RETRACTED: Acute preoperative hemodilution in cardiac surgery: volume replacement with a hypertonic saline-hydroxyethyl starch solution.
Preoperative hemodilution (HD) is a recommended practice in cardiac surgery that conserves blood and reduces the complications of homologous blood transfusion. In 45 patients undergoing myocardial revascularization, HD was performed preoperatively. Withdrawn volume (10 mL/kg) was replaced either by a new hypertonic saline (HS) solution prepared in hydroxyethyl starch (HES) (2,400 mOsm/L, HS-HES group, n = 15) or by a standard low molecular weight hydroxyethyl starch solution (6% HES 200/0.5, HES group, n = 15) to maintain baseline PCWP (acute normovolemic hemodilution [ANH]). Fifteen comparable patients without HD served as controls. Significantly less HS-HES (210 +/- 20 mL) than HES 6% (890 +/- 90 mL) was necessary to sustain hemodynamics during HD. Stable cardiocirculatory conditions were obtained even after termination of bypass. Fluid balance during cardiopulmonary bypass as well as in the postoperative period was significantly lower in HS-HES-treated patients. With regard to hemodynamics, CI increased most in the HS-HES group (+36%), whereas systemic vascular resistance was lower in these patients. Right ventricular ejection fraction increased only in HS-HES patients (+15%). However, sodium concentration as well as osmolarity increased after volume replacement with HS-HES, without exceeding normal values. None of the patients suffered from organ failure. Pulmonary gas exchange (PaO2) was less compromised in the HS-HES patients. There were no renal function differences between the groups. In conclusion, HS solution prepared in HES is an attractive alternative for blood substitution in cardiac patients undergoing acute hemodilution for blood conservation.
Boldt
Joachim
J
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
Kling
Dieter
D
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
Weidler
Burghard
B
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
Zickmann
Bernfried
B
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
Herold
Christoph
C
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
Dapper
Friedhelm
F
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
Hempelmann
Gunter
G
Departments of Anesthesiology and Intensive Care Medicine and Cardiovascular Surgery, Justus-Liebig University, Giessen, Germany.
D016280:Atrial Function, Right; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000502:physiology; D001809:Blood Viscosity; D001810:Blood Volume; D002302:Cardiac Output / Q000502:physiology; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D006339:Heart Rate / Q000502:physiology; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011300:Preoperative Care; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D014655:Vascular Resistance / Q000502:physiology; D016278:Ventricular Function, Right
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D010100:Oxygen