Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxethy starch (HES 200/0.62, 6%)
| Autor: | M Paris, J. F. Baron, B Oulare, O. Mundler, M. Arthaud, M Ismaïl, A C Degrémont |
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| Rok vydání: | 1995 |
| Předmět: |
Time Factors
Polymers Starch Plasma Substitutes Hydroxyethyl starch Critical Care and Intensive Care Medicine Plasma volume Blood substitute chemistry.chemical_compound Pharmacokinetics Osmotic Pressure Intensive care Humans Medicine Osmotic pressure Prospective Studies Plasma Volume Infusions Intravenous Aged Postoperative Care Endarterectomy Carotid business.industry Hydrolysis Hemodynamics Middle Aged Molecular Weight chemistry Anesthesia Biophysics Drug Monitoring business Perfusion medicine.drug |
| Zdroj: | Intensive Care Medicine. 21:577-583 |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/bf01700163 |
| Popis: | To define the mechanisms of the stable and prolonged post-operative plasma volume expansion observed with Hydroxyethyl Starches (HES) and to determine whether a partial intravascular hydrolysis of large molecules contribute to reinforce the colloid-osmotic effect.Prospective, pharmacologic study using single dose of drug.University-based, post-anesthesia care unit.The protocol was performed during the post-operative period, in 10 patients after stable recovery from general anesthesia for carotid endarterectomy.HES 200/0.62 (500 ml) was infused over 30 min. Standard hemodynamic and biological variables, HES concentration and colloid osmotic pressure were obtained at each measurement. Plasma volume was calculated using 51Cr-labelled RBCs. Patterns of changes in number average molecular weight (MWn) and weight average MW (MWw) were measured using gel permeation chromatography. Measurements were obtained at control, end of infusion, 1 h, 3 h, 6 h and 24 h after infusion.Plasma volume increased by 693 ml (+21%) after the infusion of HES and remained constant over 24 h. HES concentration progressively decreased to reach a value of 35% of the peak at 24 h. MWn and MWw, initially decreased when compared with the dose solution and changed little in the 24 h study period. Diuresis significantly decreased at 3 h up to 24 h. Plasma albumin decreased after infusion and then progressively increased to reach a significantly higher value at 24 h than after infusion.Initial plasma volume expansion and decrease in HES concentration agree with previously-published data. Maintenance of plasma volume expansion over 24 h was not related to a partial intravascular hydrolysis. Low elimination rate of HES, extravascular mobilization of albumin and post-operative renal adaptations were possibly the 3 main mechanisms to explain a prolonged plasma volume expansion with HES 200/0.62, 6%. |
| Databáze: | OpenAIRE |
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