Preoperative Acute Hypervolemic Hemodilution with Hydroxyethylstarch: An Alternative to Acute Normovolemic Hemodilution

• Published in: Anesthesia and analgesia Vol. 84; no. 1; pp. 26 - 30
• Main Authors: Mielke, Lars L, Entholzner, Elmar K, Kling, Michael, Breinbauer, Barbara E. M, Burgkart, Rainer, Hargasser, Stefan R, Hipp, Rudolf F. J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.01.1997; Lippincott
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Loss, Surgical; Blood Pressure; Blood Transfusion, Autologous; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Costs and Cost Analysis; Female; Hematocrit; Hemodilution - economics; Hemodilution - methods; Hip Prosthesis; Humans; Hydroxyethyl Starch Derivatives - administration & dosage; Male; Medical sciences; Middle Aged; Plasma Substitutes - administration & dosage; Platelet Count; Preoperative Care; Prospective Studies; Prothrombin Time; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Human; Transfusion; Hypervolemia; Hydroxyethylstarch; Colloid; Hip; Normovolemia; Induced hemodilution; Plasma substitute; Orthopedic surgery; Blood loss; Preoperative; Technique; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199701000-00005

Acute normovolemic hemodilution (ANH) may help to reduce demand for homologous blood but requires extra time and apparatus.A more simple procedure is acute hypervolemic hemodilution (HHD), where hydroxyethylstarch is administered preoperatively without removal of blood. In a prospectively randomized study we compared ANH (preoperatively 15 mL/kg autologous blood removal and replacement with 15 mL/kg of hydroxyethylstarch with HHD (15 mL/kg of hydroxyethylstarch administered preoperatively) in 49 patients undergoing hip arthroplasty. To avoid excessive intravascular volume, we used the vasodilating effect of isoflurane. No significant differences were found between groups (ANH, n = 23; HHD, n = 26) for intraoperative blood loss (ANH versus HHD, median [minimum-maximum]); 545 [295-785] mL versus 520 [315-825] mL) and postoperative blood loss (730 [525-945] mL versus 780 [495-895] mL), postoperative hemoglobin, hematocrit, platelet count or coagulation variables, and transfusion requirements (ANH 43% versus HHD 35% of patients received homologous blood) (P > 0.05). Heart rate did not change significantly in either group. In the ANH group mean arterial blood pressure (MAP) decreased after hemodilution (P < 0.05) while in the HHD group MAP did not change over time. Mean time required to perform ANH was 58 (46-62) min versus HHD 16 (12-19) min (P < 0.05). Costs for ANH were $63.60 USD and for HHD $32.75 USD (labor costs not included). In orthopedic patients undergoing hip replacement with a predicted blood loss of about 1000 mL, HHD seems to be a simple as well as time- and cost-saving alternative for ANH.(Anesth Analg 1997;84:26-30)