Autoclaved Gelatin (Haemagel) Versus 6% Hydroxyethyl Starch 200 ...

Alexandria Journal of Anaesthesia and Intensive Care 

Autoclaved Gelatin (Haemagel) Versus 6% Hydroxyethyl Starch 

200/0.5 (Haes-steril) For Plasma Volume Expansion In Critically-ill 

Patients 

Magdy Ali Omera, MD * , Salah A. Ismail, MD * 

* Assistant Prof. of Anaesthesia, Faculty of Medicine, Suez Canal University. 

ABSTRACT 

Synthetic colloids are used to optimize hemodynamics in the critically ill patients and a 

debate about the most suitable one is still present. The influence of short term infusion of 

autoclaved gelatin (Haemagel) and 6% hydroxyethyl starch 200/0.5 (Haes-steril) on 

hemodynamic, respiratory, coagulation, renal and oncotic parameters were examined in a 

prospective randomized study. 

Method: Thirty patients suffering from systemic hypoperfusion due to sepsis in ICU of Suez 

Canal University Hospital were assigned into 2 equal groups. In GEL group: 1000 ml of 

Haemagel was infused within an hour, while in HES group: 1000 ml of 6% Haes-steril 

200/0.5 was given within an hour. The hemodynamic, respiratory, hematological, 

coagulation, renal and colloidal osmotic pressure parameters were recorded before and after 

infusion of both colloids. 

Results: There was a significant similar increase in hemodynamic variables (Mean arterial 

pressure, central venous pressure, cardiac index, stroke volume index and left ventricular 

stroke work index) in both groups. Also, a significant improvement in tissue perfusion as 

judged by decreased arterial lactate was found. There were no significant differences in any 

of the measured respiratory parameters (respiratory rate, arterial oxygen saturation, arterial 

blood gases and intrapulmonary shunt) in the studied groups. No significant intergroup 

difference in any haemodynamic or respiratory variable was demonstrated. A significant 

expansion in plasma volume as indicated by the significant reduction in haematocrit was 

detected. There were insignificant changes in coagulation profile (prothrombin time, 

activated partial thromboplastin time, bleeding time and fibrinogen) in either group except the 

platelet count which was significantly reduced in both groups without any recorded bleeding 

complications. Creatinine, blood urea nitrogen, sodium and potassium didn't change and 

were comparable in the two groups. Colloidal osmotic pressure and urine output increased 

significantly in either group. Anaphylactic reactions were not observed in any of the patients. 

However, no significant differences between both groups in haematological, coagulation, 

renal and oncotic parameters were found. 

Conclusion: Both autoclaved gelatin (Haemagel) and 6% hydroxyethyl starch 200/0.5 

(Haes-steril) are safe and equally effective colloids for plasma volume expansion in critically 

ill patients without apparent adverse effects on respiration, coagulation and renal functions. 

INTRODUCTION 

In critically-ill patients, acute circulatory 

failure is often associated with 

intravascular volume depletion which 

contributes to inadequate cardiac output, 

tissue hypoperfusion, and development of 

multiple organ failure (1) . Replacement of 

intravascular deficit remains the most 

important therapeutic maneuver in management 

of those patients to ensure adequate 

cardiac output (2) . Whilst crystalloids 

are virtually free of major side effects, 

they don ' t necessarily ensure adequate 

volume replenishment or hemodynamic 

AJAIC-Vol. (8) No. 2 June 2005 

44 

stabilization. There are several studies 

showing the advantages of colloid solution 

over crystalloid volume replacement (3,4) 

and a debate about the choice of specific 

colloid is still present (5) . Although the 

naturally occurring colloidal agent (albumin) 

is effective for fluid resuscitation, it is also 

very expensive with the potential risk of 

infection (6) . Dextran has not been widely 

used because it might result in increased 

bleeding, allergic reaction, possible renal 

toxicity and problems with blood crossmatching 

(7) .


