Tetrastarch 6% infusion 500ml bags

Purpose: To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury. Previous meta-analyses are based on studies referring to partially or fully unpublished data or data from abstracts only. Methods: The studies included in the former meta-analyses were scrutinized by the authors independently. We completed a critical analysis of the literature, including the strengths, weaknesses and modifiers of the studies when assessing products, formulations and outcomes. Results: Both the published large studies and meta-analyses show significant bias in the context of the deleterious effect of 6% 130/0.4–0.42 HES. Without (1) detailed hemodynamic data, (2) the exclusion of other nephrotoxic events and (3) a properly performed evaluation of the dose–effect relationship, the AKI-inducing property of 6% HES 130/0.4 or 0.42 should not be considered as evidence. The administration of HES is safe and effective if the recommended dose is respected. Conclusions: Our review suggests that there is questionable evidence for the deteriorating renal effect of these products. Further well-designed, randomized and controlled trials are needed. Additionally, conclusions formulated for resource-rich environments should not be extended to more resource-scarce environments without proper qualifiers provided.

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OBJECTIVE: To describe and compare prothrombin time (PT), activated partial thromboplastin time (aPTT), thromboelastography (TEG), HCT, and platelet count measurements in a hemorrhage/over-resuscitation model. DESIGN: Randomized crossover study. SETTING: University teaching hospital. ANIMALS: Six cats. INTERVENTIONS: Anesthetized cats underwent 3 treatments at 2-month intervals. The treatments were as follows: NHR-no controlled hemorrhage and sham resuscitation; LRS-controlled hemorrhage and lactated Ringer's solution (LRS) for resuscitation; and Voluven-controlled hemorrhage and 6% tetrastarch 130/0.4 for resuscitation. The LRS and Voluven were administered at 60 and 20 mL/kg/h, respectively, for 120 minutes. Blood samples were drawn for PT, aPTT, TEG, HCT, and platelet count measurements at a healthy check (T - 7d), after controlled hemorrhage (T0), at 60 and 120 minutes of resuscitation (T60 and T120), and at 24 hours after completion of resuscitation (T24h). Data were analyzed using a general linear mixed model approach (significance was P < 0.05). MEASUREMENTS AND MAIN RESULTS: Total median blood loss (controlled hemorrhage and blood sampling from T0 to T120) at T120 was 11.4, 31.0, and 30.8 mL/kg for NHR, LRS, and Voluven, respectively. PT and aPTT during LRS and Voluven were prolonged at T60 and T120 compared to NHR (P < 0.001). On TEG, the reaction time, kinetic time, and alpha-angle were within reference intervals for cats at all time points in all treatments, while maximum amplitude was less than the reference interval (40 mm) at T0, T60, and T120 during Voluven and at T60 and T120 during LRS compared to NHR (both P < 0.001). The HCT and platelet count were significantly lower at T60 and T120 during LRS and Voluven compared to NHR (P < 0.001). CONCLUSIONS: Hypocoagulopathy was observed during hemorrhage and liberal fluid resuscitation. Prolongation of PT and aPPT and decreased clot strength may have been caused by hemodilution and platelet loss.

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This prospective experimental study evaluated the disposition of a crystalloid and a colloid solution in 10 healthy cats under general anesthesia. Each cat was randomly assigned to receive either 20 mL/kg of a balanced isotonic crystalloid solution (PLA) or 5 mL/kg of 6% tetrastarch 130/0.4 solution (T-HES), administered over 15 minutes, in a 2-period, 2-treatment crossover design. Blood samples were collected, and urine output was measured during a 3-hour experimental period. Plasma dilution was calculated using serial hemoglobin concentrations and red blood cell count. Volume kinetics (distribution and elimination) of each fluid were determined using non-linear mixed effects pharmacokinetic modeling software. Data from a previous study with a similar methodology in healthy conscious cats were included in the population kinetic analysis, revealing anesthesia as a significant covariate for k21 (peripheral-to-central intercompartmental rate constant) for PLA and k10 (dilution-dependent first-order elimination rate constant) for T-HES. Cumulative urine output under general anesthesia was approximately 3.5 times lower for PLA and 2.5 times lower for T-HES compared to conscious cats. Overall, our data suggest that the elimination of PLA and T-HES is markedly reduced, and a bolus of PLA produces a short period of plasma expansion with the potential to cause significant peripheral fluid accumulation in cats during general anesthesia.

