Hemostatic and Electrolyte Effects of Hydroxyethyl Starches in Patients Undergoing Posterior Lumbar Interbody Fusion Using Pedicle Screws and Cages

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2010-04, Vol.35 (7), p.829-834
• Main Authors: SOO JOO CHOI, HYUN JOO AHN, SUNG SOO CHUNG, MYUNG HEE KIM, DUCK HWAN CHOI, LEE, Sangmin M, JIN GU KANG, JIN KYOUNG KIM
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Coagulation - drug effects; Blood Loss, Surgical - prevention & control; Bone Screws; Cerebrospinal fluid. Meninges. Spinal cord; Double-Blind Method; Female; Hemostatic Techniques; Humans; Hydroxyethyl Starch Derivatives - therapeutic use; Lumbar Vertebrae - surgery; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system (semeiology, syndromes); Neurology; Plasma Substitutes - therapeutic use; Prospective Studies; Spinal Fusion; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181b8d9f2

Prospective, randomized, double blind, clinical study. To compare the hemostatic and electrolyte effects of 2 commonly administered hydroxyethyl starches (HES) in patients undergoing posterior lumbar interbody fusion (PLIF). HES are commonly administered colloid solutions to restore and maintain intravascular volume before transfusion is initiated. However, infusion of HES itself can impair coagulation. HES-induced coagulopathy could be a serious problem in PLIF which involves continuous bone bleeding and oozing. Voluven (Fresenius Kabi, Germany), previously regarded as the least coagulopathic due to its low molecular weight (MW) and degree of substitution (DS), is a saline-based HES. Hextend (Biotime, United States) is a new type of HES with physiologic pH and balanced electrolytes, including calcium, which is beneficial to coagulation. Studies comparing the coagulopathy of Hextend and Voluven are rare. Therefore, coagulation, pH/electrolyte changes, and blood loss using Hextend and Voluven in patients undergoing PLIF were compared. METHODS.: Fifty-four patients scheduled for PLIF involving 3 vertebrae or less were randomly assigned to the Voluven or the Hextend group. Of each solution 15 mL/kg was administered during surgery. Blood loss, coagulation, and electrolyte profiles were checked before infusion and 5 minutes, 3 hours, and 24 hours after the end of infusion. The Hextend group showed slightly better electrolyte balance, however, more coagulation impairment and postoperative transfusion (37% vs. 11%) compared with the Voluven group. The effect of Hextend on coagulation lasted until 24 hours after infusion. If coagulopathy is a concern during PLIF, then, a HES with low MW/DS in a saline-based medium (Voluven) may be a better alternative than a HES with high MW/DS in a balanced salt medium (Hextend).