Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000100003
Brazilian Journal of Anesthesiology
Scientific Article

Terapia de reposição volêmica durante artroplastia de quadril usando hidroxietilamido (130/0,4) comparado com Ringer lactato diminui transfusão de sangue alogênico e infecção pós-operatória

Volume replacement therapy during hip arthroplasty using hydroxyethyl starch (130/0.4) compared to lactated Ringer decreases allogeneic blood transfusion and postoperative infection

Adilson Hamaji; Ludhmila Hajjar; Marcelo Caiero; Juliano Almeida; Rosana Ely Nakamura; Eduardo A Osawa; Julia Fukushima; Filomena R Galas; Jose Otavio Costa Auler Junior

http://dx.doi.org/10.1590/S0034-70942013000100003 Braz J Anesthesiol, vol.63, n1, p.36-44, 2013
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Resumo

JUSTIFICATIVA E OBJETIVOS: O hidroxietilamido 130/0,4 (HES 130/0,4) é considerado um expansor plasmático efetivo quando comparado com cristaloides. Há controvérsia sobre sua superioridade em relação à otimização hemodinâmica e sobre possíveis efeitos prejudiciais na coagulação. O objetivo deste estudo foi comparar os efeitos do HES 130/0,4 com os da solução de Ringer lactato durante artroplastia de quadril em pacientes adultos sob raquianestesia e levou em consideração sangramento intraoperatório, parâmetros hemodinâmicos, coagulograma, necessidade de transfusão e desfechos clínicos. MÉTODOS: Neste estudo randômico e controlado, 48 pacientes agendados para artroplastia de quadril com raquianestesia foram alocados em dois grupos: 24 receberam uma pré-carga de HES 130/0,4 (15 mL.kg-1) e 24 receberam uma pré-carga de solução de Ringer lactato (30 mL. kg-1) antes da cirurgia. Mensurações hemodinâmicas, concentração de hemoglobina, parâmetros bioquímicos e testes de coagulação foram avaliados em três períodos durante o procedimento cirúrgico. Os pacientes receberam acompanhamento médico durante a internação e até 30 dias no período pós-operatório. O principal fator foi a necessidade de transfusão de hemácias entre os grupos durante a internação. Os fatores secundários foram parâmetros hemodinâmicos, tempo de internação, mortalidade e ocorrência de complicações clínicas. no período pós-operatório. O principal fator foi a necessidade de transfusão de hemácias entre os grupos durante a internação. Os fatores secundários foram parâmetros hemodinâmicos, tempo de internação, mortalidade e ocorrência de complicações clínicas. RESULTADOS: A transfusão de hemácias foi necessária em 17% dos pacientes do grupo HES e em 46% dos pacientes do grupo Ringer lactato (p = 0,029). Infecções pós-operatórias foram observadas com mais frequência no grupo de Ringer lactato (17%) em comparação com o grupo HES (0), p = 0,037. Não houve diferenças significativas entre os grupos em relação à mortalidade, ao tempo de internação e às complicações clínicas, exceto infecção. CONCLUSÕES: Durante a artroplastia de quadril, os pacientes tratados com hemodiluição hipervolêmica normal com hidroxietilamido 130/0,4 precisaram de menos transfusão e apresentaram índice menor de infecção em comparação com os pacientes que receberam Ringer lactato.

Palavras-chave

CIRURGIA: Ortopédica, Artroplastia de Quadril, TÉCNICAS ANESTÉSICAS: Regional, subaracnoidea, SANGUE: Transfusão, Hetamido, Hemodiluição

Abstract

BACKGROUND AND OBJECTIVES: Hydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes. METHODS: In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15 mL.kg-1 of HES 130/0.4 and 24 patients received a preload of 30 mL.kg-1 lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications. RESULTS: Red blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p = .029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p = .037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection. Conclusions: During hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.

Keywords

Arthroplasty, Replacement, Hip, Anesthesia, Spinal, Blood Transfusion, Hetastarch, Hemodilution

References

Jones SB, Whitten CW, Despotis GJ, Monk TG. The influence of crystalloid and colloid replacement solutions in acute normovolemic hemodilution: a preliminary survey of hemostatic markers. Anesth Analg. 2003;96:363-368.

Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg. 2001;93:405-409.

Boldt J, Lehmann A, Römpert R, Haisch G, Isgro F. Volume therapy with a new hydroxyethyl starch solution in cardiac surgical patients before cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2000;14:264-268.

Karanko MS, Klossner JA, Laaksonen VO. Restoring volume by crystalloid versus colloid after coronary artery bypass: hemodynamics, lung water, oxygenation, and outcome. Crit Care Med. 1987;15:559-566.

Boldt J, Knothe C, Zickmann B. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg. 1993;76:1185-1190.

Haisch G, Boldt J, Krebs C. Influence of a new hydroxyethyl starch preparation (HES 130/0.4) on coagulation in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2001;15:316-321.

Gallandat RCG, Siemons AW, Baus D. A novel hydroxyethyl starch (Voluven®) for effective perioperative plasma volume substitution in cardiac surgery. Can J Anesth. 2000;47.

