Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1 in normal saline or in balanced electrolyte solution in children
| Autor: | Robert Sümpelmann, Lars Witt, Meike Brütt, Dirk Osterkorn, Wilhelm Alexander Osthaus, Wolfgang Koppert |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Aging medicine.medical_treatment Bicarbonate Sodium Plasma Substitutes chemistry.chemical_element Electrolyte Hydroxyethyl starch Acid-Base Imbalance Sodium Chloride Cohort Studies Hydroxyethyl Starch Derivatives chemistry.chemical_compound Electrolytes Hemoglobins Hypovolemia medicine Humans Prospective Studies Child Saline reproductive and urinary physiology Acid-Base Equilibrium business.industry Infant Pharmaceutical Solutions Anesthesiology and Pain Medicine chemistry Anesthesia Child Preschool Surgical Procedures Operative Pediatrics Perinatology and Child Health Base excess Female Hemoglobin biological phenomena cell phenomena and immunity medicine.symptom business medicine.drug |
| Zdroj: | Paediatric anaesthesia. 20(1) |
| ISSN: | 1460-9592 |
| Popis: | INTRODUCTION A balanced volume replacement strategy is a well established concept for correcting hypovolemia using plasma adapted isotonic crystalloid solutions with a physiological electrolyte pattern and acetate as bicarbonate precursor. Recently, third-generation hydroxyethyl starch (HES) has also become available in a balanced electrolyte solution instead of normal saline. Therefore, in this prospective non-interventional clinical study, the perioperative administration of HES 130/0.42/6 : 1 in normal saline (ns-HES) and in balanced electrolyte solution (bal-HES) was evaluated in children with a focus on acid-base, electrolyte and hemoglobin changes. METHODS Following local ethics committee approval, pediatric patients aged up to 12 years with an ASA risk score of I-III undergoing perioperative administration of HES (ns-HES from May 2006 to December 2007, bal-HES from January 2008 to January 2009) were included. Patient demographics, the performed procedure, adverse drug reactions, hemodynamic data and the results of blood gas analysis were documented with a focus on changes in acid-base, electrolyte and hemoglobin concentrations. RESULTS Of 396 enrolled patients (ASA I-III; age 2.3 +/- 3, range day of birth - 12 years; body weight 10.8 +/- 9, range 0.9-52 kg), 249 received ns-HES and 147 bal-HES (mean volume infused 9.9 +/- 4 and 9.4 +/- 6.9 ml x kg(-1), respectively). After HES infusion, hemoglobin decreased in both groups, whereas bicarbonate and base excess (BE) decreased only with ns-HES and remained stable with bal-HES (BE before infusion: ns-HES -1.8 +/- 2.8, bal-HES -1.7 +/- 2.7 mmol x l(-1); after infusion: ns-HES -2.6 +/- 2.4; bal-HES -1.6 +/- 2.6 mmol x l(-1), P < 0.05). Chloride (Cl) concentrations increased in both groups and were significantly higher with ns-HES (Cl before infusion: ns-HES 105.6 +/- 3.7, bal-HES 105.1 +/- 2.8 mmol x l(-1); after infusion: ns-HES 107.7 +/- 3.2, bal-HES 106.3 +/- 2.9 mmol x l(-1), P < 0.01). No serious adverse drug reactions were observed. CONCLUSION Infusion related iatrogenic acid-base and electrolyte alterations can be minimized by using hydroxyethyl starch in a balanced electrolyte solution instead of normal saline. |
| Databáze: | OpenAIRE |
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