Hydroxyethyl starch (HES), a synthetic 

colloid with a high volume expanding 

effect, is produced by hydroxylation of 

the starch amylopectin. HES (200/0.5) 

has a molecular weight (200,000 D) 

which allows rapid elimination by kidney 

(8) . It also has a low molar substitution 

ratio (0.5) making it more rapidly and 

completely degraded by circulating 

amylase with less tissue retention (8) . 

Since HES has the fewest 

anaphylactoid reactions among the 

artificial colloids, it is the most comm.only 

clinically used colloid (9) . However, 

large doses of this solution may 

increase bleeding by inducing coagulopathy 

through an effect on factor VIII 

activity (8, 10-12) . 

Different colloid solutions containing 

gelatin have been developed. Collagen 

is degraded via both a thermal effect 

producing oxypolygelatin (OPG), and an 

enzymatic effect producing either 

modified fluid gelatin (Gelofusine), or 

urea cross-linked gelatin (Haemaccel), 

while double degradation and autoclaving 

producing (Haemagel). Haemagel 

is a balanced salt gelatin-based 

colloidal solution (100 mL contains 4 g 

gelatin). It has a higher half-life, no 

pseudo agglutination, and no possible 

contamination (13) . Although researchers 

have studied gelatin for volume 

replacement, its safety and efficacy 

have not been fully investigated (14-18) . 

So, this study compared autoclaved 

gelatin (Haemagel) with 6% hydroxylethyl 

starch 200/0.5 (Haes-steril) in term 

of efficacy and safety as a short term 

volume expander in critically-ill patients. 

PATIENTS AND METHODS 

After approval of the local ethics 

committee and an informed consent 

from each patient or his/her family, thirty 

critically-ill patients in ICU of Suez Canal 

University Hospital suffering from systemic 

hypoperfusion due to sepsis were 

enrolled in this study. Inclusion criteria 

were patients who required fluid therapy 


45 

on a clinical ground in the presence of 

sepsis and systemic hypo-perfusion. 

Sepsis was diagnosed, in addition to 

positive blood culture, by the presence 

of 3 of the following 5 criteria; 

tachycardia (HR >100 beat/min), tachypnea 

(RR >25 breath/min), temperature 

(>38 0 C or 15,000 or 100 mg/dl), cerebral hemorrhage, 

patients having PT >18 sec, aPTT >45 

sec, fibrinogen < 150 mg/dl or Hct


heart rate (HR), core temperature 

(Temp), respiratory rate (RR), arterial 

oxygen saturation (SaO2) and noninvasive 

mean arterial blood pressure 

(MAP) measurement through a continuous 

display (S/5, Datex Ohmeda, Instrumentation 

Corp, Finland). 

Baseline data were recorded before the 

start of infusion; 

A] Patient characteristics: Age, sex, 

weight, height, body surface area (BSA), 

temperature and clinical diagnosis. 

B] Hemodynamic parameters: HR, 

MAP, CVP, CI, SVI, LVSWI and SVRI 

were measured in supine position. 

C] Respiratory data: RR, SaO2, arterial 

blood gases [pH, arterial oxygen tension 

(PaO2), arterial carbon dioxide tension 

(PaCO2), bicarbonate (HCO3)] and 

intrapulmonary shunt [obtained through 

ABL 520 Radiometer]. 

D] Hematological and coagulation 

parameters: Haematocrit (Hct), platelet 

count, prothrombin time (PT), activated 

partial thromboplastin time (aPTT), 

bleeding time (BT) and fibrinogen (22) . 

E] Renal function and electrolytes: Urine 

output (UOP), serum creatinine, blood 

urea nitrogen (BUN), serum sodium 

(Na + ) and potassium (K + ) (22) . 

F] Colloidal osmotic pressure (COP) 

and arterial lactate (AL) were also 

measured. 

