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Moore JM, Garg K, Laskowski IA, Maldonado TS, Mateo RB, Babu S, Goyal A, Ventarola DJ, Chang H. Intraoperative Infusion of Dextran Confers No Additional Benefit after Carotid Endarterectomy but Is Associated with Increased Perioperative Major Adverse Cardiac Events. Ann Vasc Surg 2023; 97:8-17. [PMID: 37004920 DOI: 10.1016/j.avsg.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Intraoperative dextran infusion has been associated with reduction of an embolic risk in patients undergoing carotid endarterectomy (CEA). Nonetheless, dextran has been associated with adverse reactions, including anaphylaxis, hemorrhage, cardiac, and renal complications. Herein, we aimed to compare the perioperative outcomes of CEA stratified by the use of intraoperative dextran infusion using a large multiinstitutional dataset. METHODS Patients undergoing CEA between 2008 and 2022 from the Vascular Quality Initiative database were reviewed. Patients were categorized by use of intraoperative dextran infusion, and demographics, procedural data, and in-hospital outcomes were compared. Logistic regression analysis was utilized to adjust for differences in patients while assessing the association between postoperative outcomes and intraoperative infusion of dextran. RESULTS Of 140,893 patients undergoing CEA, 9,935 (7.1%) patients had intraoperative dextran infusion. Patients with intraoperative dextran infusion were older with lower rates of symptomatic stenosis (24.7% vs. 29.3%; P < 0.001) and preoperative use of antiplatelets, anticoagulants and statins. Additionally, they were more likely to have severe carotid stenosis (>80%; 49% vs. 45%; P < 0.001) and undergo CEA under general anesthesia (96.4% vs. 92.3%; P < 0.001), with a more frequent use of shunt (64.4% vs. 49.5%; P < 0.001). After adjustment, multivariable analysis showed that intraoperative dextran infusion was associated with higher odds of in-hospital major adverse cardiac events (MACE), including myocardial infarction [MI] (odds ratio [OR], 1.76, 95% confidence interval [CI]: 1.34-2.3, P < 0.001), congestive heart failure [CHF] (OR, 2.15, 95% CI: 1.67-2.77, P = 0.001), and hemodynamic instability requiring vasoactive agents (OR, 1.08, 95% CI: 1.03-1.13, P = 0.001). However, it was not associated with decreased odds of stroke (OR, 0.92, 95% CI: 0.74-1.16, P = 0.489) or death (OR, 0.88, 95% CI: 0.58-1.35, P = 0.554). These trends persisted even when stratified by symptomatic status and degree of stenosis. CONCLUSIONS Intraoperative infusion of dextran was associated with increased odds of MACE, including MI, CHF, and persistent hemodynamic instability, without decreasing the risk of stroke perioperatively. Given these results, judicious use of dextran in patients undergoing CEA is recommended. Furthermore, careful perioperative cardiac management is warranted in select patients receiving intraoperative dextran during CEA.
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Affiliation(s)
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Medical Center, New York, NY
| | - Igor A Laskowski
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Medical Center, New York, NY
| | - Romeo B Mateo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Sateesh Babu
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Arun Goyal
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Daniel J Ventarola
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Heepeel Chang
- New York Medical College, Valhalla, NY; Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.
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Construction of a Novel Chimeric Dextransucrase Fused to the Carbohydrate-Binding Module CBM2a. Catalysts 2021. [DOI: 10.3390/catal11101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lactic acid bacteria (LAB) have the potential to produce homoexopolysaccharides (HoPS). Their health benefits and physicochemical properties have been the subject of extensive research. The HoPS functional properties are determined by molecular weight, the type of glycosidic linkages, degrees of branching and chemical composition. The dextransucrases (DSases) produce a kind of HoPS (dextrans), which are among the first biopolymers produced at industrial scale with applications in medicine and biotechnology. The glycodiversification opens additional applications for DSases. Therefore, the design and characterization of new DSases is of prime importance. Previously, we described the isolation and characterization of a novel extracellular dextransucrase (DSR-F) encoding gene. In this study, from DSR-F, we design a novel chimeric dextransucrase DSR-F-∆SP-∆GBD-CBM2a, where DSR-F-∆SP-∆GBD (APY repeats and a CW repeat deleted) was fused to the carbohydrate-binding module (CBM2a) of the β-1-4 exoglucanase/xylanase Cex (Xyn10A) of Cellulomonas fimi ATCC 484. This dextransucrase variant is active and the specificity is not altered. The DSR-F-∆SP-∆GBD-CBM2a was purified by cellulose affinity chromatography for the first time. This research showed that hybrids and chimeric biocatalyst DSases with novel binding capacity to cellulose can be designed to purify and immobilize using renewable lignocellulosic materials as supports.
