130/0.4; Fresenius Kabi, Bad Homburg, Germany) and hetastarch (HES 670/0.75 in saline) for intravascular volume replacement therapy during major orthopedic surgery. METHODS: In a prospective, controlled, randomized, double-blind, multicenter trial of patients undergoing major orthopedic surgery, 49 patients were treated with HES 130/0.4 and 51 patients were treated with hetastarch. Infusion of colloids was guided by central venous and arterial blood pressures. The primary efficacy endpoint was the volume of colloid solution infused; the primary safety endpoints were calculated total erythrocyte loss, the nadir factor VIII activity, and the nadir von Willebrand factor concentration within 2 h of completion of surgery. RESULTS: The total volume of colloid solution required for intraoperative volume replacement did not differ between HES 130/0.4 and hetastarch (1,613 ± 778 [SD] ml for HES 130/0.4 and 1,584 ± 958 ml for hetastarch). The nadir factor VIII activity within 2 h of the end of surgery was lower for hetastarch than for HES 130/0.4 (P = 0.0499); for those who received greater than 1,000 ml colloid, the nadir factor VIII activity and von Willebrand factor concentration within 2 h of end of surgery were lower for hetastarch than for HES 130/0.4 (P = 0.0487 and P = 0.008, respectively). CONCLUSION: Voluven® (HES 130/0.4) and hetastarch are equally efficacious plasma volume substitutes; however, HES 130/0.4 has a lesser effect on coagulation.

Original languageEnglish (US)
Pages (from-to)1120-1127
Number of pages8
JournalAnesthesiology
Volume106
Issue number6
DOIs
StatePublished - Jun 2007

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Hydroxyethyl Starch Derivatives
Orthopedics
Colloids
Therapeutics
Factor VIII
HES 130-0.4
Starch
Plasma Substitutes
Safety
Venous Pressure
Plasma Volume

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Volume replacement therapy during major orthopedic surgery using Voluven® (Hydroxyethyl starch 130/0.4) or hetastarch. / Gandhi, Sweeta D.; Weiskopf, Richard B.; Jungheinrich, Cornelius; Koorn, Robert; Miller, Diane; Shangraw, Robert; Prough, Donald S.; Baus, Daniela; Bepperling, Frank; Warltier, David C.

In: Anesthesiology, Vol. 106, No. 6, 06.2007, p. 1120-1127.

Research output: Contribution to journalArticle

Gandhi, SD, Weiskopf, RB, Jungheinrich, C, Koorn, R, Miller, D, Shangraw, R, Prough, DS, Baus, D, Bepperling, F & Warltier, DC 2007, 'Volume replacement therapy during major orthopedic surgery using Voluven® (Hydroxyethyl starch 130/0.4) or hetastarch', Anesthesiology, vol. 106, no. 6, pp. 1120-1127. https://doi.org/10.1097/01.anes.0000265422.07864.37
Gandhi, Sweeta D. ; Weiskopf, Richard B. ; Jungheinrich, Cornelius ; Koorn, Robert ; Miller, Diane ; Shangraw, Robert ; Prough, Donald S. ; Baus, Daniela ; Bepperling, Frank ; Warltier, David C. / Volume replacement therapy during major orthopedic surgery using Voluven® (Hydroxyethyl starch 130/0.4) or hetastarch. In: Anesthesiology. 2007 ; Vol. 106, No. 6. pp. 1120-1127.
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T1 - Volume replacement therapy during major orthopedic surgery using Voluven® (Hydroxyethyl starch 130/0.4) or hetastarch

AU - Gandhi, Sweeta D.

AU - Weiskopf, Richard B.

AU - Jungheinrich, Cornelius

AU - Koorn, Robert

AU - Miller, Diane

AU - Shangraw, Robert

AU - Prough, Donald S.

AU - Baus, Daniela

AU - Bepperling, Frank

AU - Warltier, David C.

PY - 2007/6

Y1 - 2007/6

N2 - BACKGROUND: The purpose of this study was to test the equivalence of efficacy and compare the safety of the 6% hydroxyethyl starches (HES) Voluven® (HES 130/0.4; Fresenius Kabi, Bad Homburg, Germany) and hetastarch (HES 670/0.75 in saline) for intravascular volume replacement therapy during major orthopedic surgery. METHODS: In a prospective, controlled, randomized, double-blind, multicenter trial of patients undergoing major orthopedic surgery, 49 patients were treated with HES 130/0.4 and 51 patients were treated with hetastarch. Infusion of colloids was guided by central venous and arterial blood pressures. The primary efficacy endpoint was the volume of colloid solution infused; the primary safety endpoints were calculated total erythrocyte loss, the nadir factor VIII activity, and the nadir von Willebrand factor concentration within 2 h of completion of surgery. RESULTS: The total volume of colloid solution required for intraoperative volume replacement did not differ between HES 130/0.4 and hetastarch (1,613 ± 778 [SD] ml for HES 130/0.4 and 1,584 ± 958 ml for hetastarch). The nadir factor VIII activity within 2 h of the end of surgery was lower for hetastarch than for HES 130/0.4 (P = 0.0499); for those who received greater than 1,000 ml colloid, the nadir factor VIII activity and von Willebrand factor concentration within 2 h of end of surgery were lower for hetastarch than for HES 130/0.4 (P = 0.0487 and P = 0.008, respectively). CONCLUSION: Voluven® (HES 130/0.4) and hetastarch are equally efficacious plasma volume substitutes; however, HES 130/0.4 has a lesser effect on coagulation.

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