Using a randomized sequence, the 

patients were prospectively assigned to 

one of the following groups: 

1) Group (GEL): where 1000 ml of 

Haemagel (each 100 ml contains: 

Autoclaved gelatin 4 g, glycine 1 g, NaCl 

0.859 g, KCl 0.0389 g and CaCl 0.029 

g, Vacsera, Holding company for 

biological products and vaccines, Egypt) 

was infused during an hour. 

2) Group (HES): where 1000 ml of 6% 

Haes-steril (HES 200/0.5, MW 200,000, 

DS 0.5, Fresenius Kabi, Bad Hamburg, 

Germany) was infused during an hour. 

After the end of infusion, all the previous 

parameters were recorded again by a 


46 

physician not involved in the study and 

who was blind to the grouping. 

All results are expressed as means ± 

SD. The change in different parameters 

compared to the baseline values was 

analyzed using paired t-test. The 

difference between the two groups was 

assessed by one way analysis of variant 

(ANOVA). A p value


both groups. In addition, there was a 

significant decrease in platelet count in 

GEL and HES groups. However, no 

significant differences between both 

groups in any hematological or coagulation 

parameter were detected (table 

4). 

Renal function and electrolytes 

Urine volume increased significantly 

after infusion of both colloids without 

significant differences between both 

groups. Creatinine, BUN and electrolytes 

(Na + and K + ) were not changed 

and were comparable in both groups 

(table 5). 

Colloidal osmotic pressure 

In both groups, the baseline COP 

was within normal range (more than 18 

mmHg). After infusion, there was a 

significant increase in both groups 

without intergroup differences (table 6). 

No allergic reactions or bleeding 

complications were recorded in any 

studied patient 

DISCUSSION 

Hypovolemia is a common clinical 

occurrence in severe sepsis and fluid 

resuscitation remains one of the most 

important interventions. However, it is 


47 

still uncertain which solution is most 

suitable for fluid resuscitation in these 

patients (9) . The goal in fluid resuscitation 

is to maintain an effective intravascular 

blood volume, subsequently, enhancing 

cardiac output, oxygen delivery and 

tissue perfusion (1,2,6) . However, to achieve 

these goals, attempts are tried to 

minimize possible deterioration in 

pulmonary, renal and other system 

functions. 

The aim of this study was to 

compare the effect of short-term infusion 

of autoclaved gelatin and 6% hydroxylethyl 

starch on hemodynamic, respiratory, 

hematologic, coagulation, renal 

and oncotic pressure variables in a 

controlled prospective manner. 

In the present study, MAP, CVP, CI, 

SVI and LVSWI were significantly 

increased in both groups. While SVRI 

and AL were significantly decreased, 

HR did not change significantly during 

the study. However, no significant 

differences between the studied groups 

in these parameters were found. The 

improvement in these hemodynamic 

variables and arterial lactate levels are 

always associated with favorable 

prognosis in critically-ill patients (1, 2) . 

Table 1: Demographic data in both Haemagel (GEL) and Haes-steril (HES) 

groups. 

Parameter 

Age (years) 

Sex ( M/F) 

Weight (kg) 

BSA (m 2 ) 

Temperature ( 0 C) 

GEL group 

55 ± 11 

7/8 

73 ± 12 

1.88 ± 0.20 

37.3 ± 0.4 

Number of patients 

15 

Diagnosis: Pneumonia 

6 

Peritonitis 

6 

Urinary infection 

3 

Data are represented as means ± SD unless otherwise noted. 

M = Male, F = Female, BSA = Body surface area. 

HES group 

53 ± 13 

8/7 

75 ± 10 

1.86 ± 0.23 

38.0 ± 0.3 

15 

7 

6 

2


Table 2: Hemodynamic and arterial lactate changes in both Haemagel (GEL) 

and Haes-steril (HES) groups. 

