Ag. Hakaim et al., THE PENTAFRACTION OF HYDROXYETHYL STARCH INHIBITS - ISCHEMIA-INDUCED COMPARTMENT SYNDROME, The journal of trauma, injury, infection, and critical care, 37(1), 1994, pp. 18-21
Pentafraction (PF), a solution of biodegradable hydroxyethyl starch ma
cromolecules with molecular weights of 10 to 100 X 10(4) daltons, has
been shown to minimize tissue edema by sealing interendothelial clefts
at the capillary level. The effect of PF on ischemia-reperfusion-indu
ced compartment syndrome was studied. Ten rabbits underwent bilateral
femoral artery occlusion following ligation of branches from the termi
nal aorta to the popliteal artery. After 7 hours of ischemia, reperfus
ion was established with heparinized polyethylene shunts. Experimental
animals (n = 5) received PF and control animals (n = 5) received norm
al saline (NS) as an intravenous infusion (30 mL/kg) for 1 hour, begin
ning 10 minutes after shunt placement. During reperfusion, anterior co
mpartment pressure was continuously monitored in the left lower extrem
ity. To quantitate oxidative metabolism, triphenyltetrazolium chloride
(TTC) reduction (micrograms of TTC per milligram of protein) of tibia
lis anterior muscle from the right lower extremity was measured at fem
oral artery occlusion, 7 hours of ischemia, and 2 hours of reperfusion
. In the NS group, anterior compartment pressure significantly increas
ed from the end of the ischemic interval, 10.8 +/- 4.14 to 36.4 +/- 9.
9 mm Hg and 44.6 +/- 15.4 mm Hg, after 1 and 2 hours of reperfusion (p
< 0.007) compared with the PF group, which did not change significant
ly, 10.6 +/- 2.6 to 11.4 +/- 12.9 mm Hg and 7.4 +/- 2.8 mm Hg, after 1
and 2 hours of reperfusion (p < 0.67). After 1 hour of reperfusion, t
he anterior compartment pressure of the NS group was significantly gre
ater than that of the PF group (p < 0.009) as well as after 2 hours of
reperfusion (p < 0.007). The TTC reduction following 2 hours of reper
fusion increased significantly to 0.153 +/- 9.76 mug/mg in the PF grou
p compared with the NS group, 0.006 +/- 1.34 mug/mg (p < 0.02). We con
clude that the pentafraction of hydroxyethyl starch inhibits the incre
ase in compartment pressure that follows prolonged severe muscle ische
mia in this rabbit hindlimb model of skeletal muscle ischemia.