Safety and efficacy of pentastarch 6% versus albumin 5% for acute normovolemic hemodilution in patients undergoing major abdominal surgeries

ABSTRACT

Acute normovolemic hemodilution [ANH] has been used to decrease allogenic blood transfusion. ANH has different systemic effects that may include hemodynamic, oxygen transport variables, renal, hematological and acid base status. The effect of pentastarch [6% hydroxyethyl starch, MW 200 kDa] versus human serum albumin [5%, MW 69 kDa] as volume replacement solution after induction of anesthesia for major abdominnal surgery was assessed in this study. Eighty patients were divided into two groups; HES group [no = 40] received pentasarch and ALB group [no = 40] received albumin. Fifteen m1/kg of blood was removed and replaced simultaneously with the tested solutions to keep central venous pressure between 12-15 mmHg. Blood was reinfused before the end of operations. Total blood loss at 1st postoperative day was significantly higher in HES group [1198.5 +/- 354.3 vs. 1044.2 +/- 288.3 m1 in ALB group]. Significantly Higher amounts of the tested colloid [2084.7 +/- 408.6 in HES group vs. 1766.6 +/- 574.3 ml in ALB groups, 4 hrs postoperatively], crystalloids [5748.8 +/- 1165.3 in HES group vs. 5116.8 +/- 1309.8 ml in ALB group at 1 st postoperative day], FFP [243.6 +/- 29.7 in HES group vs. 123.5 +/- 25.3 ml in ALB group, at the end of surgery] and packed RBC [988.8 +/- 47.8 in HES group vs. 645.9 +/- 44.8 ml in ALB group, at the end of surgery] were used in HES group. HES group showed significantly higher cardiac index [3.9 +/- 0.9 in HES group vs. 3.4 +/- 1.0 1/min.m 2 in ALB group, at the completion of ANH], better preservation of SVRI [2052.3 +/- 251.5 in 5HES2 group vs. 1729.6 +/- 159.4 dyne.sec/cm5. m 2 in ALB group, at the completion of ANH]. Renal functions were better preserved in ALB group. Serum creatinine was significantly higher HES group [1.41 +/- 0.35 vs. 0.98 +/- 0.31 mg% in ALB group, at 3rd postoperative day]. Urinary N-acetyl-beta-glucosaminidase [beta-NAG] was significantly higher in HES group [1.38 +/- 0.52] compared with ALB group [0.97 +/- 0.52] u/mmol creatinine] at the 3rd posstoperative day. alpha-1-microglobulin was significantly higher in HES group [19.7 +/- 9.3] compared with ALB group [15.2 +/- 9.3 mg/1] at the 3rd postoperative day. Activated PTT was significantly higher in HES group [44.8 +/- 4.4] compared with ALB group [40.5 +/- 4.7 sec] 4 hrs postoperatively. D-dimer was significantly higher in HES group [2.4 +/- 0.2] compared with ALB group [3.0 +/- 0.6 ng/1] at the 1st postoperative day. Thrombin/antithrombin III [TAT] was statistically higher in HES group [2.2 +/- 0.7] compared with ALB group [1.9 +/- 0.6 micro g/1] at the 1st postperative day. There was a state of metabolic acidosis in both groups with a significant difference in base-excess results [-3.2 +/- 1.5 in HES group vs. -4.1 +/- 1.3 mmo1/1 in ALB group] at the completion of ANH. We can conclude that both solution were safe and effective for performing ANH before major abdominal operations with the superiority of albumin over pentastarch