Réactions anaphylactoïdes aux substituts colloïdaux du plasma : incidence, facteurs de risque, mécanismes

Laxenaire, M.C.; Charpentier, C.; Feldman, Laura

doi:10.1016/s0750-7658(94)80038-3

Cited by 329 publications

(53 citation statements)

References 17 publications

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“…1,2 A disadvantage of gelatin is the higher incidence of allergic reactions, e.g., in comparison with HES. 3 Hydroxyethyl starch is a derivative of amylopectin, the highly branched polysaccharide component of waxy maize which closely resembles glycogen. Hydroxyethyl starch is manufactured through hydrolysis and subsequent hydroxyethylation of amylopectin, thereby cleavage of the molecule in vivoby serum alpha-amylase is delayed.…”

Section: Discussionmentioning

confidence: 99%

A novel hydroxyethyl starch (Voluven®) for effective perioperative plasma volume substitution in cardiac surgery

Huet¹,

et al. 2000

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Purpose: To compare the new hydroxyethyl starch HES 130/0.4 (Voluven®) and the standard HES 200/0.5 (pentastarch) regarding effectiveness for plasma volume substitution and safety of large volumes in heart surgery.Methods: Fifty-nine patients scheduled for coronary artery bypass grafting were enrolled in a prospective, randomised, double-blind, parallel-group, multicentre, clinical, phase III study. Hydroxyethyl starch was used as the exclusive artificial colloid for acute normovolemic hemodilution, priming of the heart lung machine, and for intra-and postoperative plasma volume substitution from induction of anesthesia until 16 hr after the end of surgery. Efficacy was evaluated by comparing the amount of colloid infused, hemodynamics, and colloid osmotic pressure (COP). Safety endpoints were blood loss, the use of allogeneic blood products, coagulation variables, and adverse events.Results: Effectiveness, as assessed by the total amount of infused HES volumes within the treatment period, was similar between HES 130/0.4 and HES 200/0.5 (2550 mL ± 561 mL vs 2466 mL ± 516 mL). Also, no differences were found for the use of other colloids (pasteurised plasma), hemodynamics, and COP. In HES 130/0.4 patients, the postoperative increase of von-Willebrand factor (vWF) was higher (P < 0.01), blood loss was lower, and less packed red blood cells were transfused. Conclusion:Hydroxyethyl starch 130/0.4 is an effective plasma volume expander in heart surgery and may be used as the sole artificial colloid to cover the perioperative period. We found a reduced influence of HES 130/0.4 on the physiologic postoperative increase of vWF.Objectif: Comparer le nouvel hydroxyéthylamidon HEA 130/0,4 (Voluven®) et l'HEA standard 200/0,5 (pentamidon) au plan de l'efficacité, quand on l'utilise comme substitution du volume plasmatique, et au plan sécuri-taire de l'emploi de volumes importants en cardiochirurgie.Méthode : Cinquante-neuf patients qui devaient subir un pontage aorto-coronarien ont participé à une étude clinique multicentrique, prospective, randomisée, à double insu et en groupes parallèles, de phase III. L'hydroxyéthylamidon a été utilisé comme colloïde artificiel exclusif pour l'hémodilution normovolémique pratiquée d'emblée, pour amorcer l'utilisation du coeur-poumon artificiel et pour le remplacement du volume plasmatique peropératoire et postopératoire depuis l'induction de l'anesthésie jusqu'à 16 h après la fin de l'opération. L'efficacité a été évaluée en comparant la quantité de colloïde perfusé, l'hémodynamie et la pression osmotique du colloïde (POC). Les paramètres mesurés ont été : la perte sanguine, l'utilisation de produits sanguins allogéniques, les variables de coagulation et les inconvénients.Résultats : L'efficacité, évaluée selon la quantité totale d'HEA perfusé pendant le traitement, a été similaire pour l'HEA 130/0,4 et l'HEA 200/0,5 (2550 mL ± 561 mL vs 2466 mL ± 516 mL). De plus, il n'y a eu aucune différence quant à l'utilisation d'autres colloïdes (plasma pasteurisé), à l'hémodynamie et à la POC. Ch...