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Midorikawa Y, Saito J, Kitayama M, Toyooka K, Hirota K. Intra-operative intravascular effect of the difference in colloid solutions during acute normovolemic hemodilution. JA Clin Rep 2021; 7:70. [PMID: 34518959 PMCID: PMC8436869 DOI: 10.1186/s40981-021-00473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background Acute normovolemic hemodilution (ANH) is used to reduce the risk of peri-operative allogeneic blood transfusion. Although crystalloid and/or colloid solutions have been used for volume replacement during ANH, no studies have examined the differences among solutions on the volume status, electrolytes, acid-base balance, and hemodynamic status during surgery with ANH. Methods We retrospectively compared the effect of Ringer’s lactate with 3% dextran-40 (Saviosol®, DEX group) and 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®, HES group) on blood hemoglobin serum electrolytes and estimated blood volume before induction of anesthesia (baseline), after ANH and after blood transfusion following surgery in patients undergoing open gynecological surgery (n = 111 and 67, respectively). The primary outcomes were the changes in hemoglobin and electrolytes after ANH. Results There were no differences in hemoglobin or electrolytes between the two groups at baseline. Postoperative hemoglobin was significantly higher (11.0 ± 1.5 g/dL vs 9.9 ± 1.3 g/dL) (mean ± SD) in the DEX group than in the HES group (p = 0.03). Postoperative potassium was significantly decreased from the baseline both in the DEX group (137.9 ± 2.5 mmol/L vs 136.3 ± 2.7 mmol/L) and in the HES group (138.3 ± 2.0 mmol/L vs 137.8 ± 2.5 mmol/L) (p < 0.001 for both); however, it was significantly higher than in the DEX group after surgery (p < 0.001). Estimated blood volume after surgery was significantly increased after ANH in both groups; however, it was larger in the HES group than in the DEX group. Conclusions Postoperative hemoglobin and potassium were significantly higher, and estimated blood volume was significantly smaller in the DEX than in the HES group.
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Affiliation(s)
- Yoko Midorikawa
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
| | - Masato Kitayama
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Kentaro Toyooka
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
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Chen H, Pu Y, Zou Q, Hou D, Chen S. Enzymatic degradation of aqueous dextrans as affected by initial molecular weight and concentration. Polym Bull (Berl) 2021. [DOI: 10.1007/s00289-020-03351-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gratz J, Zotti O, Pausch A, Wiegele M, Fleischmann E, Gruenberger T, Krenn CG, Kabon B. Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial. J Clin Med 2021; 10:jcm10081651. [PMID: 33924407 PMCID: PMC8068812 DOI: 10.3390/jcm10081651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
The use of colloids may impair hemostatic capacity. However, it remains unclear whether this also holds true when colloids are administered in a goal-directed manner. The aim of the present study was to assess the effect of goal-directed fluid management with 6% hydroxyethyl starch 130/0.4 on hemostasis compared to lactated Ringer’s solution in patients undergoing partial hepatectomy. We included 50 patients in this prospective, randomized, controlled trial. According to randomization, patients received boluses of either hydroxyethyl starch or lactated Ringer’s solution within the scope of goal-directed fluid management. Minimum perioperative FIBTEM maximum clot firmness (MCF) served as the primary outcome parameter. Secondary outcome parameters included fibrinogen levels and estimated blood loss. In the hydroxyethyl starch (HES) group the minimum FIBTEM MCF value was significantly lower (effect size −6 mm, 95% CI −10 to −3, p < 0.001) in comparison to the lactated Ringer’s solution (RL) group. These results returned to normal within 24 h. We observed no difference in plasma fibrinogen levels (RL 3.08 ± 0.37 g L−1 vs HES 2.65 ± 0.64 g L−1, p = 0.18) or the amount of blood loss between the two groups (RL 470 ± 299 mL vs HES 604 ± 351 mL, p = 0.18). We showed that goal-directed use of HES impairs fibrin polymerization in a dose-dependent manner when compared with RL. Results returned to normal on the first postoperative day without administration of procoagulant drugs and no differences in blood loss were observed.
