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NEUROSURGICAL ANESTHESIA

Repetitive Large-Dose Infusion of the Novel Hydroxyethyl Starch 130/0.4 in Patients with Severe Head Injury

Thomas A. Neff, MD^*, Martin Doelberg, PhD, Cornelius Jungheinrich, MD, Andrea Sauerland, Donat R. Spahn, MD^*, and Reto Stocker, MD

*Institute of Anesthesiology and Division of Surgical Intensive Care, University Hospital, Zurich, Switzerland; Clinical Research Department, Fresenius Kabi, Bad Homburg, Germany

Address correspondence and reprint requests to Thomas A. Neff, MD, University of Michigan Medical School, Department of Pathology, 7526 MSRB 1/0602, 1150 West Medical Center Dr., Ann Arbor, MI 48109. Address e-mail to thomas.neff{at}gmx.net

In this prospective, controlled, randomized, single-center study, we investigated the safety of repetitive large-dose infusion of a novel hydroxyethyl starch solution (6% HES 130/0.4) in cranio-cerebral trauma patients. Patients were randomized to receive either HES 130/0.4 (n = 16) at repetitive doses of up to 70 mL · kg^-1 · d^-1 (which is the largest HES dose reported in the literature) or the control HES 200/0.5 (n = 15) up to its approved dose limit of 33 mL · kg^-1 · d^-1 followed by human albumin up to a total dose (HES 200/0.5 + albumin) of 70 mL · kg^-1 · d^-1. We found no differences between groups in mortality, renal function, bleeding complications, and use of blood products. There were also no major differences in coagulation variables. However, at some time points, factor VIII, von Willebrand factor, and ristocetin cofactor were higher in the HES 130/0.4 group despite the large HES doses administered. We conclude that HES 130/0.4 can safely be used in critically ill head trauma patients over several days at doses of up to 70 mL · kg^-1 · d^-1.

IMPLICATIONS: There are concerns that infusion of certain hydroxyethyl starch (HES) types for plasma volume expansion may influence coagulation and renal function. We investigated the safety of the novel HES 130/0.4 in patients with severe cranio-cerebral trauma. The repetitive HES doses administered in this study are the largest reported in the literature.

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