[Hypertonic-hyperoncotic volume replacement (7.5% NaCl/10% hydroxyethyl starch 200.000/0.5) in patients with coronary artery stenoses].
OBJECTIVE
To determine the efficacy and safety of intravascular volume augmentation with a hypertonic saline-hyperoncotic HES solution prior to CABG.


METHODS
Randomized, double-blind, clinical trial.


METHODS
Consecutive sample of 37 patients scheduled for elective CABG; mean age 64.5 (41-80; range) years and weight 74 (51-111) kg.


METHODS
Continuous, central-venous infusion of either 250 ml (approx. 3.5 ml/kg) HES (0.9% NaCl/10% hydroxyethyl starch 200.000/0.5) or HT-HES (7.5% NaCl/10% hydroxyethyl starch 200.000/0.5) in 15 minutes, following induction of anesthesia.


RESULTS
Groups were similar with respect to age, weight, and sex. 15 min. after fluid loading, cardiac index, pulmonary artery pressure, and wedge pressure had increased from baseline in both groups (p < 0.05), with a greater increase in the HT-HES-group (p < 0.05). In eight out of 18 patients, who had received HT-HES, transient drops in arterial blood pressure (mean 20% from baseline, range 10-35%) were observed during the first 5 minutes of infusion. Seven of the HT-HES-group patients developed transient left ventricular failure, predominantly 5-20 min. after infusion. No incidence of initial hypotension or LVF was observed in the HES-group.


CONCLUSIONS
In patients with coronary artery disease, volume augmentation with hypertonic-hyperoncotic solutions may induce transient hypotension and post-infusion hypervolemic left heart failure.
Prien
T
T
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälischen Wilhelms-Universität Münster.
Thülig
B
B
Wüsten
R
R
Schoofs
J
J
Weyand
M
M
Lawin
P
P
D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000187:drug effects* / Q000502:physiology; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D005112:Extracorporeal Circulation; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D006982:Hypertonic Solutions; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
D006895:Hydroxyethyl Starch Derivatives; D006982:Hypertonic Solutions; D012462:Saline Solution, Hypertonic; D010100:Oxygen