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Transfusion practice in resuscitation and critical illness
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
This is a low-molecular-weight analogue of hetastarch that is available as a 10% solution in isotonic saline. Pentastarch contains smaller but greater numbers of starch molecules than hetastarch and thus has a higher colloid oncotic pressure. It is more effective as a volume expander than hetastarch, and increases the plasma volume, by 1.5 times the infused volume, and its plasma expansion effects last for approximately 12 hours.27 Compared with hetastarch, pentastarch has fewer tendencies to interact with coagulation proteins, but the significance of this is unclear.28
Acquired Bleeding Disorders Associated with Disease and Medications
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
William A. Rock, Sue D. Walker
Hetastarch (hydroxyethyl starch) is a synthetic glucose polymer that is used for plasma expansion. For the same reasons as with dextran, hetastarch may prolong the bleeding time. Volumes exceeding 1 L in an average adult may result in prolongation of the PT and aPTT. This prolongation is not always associated with bleeding, but in surgical or trauma patients the cause for bleeding is not always clear. The prolongation in the PT and APTT is not always associated with bleeding and may occur before an actual defect in coagulation is present (137).
Biomaterials and drug delivery systems for intraperitoneal chemotherapy
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
A viscous solution of hydroxyethyl starch was used for the IP delivery of PTX [72] and DTX [73]. Sprague Dawley rats were administered IP with the taxane compounds using 6% hydroxyethyl starch (hetastarch) or 1.5% dextrose peritoneal dialysis solution as a carrier. Fluid clearance and mean taxane concentrations in plasma were lower when the drugs were delivered with hetastarch solution than with the peritoneal dialysis solution. Importantly, the total amount of drug remaining in the peritoneal cavity was significantly higher with hetastarch solution [72,73]. These studies demonstrate that hetastarch solution helped retain taxane compounds in the peritoneal cavity and reduce systemic exposure to the drugs.
The feasibility of a fully synthetic and self-assembled peptide solution as submucosal injection material: a preliminary animal study
Published in Scandinavian Journal of Gastroenterology, 2021
Ko Nakata, Mathieu Pioche, Shiko Kuribayashi, Hirohito Tanaka, Daisuke Uehara, Kazue Nagai, Thomas Lambin, Thierry Ponchon, Toshio Uraoka
Various submucosal injection solutions have been used in endoscopic resection procedures. Although SHA is known to be a long-lasting submucosal solution, it has been approved for reimbursement only in Japan and it has not been widely adopted in western countries because it is expensive [6,10]. Although FSSP solution is not commercially available even in Japan, FSSP solution as a hemostatic agent is currently available in some European countries. We are considering obtaining marketing approval for FSSP solution as an injection solution in Japan and in Europe in the near future. It is also expected to be not as expensive as SHA in the future market. Eleview® is a new liquid composition which is approved by the Food and Drug Administration and Conformity European (CE) marked and some randomized controlled trials were performed in the western centers [13,14]. However, Rex et al. reported that the absolute differences were small in clinical setting between this solution and hetastarch [14]. There is also little data regarding it’s efficacy in advanced EMR or ESD [15].
Non-surgical treatment for hematocele in the bladder associated with ascites puncture in a patient with ovarian hyperstimulation syndrome: a case report
Published in Postgraduate Medicine, 2021
Xue Ke, Yong-Hong Lin, Fang Wang
Twenty-nine oocytes were collected, no fresh embryo was transferred because of OHSS, and the embryos were cryopreserved. At 6 days after egg collection, she presented with signs including oliguria (decreased urine output caused by impaired venous return), hydrothorax, and ascites. TV sonography revealed bilateral enlarged ovaries with multilocular cysts (right ovary 12.9*11.7 cm, left ovary 13.6*10.7 cm), ascites (vesicouterine pouch 9.9 cm*6.6 cm, rectouterine fossa 5.2*2.5 cm) and unilateral pleural effusions (right: 3.6 cm). Laboratory work-up indicated normal partial thromboplastin times and prothrombin, increased plasma D-dimer (2.5 ug/ml), hemoconcentration (hematocrit, 42.5%) and, hypoproteinemia (albumin concentration 2.4 g/dl), which were considered to indicate severe OHSS. We initiated conservative treatments. Thromboembolic prophylaxis was maintained with low molecular weight heparin (5,000 IU/day), and hetastarch and human albumin were injected to preserve the volume of the intravascular space. Nevertheless, the patient still felt abdominal distension and mild dyspnea, so we proceeded to ascites puncture.
The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients
Published in Renal Failure, 2021
Henrique Tadashi Katayama, Brenno Cardoso Gomes, Suzana Margareth Ajeje Lobo, Renato Carneiro de Freitas Chaves, Thiago Domingos Corrêa, Murillo Santucci Cesar Assunção, Ary Serpa Neto, Luiz Marcelo Sá Malbouisson, João Manoel Silva-Jr
It is expected that, in many cases, simply restoring the circulating volume does not improve the results and maybe counterproductive [4,5]. Organ edema distorts tissue architecture, impairs oxygen and metabolite diffusion, and obstructs the capillary flow and lymphatic drainage. These effects are particularly pronounced in encapsulated organs, such as the kidney, which cannot accommodate additional volume without significant increases in interstitial pressure and compromised blood flow. Elevated intratubular pressure decreases glomerular filtration and activation of tubuloglomerular feedback, with consequent preglomerular vasoconstriction, which leads to an additional reduction in glomerular filtration [29–31]. Studies have shown that excess fluid is an independent factor for the development of AKI and that in patients with AKI, a more positive fluid balance was correlated with higher mortality [32–35]. Regarding the type of solution used, epidemiologic data suggest that 0.9% saline solution, when compared with balanced salt solutions, such as balanced solutions, may increase the risk of AKI. In addition, there is evidence of harm (increased rates of AKI) with the use of hetastarch solutions, which should generally be avoided [36]. In our study was not detect a negative influence of any type of colloid or crystalloid on the development of AKI.