LARGE-DOSE ADMINISTRATION OF 6-PERCENT HYDROXYETHYL STARCH 200 0.5 FOR TOTAL HIP-ARTHROPLASTY - PLASMA HOMEOSTASIS, HEMOSTASIS, AND RENAL-FUNCTION COMPARED TO USE OF 5-PERCENT HUMAN ALBUMIN/

Within a daily dose of 20 mL/kg, medium-molecular hydroxyethyl starch (HES) is a safe and effective colloid for intravascular blood volume r eplacement. The effect of large doses on coagulation and renal functio n is unknown. We prospectively studied 41 patients undergoing total hi p arthroplasty during the perioperative period. Inevitable blood loss was replaced with HES (HES group) or albumin (ALB group) in combinatio n with packed red blood sells (PRBC), fresh frozen plasma (FFP), and p latelets. Hemodynamic, oncotic, coagulation, and renal functions were compared initially, at the end of surgery, during the postoperative pe riod (1, 3, and 6 h), and also with respect to the volume of colloid s olution administered (1500, 2000, and 3000 mL). Total intake and outpu t balances, as well as the costs of blood replacement therapy, were re gistered at the end of the study. We found differences in oncotic vari ables even at 6 h after surgery (total serum proteins [TSP]:HES 36.4 /- 7.9 g/L versus ALB 55.6 +/- 6.1 g/L, P < 0.01; serum albumin: HES 2 5.5 +/- 5.3 g/L versus ALB 42.0 +/- 5.6 g/L, P < 0.01). Colloid osmoti c pressure (COP) and hemodynamic, coagulation, and renal functions wer e comparable, as was total blood loss (HES 4247 +/- 2090 mt versus ALB 4051 +/- 2830 mL). Total requirements for colloid solutions (HES 35.9 +/- 7.4 mL/kg versus ALB 33.9 +/- 10.5 mL/kg), PRBC, FFP, or platelet s were comparable, whereas total cost of blood replacement therapy was 33% less in the HES group. With respect to efficacy and side effects on coagulation and renal function, medium molecular I-IES is an approp riate and economic alternative to albumin at daily doses of up to at l east 36 mL/kg.