Parameter 

Group Baseline data Post infusion data 

HR (beat/min) 

GEL 

100 ± 7 

99 ± 8 

HES 

102 ± 5 

103 ± 7 

MAP (mmHg) 

GEL 62.2 ± 2.7 

74.3 ± 5.1* 

HES 60.5 ± 7.6 

73.1 ± 4.3* 

CVP (cmH2O) 

GEL 

5.6 ± 1.4 

9.3 ± 1.5* 

HES 

4.8 ± 1.9 

8.5 ± 1.3* 

CI (L/min.m GEL 

2.2 ± 0.3 

3.5 ± 0.6* 

HES 

2.3 ± 0.2 

3.5 ± 0.4* 

2 ) 

SVI (ml/m GEL 29.0 ± 6.6 

37.5 ± 3.8* 

HES 27.7 ± 3.1 

35.5 ± 4.6* 

2 ) 

LVSWI (gm.m/m GEL 20.8 ± 3.6 

35.6 ± 3.3* 

HES 21.6 ± 5.4 

35.2 ± 4.2* 

2 ) 

SVRI (dyne.sec/cm GEL 1861 ± 149 1558 ± 246* 

HES 1978 ± 222 1660 ± 234* 

5 .m 2 ) 

AL (mmol/L) 

GEL 

2.7 ± 1.6 

1.4 ± 1.2* 

HES 

2.9 ± 1.4 

1.5 ± 1.5* 

Data are presented as means ± SD. 

*A significant difference within each group compared to baseline P < 0.05. 

HR = Heart rate, MAP = Mean arterial pressure, CVP = Central venous pressure, CI 

= Cardiac index, SVI = Stroke Volume index, LVSWI = Left ventricular stroke work 

index, SVRI = Systemic vascular resistance index, AL = Arterial lactate. 

Table 3: Respiratory changes in both Haemagel (GEL) and Haes-steril (HES) 

groups. 

Parameter 


RR (breath/min) 

GEL 

20.0 ± 2 

19.0 ± 3 

HES 

22.0 ± 4 

21.0 ± 3 

SaO2 (%) 

GEL 

96.0 ± 1.7 

97.1 ± 1.3 

HES 

97.5 ± 0.5 

98.6 ± 0.7 

pH 

GEL 7.33 ± 0.06 7.37 ± 7.34 ± 0.05 7.38 ± 

HES 

0.03 

0.02 

PaO2 (mmHg) 

GEL 

88.0 ± 16 

90.0 ± 12 

HES 

86.0 ± 18 

88.0 ± 14 

PaCO2 (mmHg) 

GEL 

33.0 ± 2.7 

35.0 ± 2.3 

HES 

36.0 ± 1.5 

38.0 ± 2.0 

HCO3 (mmol/L) 

GEL 

19.3 ± 2.3 

20.0 ± 1.7 

HES 

17.9 ± 1.5 

18.4 ± 1.4 

Qs/Qt (%) 

GEL 

16.5 ± 3 

17.1± 5 

HES 

18.3 ± 4 

19.0 ± 5 

Data are presented as means ± SD and percentage. 

RR = Respiratory rate, SaO2 = Arterial oxygen saturation, PaO2 = Arterial oxygen 

tension, PaCO2 = Arterial carbon dioxide tension, HCO3 = Bicarbonate and Qs/Qt = 

Intra-pulmonary shunt fraction. 


48


Table 4: Hematologic and coagulation changes in both Haemagel (GEL) and 

Haes-steril (HES) groups. 

