Adequate long-term data on the use of hydroxyethyl starch in patients who underwent surgery or trauma are not available. The expected benefit of treatment should be carefully correlated with uncertain long-term safety. Other available therapeutic measures should be considered. Particular care should be taken when using solutions of HES in patients with coagulation disorders, as in patients with impaired liver function. High doses of hydroxyethyl starch should be avoided in patients with hypovolemia due to possible severe hemodilution.In connection with the possibility of developing allergic reactions, the introduction of the first 10-20 ml of the solution should be carried out slowly (drip), carefully monitoring the patient's condition.
In the treatment should monitor the volume of circulating blood, the concentration of electrolytes, leukocytes, platelets, hemoglobin, blood coagulation indicators.At the first signs of coagulopathy, the drug should be discontinued. In open-heart surgery related to cardiopulmonary bypass, the risk of bleeding is increased, so the use of the drug is contraindicated.
Before and during the use of the drug, it is necessary to check the function of the kidneys, to carry out a constant monitoring of the creatinine content in the blood serum, the water-electrolyte balance, and the urinary retention indices. In patients with impaired renal function, the use of hydroxyethyl starch is contraindicated. At the first signs of kidney damage against the background of treatment, the drug should be discontinued. Monitoring of kidney function should be carried out for 90 days after the infusion of the drug (the risk of kidney damage in a remote period). Disturbance of kidney function on the background of therapy with HES solution can aggravate the initial hepatic insufficiency (with portal hypertension), and can lead to mechanical obstruction of the bile ducts. It should be borne in mind that
hydroxyethyl starch can affect clinical and chemical indices (glucose, protein, erythrocyte sedimentation rate, fatty acids, cholesterol, sorbitol dehydrogenase, specific gravity of urine).
The introduction of high doses of the drug leads to a decrease in hematocrit, hemoglobin concentration and plasma protein. A hematocrit of 25% or a hemoglobin content of 8 g / 100 ml is considered to be minimal for the administration of artificial colloids in order to replace the volume of blood plasma in patients without cardiovascular or pulmonary insufficiency. In patients with cardiovascular and / or pulmonary insufficiency, hematocrit below 30% is considered critical, the hemoglobin content is below 10 g / 100 ml. With a decrease in hematocrit and hemoglobin below these values, additional administration of blood or erythrocyte mass is required. Starting with a total protein of less than 5 g / 100 ml, the introduction of albumin is indicated.
During treatment, it is necessary to ensure a sufficient supply of fluid in the body (at least 2-3 liters of fluid per day).
When anaphylactoid reactions occur, the drug should be discontinued, the patient must be placed in the "lying" position with the head lowered, and the airways released; then injected epinephrine intravenously, first diluted 1 ml of the solution (1: 1000) to 10 ml first slowly injected 1 ml of the resulting solution (0.1 mg), while controlling the pulse and blood pressure, the introduction of epinephrine can be repeated.Then 5% solution of human albumin (for replenishment of circulating blood volume), glucocorticosteroids (250-1000 mg of prednisolone), blockers of H1-histamine receptors are intravenously administered.
Patients should be under continuous medical supervision, additional therapeutic measures should be taken depending on the condition of the patients. In the treatment of patients whose blood group is not established, it must be borne in mind that the introduction of large volumes of hydroxyethyl starch may make it difficult to interpret the results of the agglutination reaction. After the administration of the drug, the activity of amylase in the blood increases markedly, which returns to the norm in 3-5 days (may interfere with the laboratory diagnosis of pancreatitis without affecting the clinical picture).
HES can give a positive result in the conduct of doping control.
The drug does not affect the definition of the blood group.
The literature describes the relationship between the dose and frequency of itching in otoneurological diseases, such as severe hearing loss, tinnitus, and sound trauma. In these diseases, to reduce the incidence of itching, it is recommended that the dose be limited to 250 ml per day.In case of an itching, the drug should be discontinued and proper hydration should be ensured.