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Affiliation(s)
- Johannes Gratz
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
| | - Oliver Zotti
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
| | - André Pausch
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
| | - Marion Wiegele
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
| | - Edith Fleischmann
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
- Correspondence:
| | - Thomas Gruenberger
- Department of Surgery, HPB-Center, Kaiser Franz Josef Hospital Vienna, Kundratstrasse 3, 1100 Vienna, Austria;
| | - Claus G. Krenn
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
| | - Barbara Kabon
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (J.G.); (O.Z.); (A.P.); (M.W.); (C.G.K.); (B.K.)
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Jonas J, Tomas V, Broz T, Durila M. Utility of rotational thromboelastometry in total hip replacement revision surgery (case-control study). Medicine (Baltimore) 2020; 99:e23553. [PMID: 33371082 PMCID: PMC7748196 DOI: 10.1097/md.0000000000023553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/06/2020] [Indexed: 12/01/2022] Open
Abstract
Total hip replacement revision surgery is accompanied by significant blood loss. Using rotational thrombelastometry (ROTEM) perioperatively to diagnose coagulopathy may help to provide rapid aimed therapy and thus decrease blood loss and the consumption of transfusion products. The aim of this case-control study was to find out whether point of care using of ROTEM may reduce blood loss and the consumption of blood transfusion products in hip replacement revision surgery.Data were prospectively collected from patients who underwent hip replacement revision surgery in the period 2017 to 2018 when the management of bleeding and coagulopathy was based on the results of ROTEM. Data were compared with a group of historical controls for the period 2015 to 2016 when bleeding and coagulopathy management was not based on ROTEM results. The consumption of blood transfusion products and perioperative blood loss were compared between the groups.The total number of analyzed patients was 90. Forty five patients were analyzed in the ROTEM group and the same number of patients were analyzed in the non-ROTEM group. Significantly decreased perioperative consumption of fresh frozen plasma and packed red blood cells was found in the ROTEM, as well as decreased perioperative blood loss comparing to non-ROTEM group. All data were statistically different with P < .05.Perioperative management of bleeding and coagulopathy based on the results of ROTEM during hip replacement revision surgery seems to help to decrease perioperative blood loss and the consumption of blood transfusion products, especially fresh frozen plasma.
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Gyllensten U, Bosdotter Enroth S, Stålberg K, Sundfeldt K, Enroth S. Preoperative Fasting and General Anaesthesia Alter the Plasma Proteome. Cancers (Basel) 2020; 12:cancers12092439. [PMID: 32867270 PMCID: PMC7564209 DOI: 10.3390/cancers12092439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Blood plasma collected at time of surgery is an excellent source of patient material for investigations into disease aetiology and for the discovery of novel biomarkers. Previous studies on limited sets of proteins and patients have indicated that pre-operative fasting and anaesthesia can affect protein levels, but this has not been investigated on a larger scale. These effects could produce erroneous results in case-control studies if samples are not carefully matched. Methods: The proximity extension assay (PEA) was used to characterize 983 unique proteins in a total of 327 patients diagnosed with ovarian cancer and 50 age-matched healthy women. The samples were collected either at time of initial diagnosis or before surgery under general anaesthesia. Results: 421 of the investigated proteins (42.8%) showed statistically significant differences in plasma abundance levels comparing samples collected at time of diagnosis or just before surgery under anaesthesia. Conclusions: The abundance levels of the plasma proteome in samples collected before incision, i.e., after short-time fasting and under general anaesthesia differs greatly from levels in samples from awake patients. This emphasizes the need for careful matching of the pre-analytical conditions of samples collected from controls to cases at time of surgery in the discovery as well as clinical use of protein biomarkers.