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Section: Discussionmentioning

confidence: 99%

A novel hydroxyethyl starch (Voluven®) for effective perioperative plasma volume substitution in cardiac surgery

Huet¹,

et al. 2000

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“…Even prophylaxis with monovalent hapten dextran cannot completely eliminate their occurrence 35 . In a large clinical trial on approximately 20,000 patients, it was demonstrated that gelatins produce more anaphylactic/anaphylactoid reactions than starch preparations 36 . Severe (life-threatening) anaphylactic reactions with the different kinds of HES preparations may also occur 37 but appear to be rare 36 .…”

Section: Side Effects Of Synthetic Colloidsmentioning

confidence: 99%

“…In a large clinical trial on approximately 20,000 patients, it was demonstrated that gelatins produce more anaphylactic/anaphylactoid reactions than starch preparations 36 . Severe (life-threatening) anaphylactic reactions with the different kinds of HES preparations may also occur 37 but appear to be rare 36 . Renal dysfunction has been reported with the use of some synthetic colloids (e.g dextrans, HES) 38,39 .…”

Section: Side Effects Of Synthetic Colloidsmentioning

confidence: 99%

Choice of a Synthetic Colloid for Surgery

Boldt

1999

Transfus Alt Transfus Med

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SUMMARY Adequate volume replacement is known to be a therapeutic cornerstone in the perioperative period. Guarantee or/of restoration of tissue perfusion represents a particular challenge in patients with circulatory abnormalities. Besides the natural colloid albumin and crystalloids, synthetic colloids such as gelatins, dextrans or hydroxethyl starch (HES) preparations are used in this situation. Meta‐analyses have shown conflicting results and appear to be more confusing than helpful in evaluating the ‘ideal’ kind of solution for volume therapy. The principles of volume therapy in the surgical and cardiac surgery patient are presented and the different synthetic colloids as plasma substitutes are reviewed.

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“…Among the available synthetic colloids, hydroxyethyl starch (HES) has been shown to have the lowest incidence of anaphylactoid reactions [1]. With the latest third generation, so called tetrastarches or HES 130/0.4, a major advancement particularly in respect of safety issues has been achieved over recent years.…”

Section: Introductionmentioning

confidence: 99%

The Volume Effect and Safety of 6% Hydroxyethyl Starch 130/0.4 in Patients Undergoing Major Elective Surgery: An Uncontrolled, Open-Labeled, Multi-Center Study

Morioka¹,

Ozaki²,

Yamakage³

et al. 2013

OJAnes

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Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need to infuse human albumin may be reduced or avoided in Japan if these large doses 6% HES 130/0.4 can be infused. Methods: The study was an uncontrolled, open-labeled, multi-center trial. Fifteen adult and 5 pediatric patients undergoing major elective surgery received 6% HES 130/0.4 (Voluven ® ) with a maximum dose of 50 mL/kg from the start of surgery until 2 hours after the end of surgery according to a treatment algorithm. The primary efficacy endpoint was the volume effect of 6% HES 130/0.4 determined by the volume of saved albumin during the investigational period and the time course of hemodynamic stability in adult and pediatric patients. Safety parameters were fluid balance, hemodynamic and laboratory parameters ECG, local and systemic tolerance and adverse events. Results: Adult patients received a mean of 32.0 mL/kg of 6% HES 130/0.4. For 12 out of 15 adult patients an average amount of 1033.8 mL (18.6 mL/kg) albumin could be saved. The other 3 adult patients did not receive more than 1000 mL of HES 130/0.4. All pediatric patients received approximately 50 mL/kg of HES 130/0.4; for these patients an average amount of 39.9 mL/kg body weight albumin could be saved. The majority of adult patients, and all pediatric patients were hemodynamically stable at all 3 time points. The observed changes of the assessed laboratory parameters including hematological and coagulation parameters or in any other safety parameter determined did not reveal any safety concern related to the administration of 6% HES 130/0.4 up to doses of 50 mL/kg body weight. Conclusion: The study results indicate that 6% HES 130/0.4 has a reliable volume effect, could contribute to significant human albumin savings and was safe and well tolerated up to a maximum dose of 50 mL/kg body weight in adult and pediatric patients undergoing major elective surgery.

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Réactions anaphylactoïdes aux substituts colloïdaux du plasma : incidence, facteurs de risque, mécanismes

Cited by 329 publications

References 17 publications

A novel hydroxyethyl starch (Voluven®) for effective perioperative plasma volume substitution in cardiac surgery

A novel hydroxyethyl starch (Voluven®) for effective perioperative plasma volume substitution in cardiac surgery

Choice of a Synthetic Colloid for Surgery

The Volume Effect and Safety of 6% Hydroxyethyl Starch 130/0.4 in Patients Undergoing Major Elective Surgery: An Uncontrolled, Open-Labeled, Multi-Center Study

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