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Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxethy starch (HES 200/0.62, 6%)

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Abstract

Objective

To define the mechanisms of the stable and prolonged post-operative plasma volume expansion observed with Hydroxyethyl Starches (HES) and to determine whether a partial intravascular hydrolysis of large molecules contribute to reinforce the colloid-osmotic effect.

Design

Prospective, pharmacologic study using single dose of drug.

Setting

University-based, post-anesthesia care unit.

Patients

The protocol was performed during the post-operative period, in 10 patients after stable recovery from general anesthesia for carotid endarterectomy.

Interventions

HES 200/0.62 (500 ml) was infused over 30 min. Standard hemodynamic and biological variables, HES concentration and colloid osmotic pressure were obtained at each measurement. Plasma volume was calculated using51Cr-labelled RBCs. Patterns of changes in number average molecular weight (MWn) and weight average MW (MWw) were measured using gel permeation chromatography. Measurements were obtained at control, end of infusion, 1 h, 3 h, 6 h and 24 h after infusion.

Measurements and main results

Plasma volume increased by 693 ml (+21%) after the infusion of HES and remained constant over 24 h. HES concentration progressively decreased to reach a value of 35% of the peak at 24 h. MWn and MWw, initially decreased when compared with the dose solution and changed little in the 24 h study period. Diuresis significantly decreased at 3 h up to 24 h. Plasma albumin decreased after infusion and then progressively increased to reach a significantly higher value at 24 h than after infusion.

Conclusion

Initial plasma volume expansion and decrease in HES concentration agree with previously-published data. Maintenance of plasma volume expansion over 24 h was not related to a partial intravascular hydrolysis. Low elimination rate of HES, extravascular mobilization of albumin and post-operative renal adaptations were possibly the 3 main mechanisms to explain a prolonged plasma volume expansion with HES 200/0.62, 6%.

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Authors and Affiliations

  1. Départment d'Anesthésie-Réanimation, Hôpial Tenon, France

    A. C. Degrémont

  2. Départment d'Anesthésie-Réanimation, Hôpial Pitié-Salpétrière, Paris, France

    M. Ismaïl

  3. Laboratoire des Urgences, Hôpital Pitié-Salpétrière, Paris, France

    M. Arthaud

  4. Laboratoire Central de Biochimie, Hôpital Broussais, Paris, France

    B. Oulare & M. Paris

  5. Laboratoire de Médecine Nucléaire, Hôpital Lariboisière, France

    O. Mundler

  6. Départment d'Anesthésie-Réanimation, Hôpital Broussais, 96 rue Didot, F-75014, Paris, France

    J. F. Baron

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  1. A. C. Degrémont
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  2. M. Ismaïl
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  3. M. Arthaud
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  4. B. Oulare
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  5. O. Mundler
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  6. M. Paris
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  7. J. F. Baron
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Degrémont, A.C., Ismaïl, M., Arthaud, M. et al. Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxethy starch (HES 200/0.62, 6%). Intensive Care Med 21, 577–583 (1995). https://doi.org/10.1007/BF01700163

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  • DOI: https://doi.org/10.1007/BF01700163

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