This document discusses different types of colloid solutions used for volume expansion, including albumin, gelatins, dextrans, starches, and hydroxyethyl starches (HES). It provides details on the properties of each type and considerations for their use. HES solutions are discussed in particular depth, focusing on factors like molecular weight, molar substitution, C2-C6 ratio, and raw materials that determine their effects and safety profile. The document emphasizes knowing the specific properties of the HES product being used and carefully selecting patients, given FDA warnings about their use in sepsis and acute kidney injury.

1. Dr. Abhijit S. Nair
Consultant Anesthesiologist
Hyderabad

2. A high molecular weight
solution that largely remains
in the intravascular
compartment, thereby
generating an oncotic
pressure

3. Natural ALBUMIN
Artificial Gelatins, Dextrans,Starches

4. Consists of a single polypeptide chain of
585 amino acids with a molecular weight of
69,000 Dalton
Monodisperse colloid i.e. all particles
have same molecular weight

5. 5%: ISO-ONCOTIC80% volume
expansion
25%: HYPERONCOTIC 200-400%
volume expansion

6. Burns
Clinically significant hypo-albuminemia
Paracentesis
Liver transplant
HRS in CLD
SBP
? Acute lung injury

7. Natural
Higher degree of volume expansion
Antioxidant and scavenging effects

8. Expensive
Volume overload

9. Branched polysaccharide molecule
produced by synthesis using the bacterial
enzyme dextran sucrase from the
bacterium Leuconostoc mesenteroides
(B512 strain) growing in a sucrose medium
Available as dextran-40 & 70 %
Mostly used for improving microcirculation

10. Anaphylaxis
AKI
Coagulopathy
Interference with cross
match

11. Used as early as 1915
Large molecular weight protein formed
by hydrolysis of collagen
Has a molecular weight of 5000-50,000

12.  Succinylated or modified
fluid
gelatins ( Gelofusine)
 Urea-cross linked gelatin
( Haemaccel )
 Oxypolygelatins ( Gelifundol
)

13. Regional anesthesia
Renal dysfunction
CP bypass: priming
Acute normovolemic hemodilution !!

14. Can be used liberally
No effect on renal function
Shortest duration of volume expansion

15. Anaphylaxis
Coagulopathy
Circulatory disturbance

18. HeSpan: DuPont Pharmaceuticals ( 1970)
First starch product commercially
available

19. Hexastarch: 1st generation
Pentastarch: 2nd generation
Tetrastarch: 3rd generation

20. Concentration
Molecular weight
Molar substitution
C2-C6 ratio

21. 3%: hypo-oncotic
6%: iso-oncotic
10%: hyper-oncotic

22. POLYDISPERSE SOLUTIONS
Weight averaged ( Mw ) Vs number averaged (
Mn )
Mw determines viscocity
Mn indicates oncotic pressure
Osmotic effectiveness depends on number of
particles not the molecular size
Available in a range from: 70-670 kDa

24. Represents average number of
hydroxyethyl residues per glucose subunit
0.5 MS means : there are 5 hydroxyethyl
residues in 10 glucose subunits
Higher the MS, more intravascular
retention time
MS determines the category of HES (
heta, hexa, penta, tetra etc )

26. Hetastarc
h
Hexastarc
h
Tetrastarc
h
Pentastarc
h

27. Not described in product literature
Describes the pattern of hydroxy-ethylation
Hydroxy-ethylation of glucose subunits is
guided towards C2 & C6 carbon atoms
HES products with high C2-C6 ratio
undergo slow degradation

34. Low MW
Low MS
Low C2-C6 ratio
Faster clearance
Less accumulation
Lesser side effects

36. TetraHES with similar nomenclature made
with different raw materials
Bioequivalance between two tetraHES with
similar nomenclature made with different
raw material might not be same or
comparable

37. Waxy maize: 98% highly branched chained
amylopectin ( eg. VOLUVEN/ VOLULYTE )
Potato starch: heterogenous mixture of 75%
amylopectin and remaining with linear chain
amylose  LOW BRANCHING ( eg.
TETRASPAN )

39. High esterified phosphate group in potato
starch HES contributes to more viscosity ,
due to more branching
Clinical significance not clear

40. Vs
?

41. Less accumulation
Negligible effect on coagulation
Minimal renal function deterioration
Effective for micro-circulation & tissue
oxygenation

42. Carrier solution

44. KNOW YOUR HES
Select your patient properly
FDA warns use in sepsis and in AKI
TEST DOSE ( 15-20ml IV, before bolus )
Keep a watch on total volume of HES
infused