A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery.

PURPOSE: To compare the new hydroxyethyl starch HES 130/0.4 (Voluven) and the standard HES 200/0.5 (pentastarch) regarding effectiveness for plasma volume substitution and safety of large volumes in heart surgery. METHODS: Fifty-nine patients scheduled for coronary artery bypass grafting were enrolled in a prospective, randomised, double-blind, parallel-group, multicentre, clinical, phase III study. Hydroxyethyl starch was used as the exclusive artificial colloid for acute normovolemic hemodilution, priming of the heart lung machine, and for intra- and postoperative plasma volume substitution from induction of anesthesia until 16 hr after the end of surgery. Efficacy was evaluated by comparing the amount of colloid infused, hemodynamics, and colloid osmotic pressure (COP). Safety endpoints were blood loss, the use of allogeneic blood products, coagulation variables, and adverse events. RESULTS: Effectiveness, as assessed by the total amount of infused HES volumes within the treatment period, was similar between HES 130/0.4 and HES 200/0.5 (2,550 mL +/- 561 mL vs 2,466 mL +/- 516 mL). Also, no differences were found for the use of other colloids (pasteurised plasma), hemodynamics, and COP In HES 130/0.4 patients, the postoperative increase of von-Willebrand factor (vWF) was higher (P < 0.01), blood loss was lower, and less packed red blood cells were transfused. CONCLUSION: Hydroxyethyl starch 130/0.4 is an effective plasma volume expander in heart surgery and may be used as the sole artificial colloid to cover the perioperative period. We found a reduced influence of HES 130/0.4 on the physiologic postoperative increase of vWF.

Effects of peripheral vasoconstriction on the blood pressure in the finger, measured continuously by a new noninvasive method (the Finapres).

The authors determined whether vasoconstriction alters the ability of a noninvasive method (Finapres) of continuously measuring arterial blood pressure in the finger to function accurately. They compared the response of the Finapres to blood pressures determined simultaneously by an oscillometric technique (Dinamap) in six anesthetized patients. Vasoconstriction was detected from a photoelectric plethysmogram, which was recorded continuously from an adjacent finger. Vasoconstriction was defined as a decrease in amplitude to less than half of its highest value in one and the same patient. From the 378 paired blood pressure readings obtained in this study, 51% took place in such a vasoconstricted state. The authors found that diastolic and mean blood pressures in the finger were, on the average, 9 mmHg below those in the upper arm and that the systolic pressure was 7 mmHg above that in the upper arm. The authors concluded that the Finapres keeps functioning well during peripheral vasoconstriction and is a recommendable method to monitor arterial blood pressure in the finger.