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Is the use of colloids for fluid replacement harmless in children?

Saudan, Sonja

Current Opinion in Anesthesiology: June 2010 - Volume 23 - Issue 3 - p 363–367
doi: 10.1097/ACO.0b013e328339384e
Pediatric anaesthesia: Edited by Walid Habre

Purpose of review Albumin has been regarded as the gold standard for maintaining adequate colloid osmotic pressure in children, but increased cost, the lack of clear-cut benefits for survival, and fear of transmission of unknown viruses have contributed to its replacement by hydroxyethyl starch and gelatin preparations. Each of the synthetic colloids has unique physicochemical characteristics that determine their likely efficacy and adverse effect profile. This review will examine the advantages and disadvantages of the use of different colloid solutions in children with a particular focus on their safety profile.

Recent findings Dextrans are rarely used because of their negative effects on coagulation and potential for anaphylactic reactions. Gelatin and albumin have little effect on hemostasis, but the disadvantages of gelatin include its high anaphylactoid potential and limited beneficial volume effect. Tetrastarches have significantly fewer adverse effects on coagulation and renal function than the older hydroxyethyl starches and are now approved for children. Dissolving tetrastarches in a plasma-adapted, balanced solution rather than in saline further improves safety with regard to coagulation and acid–base balance.

Summary Tetrastarches offer the best currently available compromise between cost-effectiveness and safety profile in children with preexisting normal renal function and coagulation.

Pediatric Anesthesia Unit, Geneva Children's Hospital, University of Geneva Hospitals, Geneva, Switzerland

Correspondence to Dr Sonja Saudan, MD, Pediatric Anesthesia Unit, Geneva Children's Hospital, University of Geneva Hospitals, 6 Rue Willy Donzé, 1205 Geneva, Switzerland Tel: +41 22 372 3311; fax: +41 22 382 5485; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.