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Affiliation(s)
- Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Box 815, Uppsala University, SE-751 08 Uppsala, Sweden;
| | | | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden;
| | - Karin Sundfeldt
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, SE-416 85 Gothenburg, Sweden;
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Box 815, Uppsala University, SE-751 08 Uppsala, Sweden;
- Correspondence: ; Tel.: +46-18-4714913
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Hahn RG, Dull RO, Zdolsek J. The Extended Starling principle needs clinical validation. Acta Anaesthesiol Scand 2020; 64:884-887. [PMID: 32270471 DOI: 10.1111/aas.13593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
The Revised (or "Extended") Starling principle is based on highly controlled laboratory-based frog and rodent experiments and remains a hypothesis awaiting clinical validation. A key point is that the endothelial glycocalyx layer moves the oncotic gradient from being between the plasma and the interstitium to between the plasma and a virtually protein-free space between the glycocalyx and the endothelial cell membrane, which dramatically changes the prerequisites for fluid absorption from tissue to plasma. However, many experimental and clinical observations in humans agree poorly with the new microcirculatory proposals. The most troubling aspect of the explanation regarding the role of the glycocalyx in the Revised Starling principle is the effective reabsorption of fluid by skeletal muscle when the capillary filtration pressure is acutely reduced. Other issues include the plasma volume effects of hypertonic saline, iso-oncotic and hyper-oncotic albumin, fluid distribution during cardio-pulmonary bypass, and the virtually identical capillary leakage of plasma and albumin despite marked inflammation found in our fluid therapy studies. The Revised Starling principle deals mainly with steady-state conditions, but the circulatory system is highly dynamic. Second to second vasomotion is always operational and must be considered to understand what we observe in humans.
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Affiliation(s)
- Robert G. Hahn
- Research Unit Södertälje Hospital Södertälje Sweden
- Karolinska Institutet at Danderyds Hospital (KIDS) Stockholm Sweden
| | - Randal O. Dull
- Departments of Anesthesiology, Pathology, Physiology College of Medicine University of Arizona Tucson AZ USA
| | - Joachim Zdolsek
- Department of Anesthesiology and Intensive Care Department of Medical and Health Sciences Linköping University Linköping Sweden
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Fei B, Shen Q. Effects of molecule weight on the liquid adsorption, surface free energy and rheological properties of dextran. JOURNAL OF MACROMOLECULAR SCIENCE PART A-PURE AND APPLIED CHEMISTRY 2018. [DOI: 10.1080/10601325.2018.1496793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ben Fei
- State Key Laboratory for Modification of Chemical Fiber and Polymer, Polymer Department of Donghua University, Shanghai, P. R. China
| | - Qing Shen
- State Key Laboratory for Modification of Chemical Fiber and Polymer, Polymer Department of Donghua University, Shanghai, P. R. China
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Sigurjonsson J, Hedman D, Bansch P, Schött U. Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery. Perioper Med (Lond) 2018; 7:21. [PMID: 30202516 PMCID: PMC6126009 DOI: 10.1186/s13741-018-0100-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/30/2018] [Indexed: 01/28/2023] Open
Abstract
Background Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and, therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy. Methods Eighteen patients undergoing major gynaecological surgery were assigned to receive either 5% albumin or 6% dextran-70 with 9 patients in each group. Standard coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and platelet count, viscoelastic coagulation test thromboelastometry (ROTEM) and the Multiplate platelet aggregation test were used to test for coagulation defects at different time points perioperatively. Blood loss, blood loss replacement data and haemodynamic parameters were retrieved from anaesthetic and postoperative charts. A local departmental fluid and transfusion/infusion protocol assured haemoglobin > 90 g/l and mean arterial pressure > 65 mmHg with Ringer’s acetate in addition to the colloid use. Results There were no differences in demographic data between the groups. The tissue factor-activated (EXTEM) clot-structure parameter ROTEM A10 was decreased significantly in the dextran group as compared to the albumin group after the infusion of 500 ml of either colloid solution. The PT and aPTT were significantly prolonged, and the platelet count decreased postoperatively in the dextran group, whereas albumin only deranged fibrinogen levels as compared to preoperative levels. There were no differences in Multiplate platelet aggregometry, amount of haemorrhage or transfusion of blood components between the groups. Conclusions Standard plasma-based coagulation tests, platelet count and whole blood viscoelastic clot structure are affected by 6% dextran-70 to a greater extent than by 5% albumin, but platelet aggregation is not. Future studies should use more advanced haemodynamic monitoring to assess isovolemic plasma volume expansion with dextran and whether this affects haemostasis to a lesser degree.
