Generic drug of the therapeutic class: Anesthesia, resuscitation, analgesics
active ingredients: Dextran 40, Sorbitol (E420)
laboratory: B-Braun Medical
Injection solution for IV infusion
- Emergency treatment of shock states: hypovolemic, haemorrhagic, toxi-infectious and traumatic.
- Preoperative normovolemic haemodilution in surgeries at high risk of haemorrhage.
Dextran 40-sorbitol is particularly indicated in patients with sodium restriction.
Dosage DEXTRAN SORBITOL B BRAUN Solution for infusion Box of 12 vials of 500 ml
Slowly infuse the first milliliters to detect any hypersensitivity reactions early (see warnings and precautions for use).
Any dehydration phenomenon must be corrected before administration.
In addition, a prior injection of 20 ml of the hapten-dextran (Promit) will be performed 1 to 2 minutes before administering dextran 40 (see warnings and precautions for use).
- shock states:
In adults, the maximum recommended dosage in the first 24 hours is 15 ml / kg. Thereafter, the daily dosage will be 10 ml / kg.
In order to infuse at a rate useful to maintain the patient's hemodynamic status, it is strongly recommended to monitor the central venous pressure as a guide for infusion.
Treatment should not be continued beyond 5 days.
- Preoperative normovolemic hemodilution:
Replacement of the amount of blood taken preoperatively by the same amount of plasma substitute, in this case dextran 40, keeping the circulating volume at its initial value, so that the hematocrit is lowered to a value defined in advance, usually around 0.30.
The blood volume to be taken is calculated taking into account the sex, the weight, the size of the initial hematocrit and the desired hematocrit.
In the aftermath of the intervention, the evaluation of the per or postoperative blood loss, the value of the hematocrit (obtained by micromethod), the supervision of the operated during the first 24 hours, guide the choice of the patient. -transfusion of blood taken and transfused or infused substances, as well as post-operative perfusion modalities.
- Infant dosage: up to 5 ml / kg.
- Dosage in children: up to 10 ml / kg.
- Dosage in the elderly: identical to that of the adult, but with particular attention to the risks of dehydration, volume overload and impaired renal function.
- Dextran 40 should under no circumstances be administered in the following situations:
. known or suspected hypersensitivity to dextrans,
. patients with congenital deficiency, known or suspected to be fructose dehydrogenase, due to the presence of sorbitol,
. severe congestive heart failure,
. renal impairment with severe oliguria or anuria,
. pregnancy: during delivery with analgesia or epidural anesthesia, do not use as a preventive or curative, because of a risk of death or severe neurological sequelae for the child. These accidents are probably related to acute fetal distress in relation to uterine hypertonia of variable intensity related to the release of prostaglandins in maternal anaphylactic or anaphylactoid reactions (maternal blood pressure may remain stable and mask the severity of fetal risk).
. and in combination with certain drugs (see interactions) (penicillins, aminocaproic acid, dihydralazine mesilate, warfarin sodium, 95% v / v alcohol, dexamethasone sodium phosphate and probanthine bromide).
- In preoperative normovolemic hemodilution, the use of dextran 40 is also contraindicated in unstabilized coronary patients and in severe cardiac failure.
Side effects Dextran Sorbitol B Braun
- There have been reports of allergic reactions such as urticaria, or even severe anaphylactoid reactions, although rare, with the possibility of anaphylactic shock.
The frequency of severe forms is currently estimated at 22/100000 infusions and can be lowered to 1.2 / 100000 thanks to the prior use of hapten-dextran.
In case of anaphylactic / anaphylactoid shock, the infusion should be stopped immediately and an appropriate treatment should be given urgently.
- Dextran is responsible for reducing the von Willebrand factor level.
It modifies the primary haemostasis, and induces a fibrinoformation disorder.
It lengthens the bleeding time, activates thromboplastin time and decreases the thrombin level.
By these mechanisms, it promotes traumatic bleeding or surgical bleeding.
- Dextran causes reversible tubular vacuolation, which can lead to kidney damage (see warnings and precautions for use).
- An increase in the viscosity and the specific weight of urine has also been reported.