Abdullah S Terkawi1,2,3, Sarah K Larkin4, Siny Tsang5, Jessica S Sheeran1, Mohamed Tiouririne6. 1. Department of Anesthesiology, University of Virginia, P.O. Box 800710, Charlottesville, VA, 22908, USA. 2. Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia. 3. Outcomes Research Consortium, Cleveland, OH, USA. 4. Department of Obstetrics and Gynecology, University of Virginia, P.O. Box 800712, Charlottesville, VA, 22908, USA. 5. Department of Epidemiology, Columbia University, 772 West 168th Street, New York, NY, 10032, USA. 6. Department of Anesthesiology, University of Virginia, P.O. Box 800710, Charlottesville, VA, 22908, USA. Mt9y@virginia.edu.
Abstract
BACKGROUND: Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. METHODS: We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). RESULTS: Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intraoperative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. CONCLUSIONS: Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.
BACKGROUND:Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. METHODS: We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). RESULTS: Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intraoperative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. CONCLUSIONS: Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.
Authors: Abdullah S Terkawi; Mohamed Tiouririne; Sachin H Mehta; Jordan M Hackworth; Siny Tsang; Marcel E Durieux Journal: Reg Anesth Pain Med Date: 2015 Jul-Aug Impact factor: 6.288
Authors: Abdullah S Terkawi; Dimitris Mavridis; Pamela Flood; Jørn Wetterslev; Rayan S Terkawi; Aref A Bin Abdulhak; Megan S Nunemaker; Mohamed Tiouririne Journal: Anesthesiology Date: 2016-04 Impact factor: 7.892