Comparative study of hydroxyethylstarch 200/0.62 versus Dextran 60 in hemodilution during total hip replacement: influences on hemorheological parameters
Affiliations: Laboratoire d'hématologie, Hôpital Robert Debré , rue Alexis Carrel, 51100 Reims, France | Département d'anesthésiologie, Hôpital Robert Debré , rue Alexis Carrel, 51100 Reims, France
Abstract: Preoperative hemodilution can be used to save blood transfusion during total hip replacement. However, plasma substitutes do not show similar rheological properties. We have carried out a randomized study to compare the hemorheological changes induced by two artificial colloids: a 6% hydroxyethylstarch 200/0.62 (HES) versus a 6% dextran 60. Eleven patients in each group were infused with 20 mL/kg of either substitute, just after spinal anesthesia for total hip replacement. Whereas the dilutional effect was similar in the two groups with a decrease in the hematocrit to 0.30 L/L, significant differences were observed concerning the hemorheological parameters. In the dextran group, the plasma and the whole blood viscosities were increased until hour 24 while they were slightly decreased in the RES group. The erythrocyte aggregation was increased in the dextran group, but was decreased in the RES group until hour 24. The favourable effect of HES on blood fluidity persisted at day 7, with a slighter postoperative rise of the fibrinogen. We conclude that 6% HES 200/0.62 improves the hemorheological parameters better than 6% dextran 60, and can reduce the postoperative inflammatory reaction.