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Affiliation(s)
- Johann Sigurjonsson
- 1Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty, Lund University, Lund, Sweden
| | - David Hedman
- 2Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, SE-221 85 Lund, Sweden
| | - Peter Bansch
- 1Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty, Lund University, Lund, Sweden.,2Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, SE-221 85 Lund, Sweden
| | - Ulf Schött
- 1Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty, Lund University, Lund, Sweden.,2Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, SE-221 85 Lund, Sweden
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Abstract
Supplemental Digital Content is available in the text An understanding of the half-life (T1/2) of infused fluids can help prevent iatrogenic problems such as volume overload and postoperative interstitial oedema. Simulations show that a prolongation of the T1/2 for crystalloid fluid increases the plasma volume and promotes accumulation of fluid in the interstitial fluid space. The T1/2 for crystalloids is usually 20 to 40 min in conscious humans but might extend to 80 min or longer in the presence of preoperative stress, dehydration, blood loss of <1 l or pregnancy. The longest T1/2 measured amounts to between 3 and 8 h and occurs during surgery and general anaesthesia with mechanical ventilation. This situation lasts as long as the anaesthesia. The mechanisms for the long T1/2 are only partly understood, but involve adrenergic receptors and increased renin and aldosterone release. In contrast, the T1/2 during the postoperative period is usually short, about 15 to 20 min, at least in response to new fluid. The commonly used colloid fluids have an intravascular persistence T1/2 of 2 to 3 h, which is shortened by inflammation. The fact that the elimination T1/2 of the infused macromolecules is 2 to 6 times longer shows that they also reside outside the bloodstream. With a colloid, fluid volume is eliminated in line with its intravascular persistence, but there is insufficient data to know if this is the same in the clinical setting.
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Fukushima T, Uchino S, Fujii T, Takinami M, Uezono S. Intraoperative hydroxyethyl starch 70/0.5 administration may increase postoperative bleeding: a retrospective cohort study. J Anesth 2017; 31:330-336. [DOI: 10.1007/s00540-017-2334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
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Zhang YQ, Li RH, Zhang HB, Wu M, Hu XQ. Purification, characterization, and application of a thermostable dextranase from Talaromyces pinophilus. ACTA ACUST UNITED AC 2017; 44:317-327. [DOI: 10.1007/s10295-016-1886-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 12/14/2016] [Indexed: 11/25/2022]
Abstract
Abstract
Dextranase can hydrolyze dextran to low-molecular-weight polysaccharides, which have important medical applications. In the study, dextranase-producing strains were screened from various soil sources. The strain H6 was identified as Talaromyces pinophilus by a standard ITS rDNA analysis. Crude dextranase was purified by ammonium sulfate fractionation and Sepharose 6B chromatography, which resulted in a 6.69-fold increase in the specific activity and an 11.27% recovery. The enzyme was 58 kDa, lower than most dextranase, with an optimum temperature of 45 °C and an optimum pH of 6.0, and identified as an endodextranase. It was steady over a pH range from 3.0 to 10.0 and had reasonable thermal stability. The dextranase activity was increased by urea, which enhanced its activity to 115.35% and was conducive to clinical dextran production. Therefore, T. pinophilus H6 dextranase could show its superiority in practical applications.