Parameter 


Hct (%) 

GEL 38.8 ± 3.4 

30.2 ± 3.2* 

HES 36.9 ± 2.8 

29.5 ± 4.7* 

PT (sec) 

GEL 14.7 ± 0.5 

15.0 ± 0.8 

HES 13.9 ± 1.2 

14.4 ± 0.6 

aPTT (sec) 

GEL 35.7 ± 3.3 

37.2 ± 3.1 

HES 38.5 ± 2.9 

39.8 ± 2.4 

BT (min) 

GEL 

6.2 ± 0.4 

6.4 ± 0.2 

HES 5.8 ± 0.6 

6.0 ± 0.3 

Fibrinogen (mg/dl) GEL 

300 ± 88 

295 ± 64 

HES 320 ± 77 

310 ± 45 

Platelets (1000/mm GEL 

200 ± 48 

150 ± 86* 

HES 210 ± 55 

150 ± 37* 

3 ) 



Hct = Hematocrit, PT = Prothrombin time, aPTT = Activated partial thromboplastin 

time, BT = Bleeding time. 

Table 5: Electrolytes and renal changes in both Haemagel (GEL) and Haessteril 

(HES) groups. 

Parameter 


UOP (ml/h) 

GEL 50 ± 15 

90 ± 20* 

HES 55 ± 10 

95 ± 15* 

Creatinine (mg/dl) GEL 1.2 ± 0.4 

1.3 ± 0.2 

HES 1.3 ± 0.5 

1.3 ± 0.3 

BUN (mg/dl) 

GEL 20.5 ± 2.3 

20.1 ± 1.5 

HES 22.2 ± 1.4 

21.8 ± 1.9 

Na GEL 138 ± 6 

137 ± 5 

HES 136 ± 9 

136 ± 7 

+ (mmol/L) 

K GEL 3.9 ± 0.4 

4.0 ± 0.2 

HES 4.1 ± 0.2 

4.1 ± 0.6 

+ (mmol/L) 



UOP = Urine output, BUN = Blood urea nitrogen, Na + = Sodium, K + = Potassium. 

Table 6: Changes in colloidal osmotic pressure (mmHg) in both Haemagel 

(GEL) and Haes-steril (HES) groups. 

Group 

Baseline data Post infusion data 

GEL 

19.6 ± 1.1 

22.1 ± 1.4* 

HES 

18.5 ± 1.5 

21.2 ± 1.2* 


*A significant difference within each group compared to baseline P


better normalization of the hypoxic 

gastric mucosal acidosis with Gelofusine 

(15) 

rather than HES. Beyer et al , 

compared 6% HES 200/0.5 with 

Gelofusine for volume replacement in 

patients undergoing orthopedic surgery. 

They studied the effect of either colloid 

on hemodynamic, colloidal osmotic 

pressure and blood clotting. Equivalent 

hemodynamic effects were found 

without alteration of coagulation profile. 

Molnar et al (23) investigated the short 

term cardio-respiratory effects of 250 ml 

Gelofusine versus 250 ml HES 200/0.6 

in patients with septic shock and acute 

lung injury. They found significant 

increases in CI and O2 delivery in both 

groups with insignificant differences in 

extra vascular lung water (no interstitial 

or pulmonary edema). 

The respiratory and blood gas 

parameters did not change significantly 

in both groups and were similar during 

the study. Consistent results were 

demonstrated in previous studies (2, 6) . 

Also, Ritto et al (16) showed no changes 

in arterial blood gases after Gelofusine 

or HES infusion, with no shunt affection. 

Expansion of plasma volume as 

indicated by the significant decrease in 

hematocrit was similar in both groups. 

Both colloids have been shown to cause 

a slight insignificant prolongation in PT, 

aPTT and BT in addition to an 

insignificant decrease in fibrinogen. This 

could be attributed to hemodilution 

which in another previous study (24) , was 

proven to be dose related. There was a 

significant decrease in platelet count 

without significant change in bleeding 

time in any group of the current study. 

The present work showed neither 

significant differences between the two 

colloids with respect to coagulation 

parameters, nor bleeding complications. 

