Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass - A randomised controlled trial

University of Strathclyde, Glasgow, Scotland, United Kingdom
Perfusion (Impact Factor: 0.94). 02/2007; 22(1):57-61. DOI: 10.1177/0267659107077903
Source: PubMed


Perioperative volume replacement after cardiopulmonary bypass is complicated by post-bypass systemic inflammatory process. The aim of this study was to assess the effects of using two different colloid solutions as priming fluids in cardiopulmonary bypass. The study's primary end point was to measure the amount of fluid replacement needed during and post-cardiopulmonary bypass; blood loss, change in blood profile and intraocular pressure were secondary end points, used as measures of plasma oncotic pressures. Patients undergoing coronary artery bypass grafting were recruited. Both patients and surgeons were blinded to receive either Gelofusine or Voluven as priming fluids. At fixed intervals during cardiopulmonary bypass, the patients had their intraocular pressures measured. Intra and postoperative fluid replacement was in the form of 4.5% human albumin and the amount was recorded for each subject. The result did not show any significant differences in the amount of fluid needed to be replaced, in blood loss or in blood profile between the two groups. However, it showed an increase in intraocular pressure in both groups once cardiopulmonary bypass commenced. The average intraocular pressure was higher in the Gelofusine group compared to the Voluven group. The significant increase in intraocular pressure measurements in the Gelofusine group compared to the Voluven group support the hypothesis that Voluven maintains the plasma oncotic pressure better and reduces fluid shift.

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    • "Yap et al. [10] studied gelatin and HES as prime solutions and compared postoperative outcomes like intraocular pressure, blood profile and blood loss. They designated intraocular pressure as a marker to determine plasma oncotic pressure and they found that HES had had significant favorable results compared to gelatin. "
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    ABSTRACT: Background Since the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery. Methods Two hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied. Results The mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05). Conclusions 6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.
    Journal of Cardiothoracic Surgery 04/2013; 8(1):71. DOI:10.1186/1749-8090-8-71 · 1.03 Impact Factor
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    • "of patients completed the study. Yap et al, 2007 40 , United Kingdom 40 elective cardiac surgical patients undergoing coronary artery bypass grafting. Exclusions: age less than 45 or more than 75 y, emergency operations, anaemia, coagulation disorders, pregnancy, hepatic or renal dysfunction, known hypersensitivity, aprotinin infusion intraoperatively and history of glaucoma. "
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    ABSTRACT: This meta-analysis aimed to evaluate the benefits and risks of gelatin solutions compared to other intravenous fluids for patients in perioperative and critical care settings. Of the 66 studies identified from MEDLINE and EMBASE databases, 30 randomised controlled trials involving 2709 patients met the inclusion criteria and were subject to meta-analysis. The risk of mortality (odds ratio 1.03, 95% confidence interval 0.80 to 1.32) and amount of blood loss (weighted-mean-difference 7.56 ml, 95% confidence interval 18.75 to 33.87) were not significantly different between patients who were treated with gelatin solutions and other types of intravenous fluids. When compared to starches, gelatin solutions were associated with a lower risk of acute renal failure (odds ratio 0.43, 95% confidence interval 0.20 to 0.92; P=0.03). When gelatin solutions were compared to isotonic albumin, patients who were treated with gelatin solutions required a small, but significantly greater amount of blood transfusion (weighted-mean-difference 180 ml, 95% confidence interval 8.1 to 353.6; P=0.04). These findings suggest that using gelatin solutions is associated with a lower risk of acute renal failure compared to older starches. Using gelatin as a plasma expander appears to have no significant advantages over crystalloids or isotonic albumin on mortality and may have a slightly higher risk of requiring allogeneic blood transfusion in perioperative and critically ill patients. An adequately powered randomised controlled trial with economic analysis is needed before gelatin solution can be recommended as a routine plasma expander for patients undergoing major surgery or who are critically ill.
    Anaesthesia and intensive care 01/2012; 40(1):17-32. · 1.30 Impact Factor
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    ABSTRACT: Seed priming and drying condition effects were investigated immediately after seed-priming and 9 week after the storage. In this experiment, carrot seeds of 'Forto C.V.' were used. These seeds were individually primed for 10 days at 20 degrees C and in PEG (6000) (273 g L(-1)) and KNO3 (200 mmol) solutions. Then they were dried for 1 and 2 h at 15, 25 and 30 degrees C, respectively. One part of the seeds was stored at 5 degrees C in RH/45% For 9 week. Chemical priming effects, drying temperature as well as germination temperature on different traits especially germination percentage were significant. However, drying time had no significant effect on germination percentage after storage period. PEG priming and drying at 25 degrees C for 2 h provided the best condition for germination percentage. Using the best material for pre-priming, along with suitable drying management with appropriate quality and good conditions of the storage is important.
    Pakistan Journal of Biological Sciences 07/2008; 11(11):1502-5. DOI:10.3923/pjbs.2008.1502.1505
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