Graphical Abstract
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Affiliation(s)
- Yu-Qi Zhang
- grid.256896.6 Department of Pharmaceutical Engineering, School of Biological and Medical Engineering Hefei University of Technology 230009 Hefei People’s Republic of China
| | - Ruo-Han Li
- grid.256896.6 Department of Pharmaceutical Engineering, School of Biological and Medical Engineering Hefei University of Technology 230009 Hefei People’s Republic of China
| | - Hong-Bin Zhang
- grid.256896.6 Department of Pharmaceutical Engineering, School of Biological and Medical Engineering Hefei University of Technology 230009 Hefei People’s Republic of China
| | - Min Wu
- grid.256896.6 Department of Pharmaceutical Engineering, School of Biological and Medical Engineering Hefei University of Technology 230009 Hefei People’s Republic of China
| | - Xue-Qin Hu
- grid.256896.6 Department of Pharmaceutical Engineering, School of Biological and Medical Engineering Hefei University of Technology 230009 Hefei People’s Republic of China
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Pu Y, Zou Q, Hou D, Zhang Y, Chen S. Molecular weight kinetics and chain scission models for dextran polymers during ultrasonic degradation. Carbohydr Polym 2017; 156:71-76. [DOI: 10.1016/j.carbpol.2016.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/19/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
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Kamath AF, Pagnano MW. Blood Management for Patients Undergoing Total Joint Arthroplasty. JBJS Rev 2016; 1:01874474-201312000-00001. [PMID: 27490505 DOI: 10.2106/jbjs.rvw.m.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Atul F Kamath
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, MN 55905
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Rugeri L, Ashrani AA, Nichols WL, Trousdale RT, Pruthi RK. A single-centre study of haemostatic outcomes of joint replacement in von Willebrand disease and control patients and an analysis of the literature. Haemophilia 2016; 22:934-942. [PMID: 27385645 DOI: 10.1111/hae.13027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters. AIMS To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders. METHODS We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA. RESULTS Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5%) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63%) vs. 12 (32%)]. Only 9 (47%) VWD patients vs. 38 (100%) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group. CONCLUSION In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.
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Affiliation(s)
- L Rugeri
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - A A Ashrani
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - W L Nichols
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - R T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - R K Pruthi
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
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Basora M, Colomina MJ, Moral V, Asuero de Lis MS, Boix E, Jover JL, Llau JV, Rodrigo MP, Ripollés J, Calvo Vecino JM. Clinical practice guide for the choice of perioperative volume-restoring fluid in adult patients undergoing non-cardiac surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:29-47. [PMID: 26343809 DOI: 10.1016/j.redar.2015.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 06/05/2023]
Abstract
The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience.
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Affiliation(s)
- M Basora
- Anestesiología y Reanimación, Hospital Clínic, Barcelona, España.
| | - M J Colomina
- Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - V Moral
- Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - M S Asuero de Lis
- Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Boix
- Anestesiología y Reanimación, Hospital Universitario del Vinalopó, Elche, Alicante, España
| | - J L Jover
- Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoi, Alicante, España
| | - J V Llau
- Anestesiología y Reanimación, Hospital Clínico Universitario, Valencia, España
| | - M P Rodrigo
- Anestesiología y Reanimación, Hospital de Basurto, Bilbao, España
| | - J Ripollés
- Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - J M Calvo Vecino
- Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, España
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Zdolsek JH, Bergek C, Lindahl TL, Hahn RG. Colloid osmotic pressure and extravasation of plasma proteins following infusion of Ringer's acetate and hydroxyethyl starch 130/0.4. Acta Anaesthesiol Scand 2015; 59:1303-10. [PMID: 26079310 DOI: 10.1111/aas.12558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/07/2015] [Accepted: 04/13/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND During fluid infusion therapy, plasma proteins are diluted and leak from the intravascular space, which alters the colloid osmotic pressure (COP) and potentially affects coagulation. We hypothesised that acetated Ringer's and starch solution, alone or in combination, influence these mechanisms differently. MATERIALS AND METHODS On different occasions, 10 male volunteers were infused with 20 ml/kg acetated Ringer's and 10 ml/kg 6% hyroxyethyl starch 130/0.4 (Voluven(®) ) alone or in combination (first with starch solution followed by Ringer's solution). Blood samples were collected every 30-min for measurements of COP, blood haemoglobin, platelets, and plasma concentrations of albumin, immunoglobulins (IgG and IgM), coagulation factor VII (FVII), fibrinogen, cystatin C, activated partial thromboplastin time (APTT) and prothrombin international normalised ratio (PT-INR). Changes were compared with the haemoglobin-derived plasma dilution. RESULTS The COP increased by 8.4% (SD 3) with starch and decreased by 26.2% (7.9) with Ringer's. These infusions diluted the plasma by 23.4% (5.3) and 18.7% (4.9) respectively. The COP changes in the combined experiment followed the same pattern as the individual infusions. Albumin and IgG changes in excess of the plasma dilution were very subtle. The intravascular contents of the IgM and platelets decreased, whereas FVII, fibrinogen and cystatin C increased. PT-INR increased by 1/3 of the plasma dilution, whereas changes in APTT did not correlate with the plasma dilution. CONCLUSIONS The starch increased COP and only minor capillary leak occurred in healthy volunteers. The fluid-induced plasma dilution correlated with mild impairment of the extrinsic coagulation pathway but not of the intrinsic pathway.