Several previous researches studied the 

influence of hydroxyethyl starch and 

gelatin on coagulation and bleeding 

parameters (10,11,17,24-29) . Fries et al (10) 

analyzed the influence of different 


50 

colloids (6% HES 130/0.4, 6% HES 

200/0.5 and Gelofusine) on the 

coagulation system using Rotation 

Thrombelastography (ROTEG). They 

found that Gelofusine had the lowest 

effect on coagulation. Haisch et al (11) 

examined the influence of HES 130/0.4 

versus Gelofusine on coagulation and 

hemodynamic data in patients undergoing 

major abdominal surgery, where 

both colloids were effective with 

insignificant changes in coagulation 

variables or blood loss. The effect of 

progressive in vitro hemodilution on 

coagulation was measured by 

SONOCLOT (17) , where HES showed the 

largest impact on markers of 

coagulation compared with gelatin or 

lactated Ringer's solution. In an 

experimental study (25) , HES infusion in 

excess of 20 ml /kg was associated with 

an increase in bleeding time, thrombin 

time together with a decrease in platelet 

count and serum fibrinogen. Also, Van 

Wyk et al (26) did not find any evidence 

that haemaccel affects haemostasis; 

neither does it increase bleeding relative 

to Ringer's lactate in plasma expansion 

during reduction mammoplasty. In 

addition, Amany et al (27) showed only 

minor effects on clotting variables and 

platelet aggregation compared to 6% 

HES 200/0.5, even at doses more than 

20 ml/Kg /day in patients undergoing 

major abdominal surgery. On the 

contrary, limited data suggest that 

gelatin based solutions may affect 

coagulation (28, 29) . 

The significant increase in UOP was 

probably due to increased blood volume 

in both groups. Creatinine, BUN, Na + 

and K + did not change significantly and 

were comparable in both groups 

indicating insignificant effects on kidney 

functions. These results are consistent 

with Vogt et al study (12) . In contrast, 

Amany et al found that creatinine 

clearance was significantly decreased in 

HES group compared to Haemagel 

group (27) .


Colloidal osmotic pressure (COP) 

could be a desirable goal in volume 

replacement because it maintains 

normal extravascular water content in 

many organs (1, 6) . Profound reduction in 

COP may reduce left ventricular 

compliance, increase pulmonary extravascular 

water content and decrease 

tissue oxygen delivery (19) . In this study 

GEL and HES were effective in 

maintaining COP without significant 

differences between both groups. This 

was also documented by several studies 

where plasma volume and colloid 

osmotic pressure were maintained even 

in septic shock with capillary leak (30-32) . 

In fact, no allergic reactions to either 

colloid were observed in any patient of 

the present study. This is agrees with 

previous researches on either colloid 

where extremely low incidence of such 

reaction was reported (9, 33) . 

In conclusion, autoclaved gelatin 

(Haemagel) showed similar efficacy and 

safety as 6% hydroxyethyl starch 

200/0.5 (Haes-steril) for plasma volume 

expansion in critically ill patients. Both 

solutions improved the hemodynamic 

responses and tissue perfusion without 

apparent adverse effects on respiration, 

coagulation, and renal functions. A 

further study may be required to 

evaluate the effects of prolonged 

administration or larger doses of this 

gelatin solution (Haemagel) in critically 

ill patients. 

REFERENCES 

1. Hankeln K, Radel C, Beez M, et al. 

Comparison of hydroxyethyl starch and 

lactated Ringer's solution on 

hemodynamics and oxygen transport of 

critically ill patients in prospective 

crossover studies. Crit Care Med 1989; 

17: 133. 

2. Rackow EC, Mecher C, Astiz ME, et al. 

Effects of pentastarch and albumin 

infusion on cardio-respiratory function 

and coagulation in patients with severe 

sepsis and systemic hypo-tension. Crit 

Care Med 1989; 17:394. 


51 

3. Nagy KK, Davis J, Duda J, et al. A 

comparison of pentastarch and lactated 

Ringer's solution in the resuscitation of 

patients with hemo-rrhagic shock. Circ 

Shock 1993; 40:289. 

