Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.
This report was performed to compare the clinical efficacy and safety of 10% pentastarch (Pentaspan, group I) for plasma volume expansion after open heart surgery with that of 5% albumin(Plasmanate, group II). There were no statistically
significant
differences between the group I(n=18) and group II(n=19) in the preoperative parameters(age, sex, body weight) and operative parameters (bypass time, aorta cross clamping time). During the first 24 hours after arrival of the patient in the
surgical
intensive care unit, colloid solution(500~1000ml) was infused to maintain left atrial pressure of more than 8mmHg, or cardiac index of 2.0L/min/M* of more.
In results, there were 3 complications of hypotension immediately after infusion of 5% albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10% pentastarch solution.
Hemodynamic
responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure(mean 1.8 versus 0.7mmHg, p<0.05) and right atrial pressure(mean 2.2 versus 1.7mmHg, p<0.05) was observed during infusion of the
first
500ml. There were no significant differences in any of the measured respiratory parameters (PaO2, intrapulmonary shunt, and effective lung compliance). Homodilution with colloid significantly reduced hemoglobin(mean 1.2 versus 0.8gm/dl), and
serum
protein and albumin level(total protein; 4.8*0.5 versus 5.2*0.5gm/dl, p<0.05: albumin; 3.2*0.4 versus 3.6*0.6gm/dl, p<0.05) by 6: 00 AM on 1 day postoperatively, however there no significant differences on 7 day postoperatively. The mean serum
colloid
osmotic pressure and osmolarity was similar in both group.
There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of
chest
tube
output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5% albumin solution with no adverse effects on coagulation. Also 10% pentastarch is
less
expensive than 5% albumin and it would appeare to be a reasonable first choice for plasma volume expansion. (Korean J Thoracic Cardiovas Surg 1994; 27:177-86)
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