TỔNG QUAN VỀ CÁC DUNG DỊCH CAO PHÂN TỬ ThS. BS. Nguyễn Minh Tuấn Bệnh viện Nhi Đồng 1

TỔNG QUAN VỀ CÁC DUNG DỊCH CAO PHÂN TỬ ThS BS Nguyễn Minh Tuấn Bệnh viện Nhi Đồng Development of synthetic colloid solutions Gelatine (1915) Dextran (1947) HES (1974) 6% HES 450 / 0.7 HES (1978) 6% HES 200 / 0.6 HES (1980) 6% / %10 HES 200 / 0.5 HES (1999) 6%, 10% HES 130 / 0.4 The properties of an ideal colloid Rapid volume replacement Good hemodynamic restoration Improvement of microcirculation Improvement of plasma oncotic pressure Fast metabolism / Excretion and Good Tolerance Less coagulopathy, hemolysis, cross-match disturbances Increase DO2 and organ function No cause acid-base disorders The Result of this process is HES No interference with organ function even with repeated administration 10 Non pyrogenic, non-allergenic and non-antigenic VOLUME EFFECT OF CRYSTALLOIDS Kanagarajan N Goal directed perioperative fluid management – Does kind of fluid matter? CLASSIFICATION OF COLLOIDS •Natural: Albumin Plasma •Synthetic: Gelatin Dextran HES GELATINS Urea-crosslinked Gelatin Cross linked Gelatin Succinylated Gelatin Concentration (%) 3.5 5.5 4.0 Mean molecular weight(Dalton) 35000 30000 30000 Volume 1-3 effect(hours)(approx) 1-3 1-3 Volume efficacy(%)(approx.) 80 80 80 Osmolarity 301 206 274 Brand name Haemacel Gelofundiol Gelofusine Boldt J, Suttner Plasma substitutes Minerva Anestesiol, 2005; 71:741-58 Dextran MW(Dalton) Volume effect (hour) Volume efficacy (%) Side effects 6% Dex 70 70,000 10% Dex 40 40,000 6% Dex 60 60,000 5-6 3-4 150% 200% 100% - Anaphylactoid shock - Coagulation disorder - Renal dysfunction Boldt J, Priebe HJ Anesth Analg 2003 Feb;96(2):376-82 Warner MA Anesthesiology 2009; 111:187–202 Characteristics of different colloids Philippe Van der Linden, Brigitte E The effects of colloid solutions on hemostasis Can J Anesth Volume 53, Supplement 2, S30-S39 ACCUMULATION AND TISSUE STORAGE Plasma concentration of different HES types after single infusion of 500ml each in healthy volunteers Jungheinrich C The starch family: Are they all equal Pharmacokinetics and pharmacodynamics of hydroxyethyl starches? Transfus Altem Transfu Med, 2007: 9, 152–163 ACCUMULATION AND TISSUE STORAGE Tetrastarches - Less tissue accumulation and even in high doses pruritus is a not a clinical problem Mitra S et al Indian J Anaesth 2009 October; 53(5): 592–607 The development of HES HES Clearance of earlier HES products is much slower, with the result that first and second generation HES products are not completely eliminated from the circulation within 24 h Different characteristics of HES preparations Boldt J Anesth Analg, 2009 May; 108(5):1574-82 Characteristics of HES Preparations Kozek-Langenecker S Effects of hydroxyethyl starch solutions on hemostasis ANESTHESIOLOGY 2005; 103:654–60 Boldt J, Suttner S: Plasma substitutes Minerva Anesthesiol 2005; 71:741–58 Hemodynamic effects of ofdifferent plasma Haemodynamic effects different plasma substitutes substitutes Boldt J Br J Anaesth 2009;103:147-151 Risk of metabolic hyperchloremic acidosis associated with replacement by unbalanced solutions -A problem with infusion of large volumes of ‘unphysiologic’ saline solution containing large amounts of sodium (154mmol/l) and chloride (154mmol/l) Risk of metabolic hyperchloremic acidosis associated with replacement by unbalanced solutions Producing acidosis by administering large amounts of unbalanced fluids may mask diagnosis of perfusion deficits Or May result in inappropriate clinical interventions due to the erroneous presumption of ongoing tissue hypoxia secondary to hyovolemia Balanced-HES 130/0.4 vs Saline-HES 130/0.4 Electrolytes Balanced-HES 130/0.4 Plasma HES 130/0.4 in 0.9% NaCl Composition of some plasma substitutes Boldt J Current Opinion in Anaesthesiology 2008, 21:679–683 Benefits of balanced solutions -Reduce the risk of hyperchloremic metabolic acidosis -Associated with significantly fewer alterations in coagulation and platelet aggregation than conventional HES Westphal M et al Anesthesiology, 2009;111:187-202 THANK YOU FOR YOUR ATTENTION ... excretion, even in the presence of severe non-anuric renal failure, is higher for HES 130/0.4 than values published for older HES specifications HES 130/0.4 may be given to patients with severe renal... of negative effects on hemostasis Gallandat HRCG et al Can J Anaesth 2000;47:1207-15 Haisch G J Cardiothorac Vasc Anesth 2001;15:316-21 No platelet function abnormalities have been observed in... of molecules in HES 130/0.4 is relatively high due to its lower average MW and narrow molecular weight distribution •The greater number of osmotically effective molecules in HES 130/0.4 is thought