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Affiliation(s)
- J. H. Zdolsek
- Department of Anaesthesiology; Vrinnevi Hospital; Norrköping Sweden
- Section for Anaesthesia; Linköping University; Linköping Sweden
| | - C. Bergek
- Section for Anaesthesia; Linköping University; Linköping Sweden
| | - T. L. Lindahl
- Department of Clinical Chemistry; Linköping University; Linköping Sweden
| | - R. G. Hahn
- Section for Anaesthesia; Linköping University; Linköping Sweden
- Research Department; Södertälje Hospital; Södertälje Sweden
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Hydroxyethyl starch reduces coagulation competence and increases blood loss during major surgery: results from a randomized controlled trial. Ann Surg 2014; 259:249-54. [PMID: 24100337 DOI: 10.1097/sla.0000000000000267] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss. BACKGROUND Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected. METHODS Eighty patients were scanned for enrollment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4. RESULTS Among the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer. CONCLUSIONS Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.
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BARK BP, GRÄNDE PO. Infusion rate and plasma volume expansion of dextran and albumin in the septic guinea pig. Acta Anaesthesiol Scand 2014; 58:44-51. [PMID: 24251847 DOI: 10.1111/aas.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous fluid treatment of hypovolaemia in states of increased capillary permeability, e.g. sepsis, is often accompanied by adverse oedema formation. A challenge is therefore to achieve and maintain normovolaemia using as little plasma volume substitution as possible to minimise interstitial oedema. In the present study, we evaluated the importance of infusion rate for the plasma volume expanding effects of 6% dextran 70 and 5% human albumin in a guinea pig sepsis model. METHODS In this prospective, randomised study, 50 anaesthetised adult male Dunkin-Hartley guinea pigs were used. After laparotomy, sepsis was induced by caecal ligation and incision. Three hours later, an infusion (12 ml/kg) of one of the studied fluids was given either over 15 min (bolus group) or over 3 h (continuous group). A sham group underwent the same surgical procedure but did not receive any fluid. RESULTS At the end of the experiment 3 h after the start of infusion, plasma volumes in the continuous group and the bolus group, respectively, were: 47.2 ± 5.3 ml/kg and 36.5 ± 3.9 ml/kg (P < 0.001) for 6% dextran 70, and 47.3 ± 7.5 ml/kg and 39.7 ± 2.8 ml/kg (P < 0.01) for 5% albumin. Plasma volume for the sham group at the same time point was 29.9 ± 3.3 ml/kg. CONCLUSIONS The study performed on a guinea pig sepsis model showed that the plasma volume expanding effects of fixed volumes of 6% dextran 70 and 5% albumin were greater when given at a slow than at a fast infusion rate.
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Affiliation(s)
- B. P. BARK
- Department of Anaesthesia and Intensive Care; Lund University and Lund University Hospital; Lund Sweden
| | - P.-O. GRÄNDE
- Department of Anaesthesia and Intensive Care; Lund University and Lund University Hospital; Lund Sweden
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Sawhney C, Subramanian A, Kaur M, Anjum A, Albert V, Soni KD, Kumar A. Assessment of hemostatic changes after crystalloid and colloid fluid preloading in trauma patients using standard coagulation parameters and thromboelastography. Saudi J Anaesth 2013; 7:48-56. [PMID: 23717233 PMCID: PMC3657925 DOI: 10.4103/1658-354x.109809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: The choice of an ideal fluid administered post trauma and its subsequent influence on coagulation still poses a clinical dilemma. Hence, this study was designed to assess the influence of in vivo hemodilution with various fluid preparations (4% gelatin, 6% hydoxyethyl starch (HES), Ringer's lactate, 0.9% normal saline) on coagulation using standard coagulation parameters and real-time thromboelastography (TEG) in patients undergoing elective surgery post trauma. Methods: In a randomized, double-blind study, 100 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective surgeries were allocated into four groups of 25 each according to the type of fluid infused. Group G (4% gelatin), Group N (0.9% normal saline), Group R (Ringer's lactate), and Group H (6% HES) received preloading with 1 L of fluid according to the group. The coagulation status of the patients was assessed during perioperative period (before surgery, after fluid preloading, and at the end