The neuroprotective effect of colloids in forebrain ischemia model

BACKGROUND: The aim of this study was to investigate the neuroprotective effects of colloids (albumin and pentastarch) after forebrain global ischemia in rats. METHODS: Thirty male Sprague-Dawley rats were randomly assigned to three groups; control, albumin and pentastarch group (each n = 10). Forebrain ischemia was induced by bilateral common carotid artery occlusion plus hemorrhagic hypotension. The control group received no treatment. The albumin group received 5 ml/kg of 20% albumin after ischemia. The pentastarch group received same volume of albumin after ischemia. Histologic outcomes were measured at 7 days after ischemia in CA1 pyramidal cells of the rat hippocampus. RESULTS: The mean percentage of viable cells in the hippocampal CA1 area was significantly higher in the albumin (47%) compared with the control group (33%) or pentastarch group (33%) (P = 0.001). The percentage of apoptotic cells was significantly lower in the albumin (30%) group than that in the pentastarch (44%) or control group (49%) (P = 0.006). CONCLUSIONS: This study shows that albumin can improve histologic outcomes after forebrain global ischemia compared with pentastarch.

Two Cases of Systemic Capillary Leak Syndrome that were Treated with Pentastarch

Systemic capillary leak syndrome (SCLS) is a condition that's caused by the shift of fluid and protein from the intravascular space to the interstitial space as a result of repetitive episodes of capillary hyperpermeability. The pathogenesis of SCLS is still unclear, but there's recently been a report showing this syndrome in association with monoclonal gammopathy. This syndrome can be a fatal disease because cardiovascular collapse can occur in the initial capillary leak phase. Although theophylline, diuretics, terbutaline, steroids, calcium antagonist, Ginkgo biloba extracts and plasmapheresis have been suggested as medication, none of them have been proven to be effective. Considering that this disease is self-limiting, conservative treatment in the acute phase is believed to be very important. Because hypoalbuminemia is very a common manifestation of SCLS, Pentastarch, which has a higher molecular weight than albumin, could be efficient to prevent cardiovascular collapse. We used 10% Pentastarch during the acute SCLS attacks of 2 patients and the patients both showed a dramatic response. Pentastarch may be helpful to treat SCLS in its initial capillary leak phase by the elevating blood pressure, and this might contribute to somewhat decreasing the acute mortality of SCLS.

The Effects of Intravascular Volume Expansion on the Stability of Hemodynamic Responses in Patients undergoing Carotid Endarterectomy / 대한마취과학회지

BACKGROUND: During carotid endarterectomy, hemodynamic stability is very important to reduce the incidence of cerebral stroke and myocardial infarction. Therefore, we studied the effects of intravascular volume expansion using colloid solution on hemodynamic stability. METHODS: We studied 22 patients undergoing elective surgery under general anesthesia. Preanesthetic mean arterial blood pressure (MABP) and heart rate (HR) were checked, and the intraoperative target range was taken +/- 20% of these values. Following standardized anesthetic technique including intravenous induction with thiopental sodium and vecuronium, standard intraoperative monitoring and direct arterial blood pressure monitoring were instituted. Patients were randomly assigned to a Hartmann's solution group (group H, n = 11) or a pentastarch group (group P, n = 11). Distinct intraoperative episodes beyond the predetermined target range, and the number of episodes requiring interventional therapy were recorded. RESULTS: The pentastarch group had a significantly lower incidence of episodes requiring interventional drug therapy during the pre-reperfusion period. No difference was found between out of target incidents in MABP and HR. CONCLUSIONS: During carotid endarterectomy, the infusion of pentastarch solution reduced drug therapy requirement for hemodynamic stability during pre-reperfusion period only.

