[Comparison of effects of hydroxyethylstarch (HES 200/0.5) administered pre- and postoperatively in vascular surgery with dextran 40 (60) (author's transl)].

In a randomised study comprising 16 patients undergoing vascular surgery of the lower extremities blood replacement was performed after preinfusion of either 500 ml 10% hydroxyethylstarch (LMW-HES) or 10% dextran 40 (followed by dextran 60 intraoperatively). After infusion of 500 ml within 30 min preoperatively there was a significant rise in PCWP, PAP, RAP and CI accompanied by an increase in blood volume and colloid osmotic pressure, whereas hematocrit fell. No difference between the two plasmasubstitutres was found, prolonged infusion of HES, however, caused a lesser rise in cardiac pressures and blood volume. Overloading of the circulation could be ruled out by ECG, Frank-Starling curves, blood gases, observation of total pulmonary vascular resistance and vascular filtration pressure. The modified haemodilution technique suggested, using preoperative priming without blood drainage and subsequent dilution by blood replacement up to a total amount of 1,500 ml by HES or dextran thus seems to be free of risks and may be recommended. For monitoring purposes during prolonged operations not only filling pressures should serve as a guideline, determination of blood volume and fluid balance being imperative.