of the surgery) using both conventional coagulation analysis and TEG. Statistical Analysis: Analysis of variance (ANOVA), post hoc and Pearson Chi-square test were used. Results: In all the patients preloaded with gelatin, there was a significant increase in prothrombin time index (PTI; 14.88±0.90 vs. 13.78±3.01, P<0.001) and international normalized ratio (INR; 1.12±0.09 vs. 1.09±0.19, P<0.05) compared to the baseline value. An increase was observed in these parameters in the postoperative period also. In the HES group, there was statistically significant increase in PT time (15.70±1.51 vs. 13.74±0.75, P=0.01) and INR (1.20±0.15 vs. 1.03±0.17, P<0.001) as compared to the baseline. In the intergroup comparisons, the patients preloaded with HES had a significant increase in INR (1.20±0.15 vs. 1.12±0.09, P=0.04) and reaction time (R time; 6.84±2.55 min vs. 4.79±1.77 min, P=0.02) as compared to the gelatin group. The fall in coagulation time (k time; 2.16±0.98 vs. 3.94±2.6, P=0.02), rise in maximum amplitude (MA; 61.94±14.08 vs. 50.11±14.10, P=0.04), and rise in A20 (56.17±14.66 vs. 43.11±14.24, P=0.05) were more in patients preloaded with RL as compared to the HES group. 100% patients in the gelatin group, 84.2% patients in the NS group, 94.4% patients in the RL group, and 66.7% patients in the HES group had hypocoagulable (R time > 14 min) state in the postoperative period. Conclusion: Crystalloids are optimal volume expanders in trauma, with RL having beneficial effects on coagulation system (decrease in k time and increase in MA and A20). Among the colloids, HES 6% (130/0.4) affects coagulation parameters (increase in PTI, INR, R time, k time) more than gelatin. Trial registration (protocol number-IEC/NP-189/2011).
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Affiliation(s)
- Chhavi Sawhney
- Department of Anaesthesia and Critical Care, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy. Intensive Care Med 2013; 39:558-68. [PMID: 23407978 DOI: 10.1007/s00134-013-2840-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/11/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT). METHODS Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects. RESULTS Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I (2) = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I (2) = 0 %). CONCLUSIONS The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.
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Van Der Linden P, James M, Mythen M, Weiskopf RB. Safety of Modern Starches Used During Surgery. Anesth Analg 2013; 116:35-48. [DOI: 10.1213/ane.0b013e31827175da] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hansson E, Elmståhl S, Svensson H, Manjer J, Brorson H. Evaluation of measurement of fat mass reduction after liposuction in obese patients. J Plast Surg Hand Surg 2012; 46:421-6. [PMID: 23088636 DOI: 10.3109/2000656x.2012.715086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Body composition measurements are used to evaluate surgical treatment, such as bariatric surgery in overweight patients. Nowadays, there are many different methods to measure body composition available. However, none of them has been validated for use in patients after operation. The aim of the present study was to compare the amount of surgically removed fat with two different methods, bioelectrical impedance analysis (BIA) and total body potassium (TBK). Amount of removed fat during liposuction was measured 1, 2, 3, 4, 14 days, and 1 year postoperatively in 27 obese patients after liposuction. The results were compared with actual removed fat during the operation. The median fat mass removed was 4020 grams (range 1954-9655). Postoperatively there was a varying reduction in fat mass, as measured with BIA and with TBK. There was a clear difference between the range of amounts removed measured with BIA and the range of amount removed measured with TBK. This study indicates that BIA, but not TBK, is an appropriate method to measure fat mass in obese subjects in a surgical setting. BIA seems to underestimate the amount of fat removed, whereas TBK seems to overestimate it.
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Affiliation(s)
- Emma Hansson
- Department of Clinical Sciences Malmö, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital , Malmö , Sweden.
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Wetzel L, Kozek-Langenecker S. Allergic reaction after dextran. Acta Anaesthesiol Scand 2012; 56:132; author reply 132-3. [PMID: 22092241 DOI: 10.1111/j.1399-6576.2011.02515.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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