Cord Blood RBC Depletion Using 10% Pentastarch and 6% Hydroxyethylstarch / 대한소아혈액종양학회지

PURPOSE: For separation of RBC from cord blood, it is important to minimize RBC contamination without significant loss of nucleated cells using sedimentation agent that is safe for human use. This study was performed to investigate the possibility of replacing 6% hydroxyethylstarch (HES) with 10% pentastarch (PS) which is a lower molecular weight hetastarch-analog that is cleared from the circulation rapidly. METHODS: After dilution of cord blood till hematocrit 25%, PS or HES were added by the ratio of 7:1 and 5:1 respectively. Sedimentation was performed for 2 hours by gravity. RESULTS: PS was used in 14 cases with volume of 72.4+/-22.3 mL (45~126 mL) and HES in 8 cases with volume of 58.4+/-8.0 mL (50~70 mL). Sedimentation rate has reached at plateau by 90 minutes in PS group and it was slightly faster than in HES group. Recovery rate of nucleated cells and residual RBC were 82.9+/-10.7%, 7.6+/-5.4% in PS group, and 84.0+/-4.7%, 10.7+/-2.3% in HES group. There were no significant differences between the two groups (P=0.657, 0.219). Cell viabilities were high in both groups; 92+/-3% before separation and 97+/-2% in PS group and 98+/-3% in HES group. CD34+ cells were 0.75+/-0.28% before separation and 0.64+/-0.21% in PS group and 0.60+/-0.30% in HES group (P=0.690). CFU-GM after 2 week culture were 27.4+/-20.0 per 1 105 mononuclear cells in PS group and 22.9+/-8.6 in HES group (P=0.856). CONCLUSION: These results demonstrated that PS has similar efficacy to HES for separation of RBC from umbilical cord blood. Considering its rapid clearance and faster sedimentation rate, PS can replace HES for RBC separation in cord blood banking.

An Optimal Condition for Red Cell Depletion of Cord Blood with Pentastarch / 대한소아혈액종양학회지

PURPOSE: We evaluated the optimal temperature, from comparing at room temperature and at 4degrees C, on separation of cord blood with 10% pentastarch to increase the yield of progenitor cells. The yield of progenitor cells could be decreased in elapsed cord blood following collection, probably due to microclot or clumping as we observed in previous study. Thus, we also assessed the effect of urokinase on the recovery rate of progenitor cells in elapsed cord blood. METHODS: We collected 11 samples of cord blood by syringes anticoagulated with ACD from the umbilical cord vein during or following vaginal delivery. The cord blood was separately stored at room temperature with and without urokinase (5,000 IU/mL), and processed with 10% pentastarch to sediment RBCs at room temperature and at 4degrees C, respectively. Total nucleated cell (TNC) and CD34+ cell counts of unseparated and separated cord blood were performed on 0,24 and 48 hours after being held at room temperature. RESULTS: 1) The recovery rate of TNC in the cord blood elapsed for 24 hours was 47.22+/-40.19% by processing at room temperature and 17.30+/-14.67% at 4degrees C (P=0.06). The recovery rate of CD34+ cell was 94.48+/-84.34% at room temperature and 27.30+/-33.44% at 4degrees C (P=0.05). There were no statistical significances in the cord blood elapsed for 48 hours. 2) There were no statistical differences of TNC and CD34+ cell count in the unseparated and separated cord blood regardless adding urokinase. CONCLUSION: We suggest that it could minimize the loss of progenitor cells during processing to sediment red cells of cord blood with 10% pentastarch at room temperature rather than at 4degrees C. Further studies regarding the optimal dosage of urokinase to prevent clumping or microclot in elapsed cord blood and to increase the yield of progenitor cells would be required.

Evaluation of the Collection Efficiency of the Granulocyte in Leukapheresis Using 10% Pentastarch / 대한임상병리학회지

BACKGROUND: To collect high concentration of granulocytes for transfusion to neutropenic cancer patients with infections, we investigated the effect of G-CSF or dexamethasone as granulocyte mobilizers and 10% pentastarch (PS) as the sedimentation agent in granulocyte collection by leukapheresis. Subsequently, the therapeutic effect of the granulocyte transfusions was assessed. METHODS: Forty five leukapheresis were performed with CS-3000Plus (Baxter, Deerfield, IL, USA) using 10% pentastarch. The donors were classified into three groups according to their premedication drugs and the interface detector offset; group 1 used dexamethasone with offset 15 (n=16), group 2 used dexamethasone with offset 33 (n=16), and group 3 used G-CSF with offset 33 (n=10). We compared total collected granulocyte counts and granulocyte collection efficiency (GCE). RESULTS: The mean counts of total granulocytes collected and GCE were as follows; 0.9 0.5 x 1010 and 31.6 14.3% in group 1, 1.3 0.6 x 1010 and 39.0 14.2% in group 2, and 1.6 0.9 x 1010 and 63.9 32.2% in group 3, respectively. The counts of granulocytes collected in group 3 was significantly higher than that in group 1 (P<0.05). The GCE of group 3 was significantly higher than that of group 1 and group 2 (P<0.05). Sixteen granulocyte transfusions were performed to 11 patients. We observed successful therapeutic effects in 10 out of 16 transfusions (63%). CONCLUSIONS: G-CSF indicates greater potency than dexamethasone although its high cost is limitation of routine use as mobilizing agents and PS was an excellent red cell sedimenting agent in granulocyte collection. Large volume granulocyte transfusions allow high therapeutic effects in neutropenic patients with marrows of sufficient regenerating capacity.

