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Plasma substitutes: the choice during surgery and intensive care


Colloidal solutions are used to support the circulation in hypovolaemic shock, before blood is available or when it is not needed. They can also be used to supplement the volume of red cell concentrates, which may have as little as 40ml of the original plasma per unit. Fresh or fractionated plasma is scarce and its use for these purposes is wasteful and very expensive. Several cheap, storable and readily usable synthetic plasma substitutes are now available. The three types of preparation - dextrans, gelatins and hetastarch (hydroxyethyl starch) - differ in several important respects. This article discusses factors affecting the choice between these preparations, but not the indications for their use.

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