Grauer MT, Baus D, Woessner R. Effects on general safety and coagulation after long-term, high-dose volume therapy with 6 % hydroxyethyl starch 130/0.4 in patients with acute ischemic stroke: Results of a randomized, placebo-controlled, double-blind study. Critical Care. 2001;5:P115-S54.

Langeron O, Doelberg M, Ang ET, Bonnet F, Capdevila X, Coriat P. Voluven® a lower substituted novel hydroxyethylstarch (HES 130/0.4) causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5. Anesth Analg. 2001;92:855-862.

Gandhi SD, Weiskopf RB, Jungheinrich C. Volume replacement therapy during major orthopedic surgery using Voluven® (hydroxyethyl starch 130/0.4) or hetastarch. Anesthesiol. 2007;106:1120-1127.

Hébert PC, Wells G, Blajchman MA. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care: Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409-417.

Taylor RW, O'Brien JRN, Trottier Steven J. Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med. 2006;34:2302-2308.

Hladik W, Dollard Sheila, Mermin J. Transmission of Human Herpesvirus 8 by Blood Transfusion. New Engl J Med. 2006;355:1331-1338.

Innerhofer P, Walleczek C, Luz G. Transfusion of buffy coatdepleted blood components and risk of postoperative infection in orthopedic patients. Transfusion. 1999;39:625-632.

Spiess BD. Red cell transfusions and Guidelines: a work in progress. Hematol Oncol Clin North Am. 2007;21:185-200.

D'Ambrosio A, Borghi B, Damato A, D'Amato G, Antonacci D, Valeri F. Reducing perioperative blood loss in patients undergoing total hip arthroplasty. Int J Artif Organs. 1999;22:47-51.

Lentschener C, Cottin P, Bouaziz H. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion. Anesth Analg. 1999;89:590-597.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247-2256.

Cardinal DC, Flower RJ. The electronic aggregometer: a novel device for assessing platelet behavior in blood. J Pharmacol Methods. 1980;3:135-158.

Bernard GR, Artigas A, Brigham KL. The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. AmJ Respir Crit Care Med. 1994;149:818-824.

Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction: Universal definition of myocardial infarction. J Am Coll Cardiol. 2007;50:2173-2195.

Haase M, Bellomo R, Matalanis G, Calzavacca P, Dragun D, Haase-Fielitz A. A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery: associated acute kidney injury. J Thorac Cardiovasc Surg. 2009;138:1370-1376.

Despotis GJ, Skubas NJ, Goodnough LT. Optimal management of bleeding and transfusion in patients undergoing cardiac surgery. Semin Thorac Cardiovasc Surg. 1999;11:84-104.

Levy MM, Fink MP, Marshall JC. SCCM/ESICM/ACCP/ATS/SIS: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250-1256.

Riley E, Cohen S, Rubenstein , Flanagan B. Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer's solution. Anesth Analg. 1995;81:838-842.

Hartog CS, Bauer M, Reinhart K. The efficacy and safety of colloid resuscitation in the critically ill. Anesth Analg. 2011;112:156-164.

Langdown AJ, Field J, Grote J, Himayat H. Aprotinin (Trasylol) does not reduce bleeding in primary total hip arthroplasty. J Arthroplasty. 2000;15:1009-1012.

Ellger B, Freyhoff J, van Aken H, Marcus MAE, Booke M. High dose volume replacement using HES 130/0.4 during major surgery does not alter coagulation. Europ J of Anaesth. 2002;19.

Rosencher N, Kerkkamp HE, Macheras G. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43:459-469.

Holcomb JB. Methods for improved hemorrhage control. Crit Care. 2004;8:S57-S60.

Fraga A de O, Fantoni DT, Otsuki DA, Pasqualucci CA, Abduch MC, Auler Jr JOC. Evidence for myocardial defects under extreme acute normovolemic hemodilution with hydroxyethyl starch and lactated Ringer's solution. Shock. 2005;24:388-395.

Margarido CB, Margarido NF, Otsuki DA. Pulmonary function is better preserved in pigs when acute normovolemic hemodilution is achieved with hydroxyethyl starch versus lactated Ringer's solution. Shock. 2007;27:390-396.

Otsuki DA, Fantoni DT, Margarido CB. Hydroxyethyl starch is superior to lactated Ringer as a replacement fluid in a pig model of acute normovolaemic haemodilution. Br J Anaesth. 2007;98:29-37.

Ruttmann TG, James MF, Finlayson J. Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery. Br J Anaesth. 2002;89:226-230.

Kozek-Langenecker S. In vitro testing of haemostatic sideeffects of colloids. Acta Anaesthesiol Scand. 2006;50:518.

Thyes C, Madjdpour C, Frascarolo P. Effect of high- and low-molecular-weight low-substituted hydroxyethyl starch on blood coagulation during acute normovolemic hemodilution in pigs. Anesthesiol. 2006;105:1228-1237.

Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model. Health Technol Assess. 2006;10:iii-iv.

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