The incidence of hydroxyethyl starch-associated pruritus

Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section IV: Treatment Options for the Management of Atopic Dermatitis

The objectives of therapy for atopic dermatitis (AD) are to reduce skin inflammation and pruritus, restore skin barrier function, and improve quality of life (QoL). Treatments can be classified as moisturizing and basic care, topical therapy, phototherapy, and systemic therapy. In this review, we summarize the treatments for AD and recommendations for their use.

Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass - a randomised controlled trial

Perioperative volume replacement after cardiopulmonary bypass is complicated by post-bypass systemic inflammatory process. The aim of this study was to assess the effects of using two different colloid solutions as priming fluids in cardiopulmonary bypass. The study's primary end point was to measure the amount of fluid replacement needed during and post-cardiopulmonary bypass; blood loss, change in blood profile and intraocular pressure were secondary end points, used as measures of plasma oncotic pressures. Patients undergoing coronary artery bypass grafting were recruited. Both patients and surgeons were blinded to receive either Gelofusine® or Voluven® as priming fluids. At fixed intervals during cardiopulmonary bypass, the patients had their intraocular pressures measured. Intra and postoperative fluid replacement was in the form of 4.5% human albumin and the amount was recorded for each subject. The result did not show any significant differences in the amount of fluid needed to be replaced, in blood loss or in blood profile between the two groups. However, it showed an increase in intraocular pressure in both groups once cardiopulmonary bypass commenced. The average intraocular pressure was higher in the Gelofusine ® group compared to the Voluven® group. The significant increase in intraocular pressure measurements in the Gelofusine® group compared to the Voluven® group support the hypothesis that Voluven maintains the plasma oncotic pressure better and reduces fluid shift. Perfusion (2007) 22, 57—62.

Hydroxyethyl starch: a review of pharmacokinetics, pharmacodynamics, current products, and potential clinical risks, benefits, and use

OBJECTIVE

To review and summarize the pharmacokinetics and pharmacodynamics of hydroxyethyl starch (HES), as well as reported risks and benefits of HES infusion, and to provide administration and monitoring recommendations for HES use in dogs and cats.

DATA SOURCES

Veterinary and human peer-reviewed medical literature, including scientific reviews, clinical and laboratory research articles, and authors' clinical experience.

SUMMARY

HES solutions are the most frequently used synthetic colloid plasma volume expanders in human and veterinary medicine. The majority of research in human medicine has focused on the adverse effects of HES infusion, with emphasis on acute kidney injury and coagulation derangements. The studies often differ in or fail to report factors, such as the type, amount, interval, and concentration of HES administered; the patient population studied; or concurrent fluids administered. Currently, there is no definitive clinical evidence that the reported adverse effects of HES use in human medicine occur in veterinary species. There is little information available on HES administration techniques or simultaneous administration of additional fluids in human and veterinary medicine. The rationale for HES use in small animals has been largely extrapolated from human medical studies and guidelines. A controlled approach to intravenous fluid resuscitation using crystalloid and HES volumes titrated to reach desired resuscitation end point parameters is outlined for small animal practitioners.

CONCLUSION

The extrapolation of data from human studies directly to small animals should be done with the knowledge that there may be species variations and different pharmacokinetics with different HES solutions. Veterinary reports indicate that bolus and continuous rate infusions of 6% hetastarch solutions at moderate doses are well tolerated in feline and canine subjects. Further research in domesticated species is necessary to better define and expand the knowledge regarding use of HES solutions in small animal medicine.

Pruritus precipitated by hydroxyethyl starch: a review

Hydroxyethyl starch (HES) is widely used for fluid management in broad populations of patients, particularly in the surgery and intensive care settings. Pruritus, often manifested as pruritic crises, is increasingly being recognized as a common major adverse effect of HES administration. This iatrogenic form of pruritus is frequently severe and protracted with a serious negative impact on patient quality of life, including sleep disturbance, disruption of daily routine and mental distress. Such pruritus is generally refractory to available therapies and can persist for up to 12-24 months. All currently clinically available HES solutions entail the risk of pruritus, including those of diverse molecular weights and substitutions. Although dose dependent, HES-induced pruritus nevertheless can often be provoked by relatively low routine doses. The pathophysiological basis for pruritus is the widespread tissue deposition of HES, prominently in macrophages. HES tissue deposits are long lasting and sometimes massive. Usually several weeks elapse between HES exposure and the onset of pruritus. Consequently, it is important to inquire about prior HES exposure in the diagnostic evaluation of pruritus sine materia. Awareness about the scope of the pruritus problem needs to increase among physicians administering HES. Well-designed clinical outcome studies are needed to assess more fully the incidence, dose dependency and mechanisms of pruritus with particular HES solutions.

Blood substitutes

Blood substitutes are solutions intended to replace transfusion of banked red blood cells. Several variations of products based on either hemoglobin (animal or human) or perfluorocarbon emulsions are in advanced stages of clinical development. The need for such products is pressing as shortages of banked blood worsen and awareness of the dangers of blood transfusion increases. Animal and human studies with these cell-free oxygen carriers have led to new concepts of how oxygen is delivered to tissue and how the microcirculation is regulated. Although development of products is exciting and timely, understanding how they function to perfuse and oxygenate tissue could be at least as important. Because cell-free oxygen carriers will perfuse every organ of the body, their effects are far-reaching, and the transition from the laboratory to the bedside can be expected to be slow and deliberate. Comparison of oxygen carriers with more traditional starch-based products provides new insight into the interaction of oxygen transport, microvascular perfusion, and blood volume expansion.