4. Olthof CG, de Vries JP, de Vries PM, et 

al. The influence of Ringer's lactate and 

gelatin infusion on the internal fluid 

balance of healthy volunteers measured 

by a non-invasive conductivity 

technique. Eur J Anaesth 1993; 10:397. 

5. Boldt J, Müller M, Heesen M, et al. 

Influence of different volume thera-pies 

on platelet function in the critically ill. 

Intensive Care Med 1997; 23:709. 

6. Boldt J, Heesen M, Müller M, et al. The 

effects of albumin versus hydro-xyethyl 

starch on cardio-respiratory and 

circulatory variables in critically ill 

patients. Anesth Analg 1996; 83:254. 

7. Petroianu GA, Jie Liu, Maleck WH, et al. 

The effect of in vitro hemo-dilution with 

gelatin, dextran, hydro-xyethyl starch, or 

Ringer's solution on 

Thrombelastography. Anesth Analg 

2000; 90:795. 

8. Boldt J, Haisch B, Suttner S, et al. 

Effects of a new modified, balanced 

hydroxyethyl starch preparation 

(Hextend) on measures of coagula-tion. 

Br J Anaesth 2002; 89:722. 

9. Laxenaire M C, Mertes P, et al. 

Anaphylaxis during anaesthesia: 

Results of two-years survey in France. 

Br J Anaesth 2001; 87: 549. 

10. Fries D, Innerhofer P, Klinger A, et al. 

The effects of the combined 

administration of colloids and lactated 

Ringer's solution on the coagulation 

system: An in vitro study using 

thrombelastograph ® coagula-tion 

analysis (ROTEG ® ). Anesth Analg 2002; 

94:1280. 

11. Haisch G, Boldt J, Krebs C, et al. The 

influence of intravascular volume 

therapy with a new hydro-xyethyl starch 

preparation [6% HES 130/0.4] on 

coagulation in patients undergoing 

major abdominal surg-ery. Anesth Analg 

2001; 92:565. 

12. Vogt NH, Bothner U, Lerch G, et al. 

Large-dose administration of 6% 

hydroxyethyl starch 200/0.5 for total hip 

arthroplasty: Plasma homeo-stasis, 

hemostasis, and renal func-tion


compared to use of 5% human albumin. 

Anesth Analg 1996; 83:262. 

13. Evans PA, Heptinstall S, Crowhurst EC, 

et al. Prospective double-blind 

randomized study of the effects of four 

intravenous fluids on platelet function 

and hemostasis in elective hip surgery. 

J Thromb Haemost 2003; 1:2140. 

14. Beards SC, Watt T, Edwards JD, et al. 

Comparison of the hemodynamic and 

oxygen transport responses to modified 

fluid gelatin (Gelofusine) and heta starch 

in critically ill patients: A prospective 

randomized trial. Crit Care Med 1994; 

22: 600. 

15. Asfar P, Kerkeni N, Labadie F, et al. 

Assessment of hemodynamic and 

gastric mucosal acidosis with modi-fied 

fluid gelatin versus 6% hydro-xyethyl 

starch: A prospective, rando-mized 

study. Intensive Care Med 2000; 

26:1282. 

16. Beyer R, Harmening U, Rittmeyer O, et 

al. Use of modified fluid gelatin and 

hydroxyethyl starch for colloidal volume 

replacement in major orthopedic 

surgery. Br J Anaesth 1997; 78:44. 

17. Ritto D, Gosling P, Burnley S, et al. 

Randomized study comparing the 

effects of hydroxyethyl starch solu-tion 

with gelofusine on pulmonary function in 

patients undergoing abdominal aortic 

aneurysm surgery. Br J Anaesth 2004; 

92:61. 

18. Konard C, Markl T, Schuepfer G, et al. 

The effects of in vitro hemo-dilution with 

gelatin, hydroxyethyl starch, and 

lactated Ringer's solution on markers of 

coagulation: An analy-sis using 

SONOCLOT . Anesth Analg 1999; 

88:483. 

