[Volume substitution in acute normovolemic hemodilution. 5% human albumin vs. 6% hydroxyethyl starch].

Abstract

In order to ascertain the hemodynamic and biochemic effect of different colloid solutions, 60 patients scheduled for hip arthroplasty were randomly divided into two groups. Prior to surgery, acute normovolemic hemodilution was performed by withdrawal of 15 ml blood/kg bodyweight and simultaneous compensation using either 5% human albumine (HA) or 6% hydroxyethylstarch (200/0.5) (HAES), each group consisting of 30 patients. During and after the operation a decrease of hemoglobin-levels to 8 g% was accepted before autologous plus (if necessary) homologous blood was applied. Neither hemodilution nor tolerance of normovolemic anemia during the intra- and postoperative period had any negative effects on clinical course. Hemodynamics kept stable, no disorders of coagulation were observed. In addition lactate levels as well as histamin values remained within normal range during the whole investigation period (until the 10th postoperative day). There were no significant differences between the two groups; only histamine levels after albumin were up to 2.2 as high as after HAES. Colloid consumption at the day of operation was on the average 2.6 l/patient x day (HAES) and 3.11 (albumin) respectively. Colloidosmotic pressure remained constant in both groups and seemed to be independent from the kind of volume therapy. The present data demonstrate that normovolemic anemia can be tolerated during the perioperative period even when large amounts of colloid infusion are applied. HAES is an less expensive but adequate colloid solution compared to albumin.