Comparison of a Waxy Maize and a Potato Starch-Based Balanced Hydroxyethyl Starch for Priming in Patients Undergoing Coronary Artery Bypass Grafting

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• 作者：Brijindera Singh Sethi ; MD^* ; ^{drbssethi72@gmail.com" class="auth_mail} ; Sandeep Chauhan ; MD^* ; Akshay Kumar Bisoi ; MCh^&dagger ; ; Poonam Malhotra Kapoor ; MD^* ; Usha Kiran ; MD^* ; Randhir Singh Rajput ; MD^*
• 关键词：cardiopulmonary bypass ; coagulation ; hemodilution ; hydroxyethyl starch ; priming ; outcome
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：June 2014
• 年：2014
• 卷：28
• 期：3
• 页码：690-697
• 全文大小：191 K

文摘

Concerns have been raised about differences in the safety profile of potato- versus waxy maize-derived hydroxyethyl starch (HES). The objective of this study was to compare 2 HES solutions derived from 2 different source materials (potato versus waxy maize) for their dose-related effects on hemostasis and organ function when used to prime the cardiopulmonary bypass circuit (CPB).

Design

A prospective, randomized, controlled study.

Setting

Tertiary care center.

Participants

Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB.

Interventions

For priming the CPB circuit, the HES_PRL group received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500 mL of Ringer’s lactate; the HES_P group received 1,500 mL of potato-derived balanced 6% HES 130/0.42; the HES_MRL group received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with 500 mL of Ringer’s lactate, and the HES_M group received 1500 mL of waxy maize-derived balanced 6% HES 130/0.4.

Measurements and Main Results

There were no significant differences in 24-hour mediastinal drainage, rate of re-exploration, blood product usage, coagulation parameters, and measures of pulmonary, renal, and hepatic function with respect to plant source of HES, when equivalent doses were used. Sonoclot activated clotting time (SonACT) was significantly higher and clot rate (CR) significantly lower at end of surgery (T₁) and 24 hours after surgery (T₂) in the HES_P and HES_M groups compared with the HES_PRL and HES_MRL groups. Compared with baseline, CR and platelet function were significantly lower at T₁, PaO₂/F_IO₂ ratio decreased significantly at T₁ and T_2, and serum bilirubin and transaminases increased significantly at T₂ in all 4 groups.

Conclusions

There was no significant difference in cumulative 24-hour mediastinal drainage when potato-derived balanced 6% HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to prime the CPB circuit in patients undergoing CABG. In equal doses, both starches exerted the same effect on blood coagulation and pulmonary, renal, and hepatic function.