Giving long-persistent starch as volume replacement can cause pruritus after cardiac surgery

Abstract

We reviewed the prevalence and severity of pruritus in 85 patients after cardiac surgery. EloHAES, a long-lasting hydroxyethylated starch, was given to 59 of these patients. None of the patients who did not receive EloHAES developed pruritus, compared with 22% of those who did (P = 0.007). The timing of onset, duration and severity of the pruritus are similar to those found previously for other hydroxyethylated starches, and the cause of this pruritus is likely to be similar. Hydroxyethyl starch can cause long-term pruritus.

Hydroxyethyl Starches and Pruritus: A Real Problem?

“…Kimme et al 12 have demonstrated in a retrospective study involving 37 patients operated for cerebral aneurysm and treated with 10% HES 200/0.5 (i.e., an average molecular weight of 200 kDa and a molar substitution of 0.5) that incidence and severity of pruritus were significantly higher for a total infused HES volume larger than 500 g. Total infused volume varied between 50 and 1,950 g and the global incidence of pruritus was 54%. Morgan et al 11 have also underlined this relationship. Eighty-five patients were reviewed retrospectively after cardiac surgery.…”

“…This is not a surprise since pruritus following HES administration frequently develops tardily and is generally observed only with higher cumulative doses exceeding 200 g. 10,12,13,[16][17][18][19] However, other studies, which were not prospective and randomized, have assessed a possible link between the administration of HES and the development of pruritus. These studies show a very variable incidence of pruritus, varying between 0-54 %, [8][9][10][11][12][13][16][17][18][19][20] and a link between the total amount of HES infused and the incidence and severity of pruritus. 10,12,13,[16][17][18][19] In patients who are developing pruritus after HES administration, itching usually starts with a delay of 3 days to 15 weeks.…”

“…In approximately 50% of cases, pruritus is so severe as to significantly compromise quality of life. 11,12,20 Pruritus crises vary between 2 and 30 minutes and they can occur months or years after administration of HES.…”

A Systematic Review of the Comparative Safety of Colloids

“…Pruritus associated with HES was reported in 14 studies involving a total of 2598 patients, of whom 2173 (83.6%) received HES and 425 (16.4%) did not. * The odds of pru-*References 45,52,53,55,58,59,76,84,86,95,96,99,105,106. ritus were significantly increased by HES exposure ( Table 5).…”

HES: Is There a Maximal Dose?

“…Itching after using HES remains a debatable topic [18][19][20] . Special features of HES-induced pruritus include long latency of onset and persistence.…”