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Korean J Anesthesiol > Volume 46(2); 2004 > Article
Korean Journal of Anesthesiology 2004;46(2):204-212.
DOI: https://doi.org/10.4097/kjae.2004.46.2.204   
The Influences of 6% HES (130/0.4) Solution on Hemostasis.
Yoo Sung Jeong, Kyungtae Kim, Byung Hoon Yoo, Kyemin Kim, Younsuk Lee, Jun Heum Yon, Ki Hyuk Hong
Department of Anesthesiology, College of Medicine, Inje University, Seoul, Korea.
Abstract
BACKGROUND
Hydroxyethyl starches (HES) solutions are the most commonly used colloids for treating hypovolemia and expanding plasma, but they compromise platelet function and reduce the level of coagulation factors. As opposed to other HES solutions, 6% HES (130/0.4) solution may influence hemostasis minimally due to its low mean molecular weight and degree of substitution. This study was designed to establish the safety of HES (130/0.4) infusion in the presence of massive blood loss.
METHODS
Twelve healthy adult patients scheduled for spine surgery were enrolled in this study. Before the induction of general anesthesia, all patients underwent acute normovolemic hemodilution (ANH), which was independent of surgical stress and other confounding factors. While approximately 30% of the estimated blood volume was procured, the blood deficit was replaced with the same volume of 6% HES (130/0.4) solution. Hematocrit, platelet count, factor VIII activity and plasma fibrinogen concentration were determined and thrombelastography was performed to evaluate the hemodilution effect and hemostatic impairment before and after ANH. Statistical testing was conducted to analyze the effect of HES on hemostasis.
RESULTS
Hematocrit, platelet count, factor VIII activity and plasma fibrinogen concentrations decreased significantly (P < 0.05 respectively) after the ANH. On comparing pre-ANH and post-ANH thrombelastographic findings, the R time was shortened (P = 0.045), the alpha angle increased (P = 0.01) and MA decreased (P = 0.003) significantly.
CONCLUSIONS
Summarizing, little effect was observed on the hemostatic system when 20 ml/kg of 6% HES (130/0.4) solution was infused. HES (130/0.4) solution as used to maintain normovolemia during ANH may be free from bleeding risk.
Key Words: hemostasis; hydroxyethyl starch; thrombelastography
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