THE PENTAFRACTION OF HYDROXYETHYL STARCH INHIBITS - ISCHEMIA-INDUCED COMPARTMENT SYNDROME

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.