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Introduction: Colloids and crystalloids are frequently used for fluid resuscitation. However, their differing physiological properties may impact postoperative outcomes in distinct ways. Emerging evidence indicates that these variations could play a role in influencing surgical morbidity. Aim: To evaluate the impact on postoperative outcomes using crystalloids and colloids intraoperatively in patients undergoing major surgeries. Materials and Methods: This double-blinded, interventional study was conducted from July 2019 to December 2020 at Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India. A total of 150 patients, aged 16-60 years, American Society of Anaesthesiologists (ASA) Grade I, II and III, undergoing elective major surgery were enrolled in the study and divided into three groups, with 50 patients per group: group RL (n=50), Group Hetastrach and Ringer’s Lactate (HS-RL) (n=50) and Group Tetrastarch and Ringer’s Lactate (TS-RL) (n=50). All patients received Ringer’s Lactate (RL) at a rate of 7.0 mL/kg/hour before induction. Intraoperatively, group RL received Ringer’s Lactate alone at a rate of 8.0 mL/kg/hour, group HS-RL received both Ringer’s Lactate and 6% hetastarch at a rate of 8.0 mL/kg/hour and group TS-RL received 6% tetrastarch and Ringer’s Lactate at a rate of 8.0 mL/kg/hour. The patients were observed for 8 days postoperatively for vital signs, Arterial Blood Gas (ABG) analysis, ambulation, Postoperative Nausea and Vomiting (PONV) and complications. The data were represented as mean standard deviations and percentages and analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. A p-value of &lt;0.05 was considered statistically significant. Results: Two patients were excluded from the study due to missing data in group RL (n=48). The demographic characteristics were statistically not significant among the groups (p-value&gt;0.05). The proportion of patients who could ambulate independently or with assistance was higher in the HS-RL group 23 (46%) patients compared to the TS-RL group 16 (32%) patients, followed by patients in group RL (3 patients, 6.25%) (p-value &lt;0.05). Intravenous fluids were administered to most patients for five days. Statistically, there was no significant difference among the groups (p-value=0.230). The data were represented as mean standard deviations and percentages and analysed using SPSS version 20.0. A p-value of &lt;0.05 was considered statistically significant. Conclusion: Colloids are superior to crystalloids in terms of independent ambulation, ambulation with assistance, temperature regulation and reduction of nausea and vomiting. Overall, the present study concluded that colloids are able to effectively reduce postoperative complications more effectively than crystalloids without any serious side-effects.

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Objectives To determine the effects of haemorrhage and fluid over-resuscitation on colloidal osmotic pressure of albumin (COP albumin), plasma (Posm) and effective (Eosm) osmolality in anaesthetised cats. Methods A total of six cats were given three treatments once, at 2-month intervals, in a randomised, crossover haemorrhage-resuscitation study. The treatments were divided into two phases, a controlled haemorrhage phase and a fluid resuscitation phase, as follows: (1) NoHR = no controlled haemorrhage and no resuscitation; (2) LRS = controlled haemorrhage followed by lactated Ringer’s solution infusion (60 ml/kg/h); and (3) TS = controlled haemorrhage followed by 6% tetrastarch 130/0.4 suspended in 0.9% saline infusion (20 ml/kg/h). The resuscitation fluids were administered for 120 mins. Data were collected before haemorrhage, before resuscitation and at 30 min intervals until 120 mins. Variables were calculated at each time point as follows: COP albumin = albumin concentration (g/l) × 0.57; Posm = (2 × sodium) + glucose + blood urea nitrogen; and Eosm = (2 × sodium) + glucose. All Posm and Eosm concentrations were measured as mmol/l. Data were compared using a general linear mixed model (significance: P &lt;0.05). Results Mean ± SD total haemorrhage volumes for NoHR, LRS and TS were 10.2 ± 2.3, 29.3 ± 9.0 and 29.1 ± 6.3 ml/kg, respectively. The COP albumin decreased over time in all treatments regardless of volumes of blood lost and fluid administered. The decrease in COP albumin was profound and clinically relevant in LRS and TS (both P &lt;0.001). There were no statistical differences in Posm and Eosm over time except in LRS at 90 ( P = 0.004) and 120 ml/kg ( P &lt;0.001). Conclusions and relevance The COP albumin decreased in all treatments but to low and clinically relevant concentrations in LRS and TS, putting the cats at risk of fluid overload. There were no clinically relevant derangements in Posm and Eosm.

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Objective: To investigate the feasibility of characterizing fluid disposition-including potency, distribution, and elimination-of different IV fluids in healthy, isoflurane-anesthetized rabbits using microconstant volume kinetic analysis. Methods: In this prospective, randomized crossover study, 10 rabbits were anesthetized and received 25 mL/kg of lactated Ringer solution (LRS) and 6.25 mL/kg of 6% tetrastarch 130/0.4 solution (HES), each infused IV over 20 minutes, with a washout period of at least 14 days between treatments. Serial measurements of hemoglobin concentration, RBC count, and Hct were obtained at preestablished time points and served as input variables for volume kinetic analysis. Results: The prescribed doses of LRS and HES produced similar peak plasma dilutions, consistent with the convention that colloids are approximately 4 times more potent than isotonic crystalloids. The distribution and elimination half-lives of LRS were approximately 4.6 and 57.8 minutes, respectively, whereas those of HES were approximately 53.5 and 231.0 minutes. Conclusions: Volume kinetic analysis is a feasible method to characterize fluid disposition in anesthetized rabbits. The potency, distribution, and elimination of LRS and HES in healthy, isoflurane-anesthetized rabbits align with previously reported data in other mammalian species. However, further studies incorporating urine volume measurements are warranted. Clinical Relevance: Intravenous HES demonstrates greater fluid potency and longer intravascular persistence than LRS in healthy, isoflurane-anesthetized rabbits.

Abstract licence: CC BY-NC