19. Balk RA. Severe sepsis and septic 

shock: Definitions, epidemiology, and 

clinical manifestations. Crit Care Clin 

2000; 16: 179. 

20. Tonnessen T, Tollofsrud S, Kongsgaard 

UE, et al. Colloid osmotic pressure of 

plasma replacement fluids. Acta 

Anaesthesiol Scand 1993; 37: 424. 

21. Bernstein DP. Continuous non-invasive 

real time monitoring of stroke volume 

and cardiac output by electrical thoracic 

bioimpedance. Crit Care Med 1986; 14: 

898. 


52 

22. Jacobs DS, De Mott WR, Strobel SL 

and Fody EP. Chemistry. In: Labo-ratory 

Test Handbook. Jacobs DS, Kasten BL, 

De Mott WR, Wolfson WL (eds) Lexi 

Company Incorpora-tion, Ohio, (2 nd ed.) 

1990; 4 : 358-63. 

23. Molnar Z, Mikor A, Leiner T, et al. Fluid 

resuscitation with colloids of different 

molecular weight in septic shock. 

Intensive Care Med 2004; 30:1356. 

24. Claes Y, Van Hemelrijck J, Van Gerven 

M, et al. Influence of hydroxyethyl starch 

on coagulation in patients during the 

perioperative period. Anesth Analg 

1992; 75:24. 

25. Thompson WL, Gadsen RH. Pro-longed 

bleeding times and hypo-fibrinogenemia 

in dogs after infusion of hydroxylethyl 

starch and dextran. Transfusion 1965; 5: 

440. 

26. Van Wyk V, Marais A, Diedericks J, Van 

der Walt E, et al. Plasma volume 

expansion with Haemaccel does not 

impair haemostasis during reduction 

mammoplasty. Afr J Surg 1998; 36:22. 

27. Amany K El-Saway, Wael M R Sakr and 

Ismail A Shafik. Haemagel 4% versus 

hydroxyethyl starch 6%: Effect on blood 

coagulation, hemo-stasis, renal 

functions and platelet aggregation in 

patients undergoing major abdominal 

surgery. Med J Cairo Univ 2004; 72 (1) 

Suppl: 99. 

28. Mardel SN, Saunders F, Ollerenshaw L, 

et al. Reduced quality of in vitro clot 

formation with gelatin-based plasma 

substitutes. Lancet 1996; 347: 825. 

29. Evans PA, Garnett M, Boffard K, et al. 

Evaluation of the effect of colloid 

(Haemaccel) on the bleeding time in the 

trauma patient. J R Soc Med 1996; 

89:101P. 

30. Marx G, Cobas Meyer M, Shuerholz, et 

al. Hydroxyethyl starch and modi-fied 

fluid gelatin maintain plasma volume in 

a porcine model of septic shock with 

capillary leakage. Intensive Care Med 

2002; 28: 629. 

31. Upadhyay M, Singhi S, Murlidharan J, et 

al. Randomized evaluation of fluid 

resuscitation with crystalloid (saline) and 

colloid (polymer from degraded Gelatin 

in saline) in pediatric septic shock. 

Indian Pediatr 2005; 42:223.


32. Kohler H, Zchiedrich H, Clasen R, et al. 

Blood volume, colloidal osmotic 

pressure and renal function in 

volunteers after infusion of middlemolecular 

10% hydroxyethyl starch 

200/0.5 and 10% dextran 40. 

Anaesthesist 1989; 38: 1. 


53 

33. Kimme P, Jannsen B, Ledin T, et al. 

High incidence of pruritis after large 

doses of hydroxyethyl starch (HES) 

infusions. Acta Anaesthesiol Scand 

2001; 45: 686.

Autoclaved Gelatin (Haemagel) Versus 6% Hydroxyethyl Starch 200 ...

Create successful ePaper yourself

Delete template?

Save as template?