Effects of 10% Pentastarch Infusion on the Cerebral Blood Flow and Cerebral Metabolic Rate for Oxygen in Canine Hemorrhagic Shock Model / 대한마취과학회지

BACKGREOUND: Cerebral damage caused by hemorrhagic shock presents an important challenge for critical care medicine. The type of fluid to resuscitate hemorrhagic shock is important for the outcome of such patients. Pentastarch is low-molecular-weight hydroxyethyl starch, which increases cerebral blood flow (CBF) by plasma volume expansion and compensatory vasodilation, and improves the microcirculation in the ischemic brain area by reducing the blood viscosity. METHODS: The authors continuously determined CBF and CMRO2 in 10 mongrel dogs weighing 20.1 +/- 0.8 kg with posterior sagittal sinus outflow method. Dogs were subjected to the 20 minute-period of hemorrhagic shock to a mean arterial pressure of 40 mmHg. The shock phase was followed by resuscitation with the same volume of 10% pentastarch as blood loss. The authors assessed the changes of CBF, CMRO2, and CBF/CMRO2 ratio immediately and 30, 60, 90, 120 minutes after pentastarch infusion. Brain water content was assessed by the wet-dry weight method. RESULTS: CBF was increased above the control level, immediately and 30 minutes after 10% pentastarch infusion (p<0.05), and approximated to the control level for the remaining time. CMRO2 was increased, immediately and 30, 60, 90 minutes after 10% pentastarch infusion (p<0.05), and approximated to the control level at 120 minutes. CBF/CMRO2 ratio was recovered to the control level after 10% pentastarch infusion. Brain water content was not significantly different from the normal value of dogs. CONCLUSION: 10% pentastarch may be used with safety to resuscitate hemorrhagic shock because it recovers the balance between the cerebral oxygen supply and demand, and does not cause cerebral edema.

Intraoperative Normovolemic Hemodilution in Patients Undergonig Posterolateral Spinal Fusion: Safety and Efficacy / 대한마취과학회지

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.

A Comparison between 20% Albumin and 10% Pentastarch in Priming fluid for Cardiopulmonary bypass / 대한마취과학회지

BACKGROUND: Since hydroxyethyl starch has colloidal properties closely approximating those of human albumin, it is considered to be a good plasma volume expander. Pentastarch is a hydroxyethyl starch similar to hetastarch, but with lower average molecular weight and molar substitution ratio. These characteristics result in enhanced enzymatic hydrolysis, faster renal elimination and less effect on coagulation. This study was designed to evaluate the safety and clinical efficacy of 10% pentastarch in priming fluid for cardiopulmonary bypass compared with that of 5% albumin. METHODS: Thirty- two adult patients undergoing elective cardiac surgery were randomized into two groups. Sixteen patients received 500 ml of 10% pentastarch and sixteen patients received 100 ml of 20% albumin in a bloodless priming solution for cardiopulmonary bypass. The fluid balance, coagulopathy and organ functions(cardiac, pulmonary and renal) were evaluated at several time intervals. RESULTS: There were no differences between the two groups in operation and bypass time, chest tube drainage and blood usage. The measured prothrombin time, partial thromboplastin time and platelet count of pentastarch group were not significantly different from those of the albumin group at each time interval(p<0.05). We did not find any differences of statistical significance in hemodynamic data, serum osmolarity, pulmonary shunt and BUN between the two groups(p<0.05). CONCLUSIONS: Our study suggests that 10% pentastarch can be used safely and effectively as cardiopulmonary bypass prime in cardiac surgery.

