The role of tetrastarches for volume replacement in the perioperative settingJames, Michael FMCurrent Opinion in Anesthesiology: October 2008 - Volume 21 - Issue 5 - p 674–678 doi: 10.1097/ACO.0b013e32830dd073 Transfusion medicine: Edited by Martin Westphal Abstract Author Information Purpose of review Current opinion in perioperative fluid therapy suggests that the use of colloids to achieve haemodynamic optimization may result in improved clinical outcomes. This has focused interest on the colloid solutions, particularly on the newest of these, the tetrastarches. This review will address the advantages and disadvantages of the starch solutions with particular emphasis on the advantages offered by the tetrastarches, as these products, which have been widely used in Europe for a number of years, have recently been released in the United States. Recent findings The tetrastarches have a molar substitution of 0.4, compared with the older hetastarches that had a molar substitution of 0.7. This results in a lower in-vivo molecular weight leading to more rapid clearance of the starch particles and a reduced incidence of adverse effects such as coagulation disorders and skin itching. It is probable that the more rapidly degradable tetrastarch also decreases, or possibly eliminates, the risk of renal dysfunction that has been associated with some of the earlier starch products. Summary Tetrastarch represents a substantial advance in colloid therapy, offering good volume effectiveness with a very low risk of adverse effects. Department of Anaesthesia, UCT Faculty of Health Sciences, Cape Town, South Africa Correspondence to MFM James, MBChB, PhD, FRCA, FCA (SA), Professor and Head of Department, Department of Anaesthesia, UCT Faculty of Health Sciences, Anzio Road, Cape Town, Western Cape 7925, South Africa Tel: +27 021 406 6143; fax: +27 021 447 5206; e-mail: firstname.lastname@example.org © 2008 Lippincott Williams & Wilkins, Inc.