ABSTRACT
Hydroxyelhyl starch [HES] solutions are effective plasma volume expanders. Impairment of coagulation and renal junction occur with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES [Voluven] was developed to minimize hemostatic interactions. The aim of the study is to evaluate the benefit of voluven to reduce hemostatic interactions and preserve renal junction while preserving its efficacy in restoring plasma volume in comparison to HAES-steril [pentastarch]. After approval of our local institutional university ethical committee, and a written consent was obtained from each one. Fifty consecutive adult patients, ASA I and II, scheduled for elective major orthopedic surgery at Assiut University Hospital were included in the study. The patients were allocated into two equal groups [each of 25 patients] according to the type of the study solution used as plasma volume replacement. Group-A: received [Voluven]. Group-B: received HAES-steril. Hemodynamic parameters: central venous pressure [CVP], mean arterial blood pressure [MABP], and heart rate [HR] were recorded before anesthesia induction [baseline], one hour after induction of anesthesia, at the end of surgery, 5 h after surgery and 24 h after surgery. Coagulation profile: Screening tests: prothrombin time [PT], prothrombin concentration [PC], International Normalized Ratio [INR]], partial thromboplastin time [aPTT] and serum fibrinogen level. Specific tests of haemostasis: factor VIII concentration and von Willebrand factor [vWF], Renal function tests: blood urea nitrogen and serum creatinine. Measurements time: sample were collected one day before surgery ['baseline], at 5 h and 24h after surgery. Amount of given colloids [ml], blood loss [ml] and packed RBCs [ml,] were recorded in all patients in two groups. All patients in the two groups were subjected to the some anesthetic management. Data was statistically analyzed using SPSS program version 16, a p value < 0.05 was considered statistically significant. There were significant differences with time as regard PT, PC, and INR in both groups and there was significant difference between the two groups, more increase in PT, INR and more decrease in PC in Haesteril group than in Voluven group. Voluven produced less inhibitory effect on coagulation factor VIII and Von Willibrand factor concentration and consequently, aPTT in comparison with HA ES-steril. Blood loss and transfusion requirements were less with Voluven group than with HAES-steril group. BUN and serum creatinine significantly changed over time in both groups but still within normal range in Voluven groups, but in Haesteril group there were significantly changed over time, mildly elevated above normal range and there was significant difference between the two groups with more increase in Haestril group. Compared with HAES-steril, Voluven are more likely to produce less coagulation abnormalities and less renal impairment in patients undergoing major orthopedic surgery manifested by less blood loss and less erythrocytes transfusion