Effect of 10% Pentastarch Preloading on Hemodynamic Changes during Transurethral Resection of Prostate (TURP) under Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Isotonic crystalloid solutions have been intravascularly administered before spinal anesthesia for prevention of spinal anesthesia induced hypotension in TURP, however many investigators have suggested that synthetic colloids administered before spinal anesthesia is more effective than equal volume of crystalloid solutions. In this study, effect of 10% pentastarch comparing with eqaul volume of crystalloid solution before spinal anesthesia on cardiovascular response were examined. METHODS: 30 patients undergoing elective TURP were randomly allocated to receive either 7 ml/kg of isotonic saline (saline group) or 7 ml/kg of 10% pentastarch (pentastarch group) for 15 minutes before spinal anesthesia. Blood pressure, heart rate and central venous pressure (CVP) were measured before and after operation. RESULTS: In pentarstarch group, systolic blood pressure and CVP were significantly higher than saline group untill 55minutes and 15 minutes after spinal anesthesia respectively. CONCLUSIONS: 10% pentarstarch administered before spinal anesthesia is more effective than equal volume of isotonic saline in TURP with respect to preserving blood pressure and CVP.

The Comparison of the Effects of Pentastarch or Normal Saline Infusion on the Shock Resuscitation / 대한마취과학회지

Volume replacement is a vital therapy in patient with circulatory shock, but the type of fluid that should be infused remains in controversy. This study is designed to compare the cardiopulmonary effects of a colloid solution and a crystalloid solution in dogs subjected to severe hemorrhagic shock. Twelve dogs were bled into shock and mean arterial pressure(MAP) were maintained at 60 mmHg for 1 hour followed by further hemorrhage to 40 mmHg for additional one hour, Animals were randomized to fluid challenge with 10% pentastarch(group P) or 0.9% normal saline(group S) to restore MAP. Complete hemodynamic and blood gas parameters and plasma lactate concentration were measured at pre-shock, during shock and after resuscitation for 2 hours. Cardiac function and hemodynamic stability were restored to higher level than the control level on the completion of fluid challenge with each type of solution, but hemodynamic parameters decreased as time goes after resuscitation. Especially in group S, hemodynamic parameters decreased more significantly and rapidly than group P. Considering the relation of left ventricular stroke work index(LVSWI) and pulmonary capillary wedge pressure(PCWP), the cardiac performance was well maintained to normal level in group P during post-resuscitation period, but rapidly deteriorated in group S. There was a significant increase in intrapulmonary shunt fraction with pentastarch that was maximal on the completion of fluid challenge but which normalized over the next 1 hour. Assessment of tissue perfusion was measured by mixed venous oxygen tension(PVO2) and plasma lactate concentration. In group P, PVO. was restored to higher than the control level and maintained to the cantrol level during post-resuscitation period, but in group S, it was not restored to control level at the completion of fluid challenge, moreover after then, it decreased progressively. Plssma lactate concentration was recovered to control level in group P at the completion of fluid challenge, but in group S, it was recovered lately. It means that tissue perfusion was more rapidly and effectively restored in group P than group S. In conclusion, infusion of pentastarch at severe hemorrhagic shock restored the hemodynamic parameter more rapidly and maintained cardiac performance more effectively during post-resuscitation period than normal saline. Infusion of pentastarch also maintained tissue perfusion more effectively but it increased intrapulmonary shunt fraction transiently.

Comparison of the Circulatory Responses of Autotransfusion and Fluid Resuscitation in Dogs with Hemorrhagic Shock / 대한마취과학회지

