[Blood volume replacement and hemodilution with hydroxyethyl starch].

For high molecular hydroxyethylstarch (MW 450000, DS 0.7-0.8) an adequate volume effect has been demonstrated in numerous experimental and clinical studies; this colloid is, therefore, suitable for primary volume replacement as well as for preoperative normovolemic hemodilution. In contrast to colloids hitherto known HES infusion results in hyperamylasemia of probably non-pathogenic importance but significance for differential diagnosis in the post-operative period. Anaphylactoid reactions to HES are infrequent (0.08%). With regard to the manifestation and the degree of severity these reactions are not different from those observed after infusion of other colloids. Since the pathomechanism of anaphylactoid reactions to HES is still unknown prophylactic measures are not available. The elimination of HES from the circulation follows a protracted course, therefore accumulation of HES in tissues may occur after repeated infusions presenting a clear disadvantage of HES. There is, however, evidence that starch-preparations will be available in the future presenting an adequate volume effect while the elimination from the organism occurs rapidly. Low molecular hydroxyethylstarch (HES 450000, DS 0.5-0.55) yields inadequate volume effects; for this, low molecular HES can neither be recommended for long-lasting volume replacement nor for preoperative hemodilution.