Perioperative Hydroxyethyl Starch: A Potential Threat to Patient Safety

Pagel et al1 surprisingly do not report that the 2013 restrictive rules for hydroxyethyl starch (HES) pre scription by the US and European regulatory agen cies (Food and Drug Administration and European Medical Agency) are being violated to such an extent that in October 17, 2017, the European Medical Agency began an ongoing scrutiny of HES use.2 New data provided by Pagel et al1 were collected in patients at “low risk” for acute kidney injury and do not rule out toxic effects of HES on renal function. They can only say that the effect, if present, was not sufficient to require post operative renal replacement therapy. In addition, their data provide strong and alarming evidence that the use of HES in the perioperative setting is associated with a significant increase in blood loss, red blood cell transfusion, intraop erative noradrenaline administration, and length of hospital stay. All of these conditions raise substantial concerns for patient safety