Fluid resuscitation is a basic treatment in hemorrhagic shock. We compared the circulatory responses to fluid resuscitation of 10% pentastarch with those of fresh whole blood and plasmanate in hemorrhagic shock. Eighteen mongrel dogs were bled 24 ml/kg and replaced by equivalent amounts of fresh whole blood(n=6, group B), pentastarch(n=6, group P) and plasmanate(n=6, group PL). Hemodynamic measurements and calculations were performed before and after bleeding and after volume therapy. The decrease of hematocrit and platelet count after volume replacement indicate that hemodilutional effect was maximum 30 min after volume therapy and significantly greater in group P than PL(p<0.05). Central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP) and cardiac index(CI) were increased to 146-189%, 146-172% and 146-175% in group P, respectively during 60 min. These changes were significantly greater than group B and PL(p<0.05). There was delayed recovery of mean arterial pressure in group PL(92% 30 min after volume therapy) compared with group B and P(92% and 93% 5 min). Also group P and PL showed significant prolongation in prothrombin time and partial thromboplastin time during experiment(120 min) and these were significantly more prolonged in group P than PL(P<0.05). And group P showed similar O transport and O extraction ratio to those of group B. The increases in plasma catecholamine were observed after hemorrhage, but no significant changes 5 and 30 min after volume therapy. This suggests that the neurohumoral response to hemodilution was not marked. Mixed venous O2 saturation(SvO2) was directly proportional to CI during experiment(r=0.69, p<0.01), indicating that SvO2 can represent CI during shock and volume therapy. In conclusion, l0% pentastarch is useful as a substitute for fresh whole blood or plasmanate.

Effects of Plasmanate and Pentastarch Infusion on Hemodynamic and Coagulation in Patients Undergiong Heart Surgery / 대한마취과학회지

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.

Effects of Plasmanate and Pentastarch Infusion on Hemodynamic and Coagulation in Patients Undergiong Heart Surgery / 대한마취과학회지

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.

The Effects of 10 % Pentastarch Preloading for Cesarean Section Under Epidural Anesthesia / 대한마취과학회지

Epidural anesthesia is the most commonly used anesthesia for cesarean section. But preg- nant women under epidural anesthesia for cesarean section are particularly prone to arterial hypotension following sympathetic blockade. Its prevention is the most important thing to obstetric anesthetists. Forty women at term were randomly allocated to receive either 1,500ml of crystalloid (Hartmann's solution) or 500ml of colloid solution (10% pentastarch) in order to preload the circulation prior to elective cesarean section under epidural anesthesia. And to investigate the adverse effect of pentastarch on coagulation, other forty mothers undergoing cesarean section under general anesthesia were examined with computerized thrombelastograph coagulation analyzer(TEG) before and after 1,500ml of Hartmanns solution or 500ml of 10% pentastarch preloading (each group n=20). There were no differences in the incidence of hypotension, degree of hemodilution, umbilical cord blood gas tension and TEG findings between the two groups. But the serial change of the central venous pressure of the Hartmann group from fluid preloading to anesthesia and operation was significantly different from that of pentastarch group (p<0.05). The TEG findings before fluid preloading presented the hypercoagulable stste of the pregnant women at term, and no adverse effect of pentastarch on coagulation except hemodilution. It was concluded that 10% pentastarch was a good choice as a circulatory preloading agent for cesarean section under epidural anesthesia.

Effects of 10 % Pentastarch on Hypervolemia and Hemodilution following clipping of cerebral aneurysm / 대한마취과학회지

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is one of the most important causes of cerebral ischemia. Hypervolemic hypertension and hemodilution have been reported to be an effective method for prevention and treatment for cerebral ischemia secondary to cerebral vasospasm.We compared the volume expanding effects between normal saline(20 cases), 10% pentastarch(20 cases) and dextran(20 cases) after clipping of cerebral aneurysm in the patients with subarachnoid hemorrhage and the incidence of vasospasm by transcranial doppler(TCD) postoperatively. The results were as follows ;1) The total amount of infused volume in pentastarch and dextran group were 310+/-46ml, 438 +/-262ml respectively,and were significantly smaller than normal saline group, 1078+/-187ml.(p<0.05) 2) Plasma osmolality was increased by 10 mOsm/kg in pentastarch group, but statistically insignificant. 3) Hematocrit value was decreased significantly in pentastarch and dextran group from 34.9+/-1.03%, 34.8+/-1,4% to 31.6+/-1.38%, 31.9+/-0.9% respectively.(p<0.05) 4) Cases over 80cm/sec by TCD were 3 in normal saline, 2 in pentastarch, and 2 in dextran group. We conclude that 10% pentastareh could be used as an effective blood volume expander after cerebral aneurysm clipping.