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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 785-797, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MJ London, JS Ho, JK Triedman, ED Verrier, J Levin, SH Merrick, FL Hanley, WS Browner and DT Mangano
Pentastarch is a hydroxyethyl starch similar to hetastarch, but with a
lower average molecular weight (264,000 versus 450,000) and fewer
hydroxyethyl groups (molar substitution ratio = 0.45 versus 0.70). These
characteristics result in enhanced enzymatic hydrolysis, faster renal
elimination (initial intravascular half-life = 2.5 versus 25.5 hours), and
less effect on coagulation. We report on a randomized clinical trial
comparing the clinical efficacy and safety of 10% pentastarch (group P) for
plasma volume expansion after cardiac operations with that of 5% serum
albumin (group A). During the first 24 hours after arrival of the patient
in the intensive care unit, colloid was infused to maintain a cardiac index
of 2.0 L/m2 or more and a mean arterial pressure within 10% of the
preinduction value. Group P (n = 50) received 1706 +/- 393 ml of colloid
(mean +/- standard deviation) during this period, and group A (n = 44),
1794 +/- 341 ml (p = no significant difference). Hemodynamic responses to
infusion were similar for both groups, although in group P a greater
increase in both cardiac index (0.5 +/- 0.5 versus 0.3 +/- 0.5 L/min/m2 in
group A, p less than 0.01) and left ventricular stroke work index (10.8 +/-
8.0 versus 5.8 +/- 6.0 gm-m/m2, p less than 0.01) was observed during
infusion of the first 500 ml. There were no significant differences in any
of the measured respiratory parameters (alveolar-arterial oxygen gradient,
estimated shunt fraction, and effective pulmonary compliance). Hemodilution
with colloid significantly reduced serum protein levels in group P by 24
hours postoperatively (4.0 +/- 0.6 versus 5.0 +/- 0.7 gm/dl in group A, p
less than 0.05), although mean serum colloid osmotic pressure was similar
(15.4 +/- 2.6 [P] versus 15.5 +/- 2.7 mmHg [A], p = no significant
difference). There were no significant between- group differences in
prothrombin time, activated partial thromboplastin time, platelet count,
bleeding time, or coagulation factors (fibrinogen, V, VII, VIII, or IX) on
postoperative days 1 and 7. Perioperative fluid balance, weight change,
chest tube output, red blood, platelet, or fresh frozen plasma usage,
reexploration for bleeding, and clinical outcome were also similar. These
findings indicate that pentastarch is as safe and effective s 5% albumin
for plasma volume expansion after cardiac operations with no apparent
adverse effects on coagulation. If commercially available at a lower cost
than albumin, it would appear to be a reasonable first choice for colloid
therapy in this setting.
ARTICLES
A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations
Department of Anesthesia, University of California, San Francisco.
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