title: Optimal preoperative titrated dosage of hypertonic-hyperoncotic solutions in cardiac risk patients.
abstract: Hypertonic-iso/hyperoncotic solutions have been the subject of numerous studies, mostly used in a fixed dosage (4 mL/kg bw or 250 mL). Nearly no study exists to prove whether this is the appropriate dosage especially in cardiac risk patients with accompanying diseases. We have compared preoperative volume loading with either 10% hydroxyethyl-starch/7.5% NaCl (HHT-HES) or 10% hydroxyethyl-starch/.9% NaCl (HES) in 50 mL bolus infusions. Volume loading was done with either HES or HHT-HES in 2 x 20 patients before aortic aneurysmectomy. The endpoint of stepwise infusion represented the highest cardiac index (CI) at the lowest possible wedge pressure (PCWP) (turning point of each individual Frank Starling relation). 167.5 mL (+/- 45.5 mL = 2.41 mL/kg bw) of HHT-HES and 440 mL (+/- 26.15 mL = 6.33 mL/kg bw) of HES were necessary. We observed a significant higher increase of the CI in the HHT-HES group. Significant increases of PCWP, pulmonary artery pressure, and central venous pressure occurred within the groups without any significant differences between the groups (p < .05). Results of the study showed: 1) The commonly used fixed dosage of 4 mL/kg bw of HHT-HES is too high in cardiac risk patients with slight hypovolemia. 2) HHT-HES should be given in an individual titration. 3) In the HHT-HES group we observed a positive inotropic effect (higher CI). 4) With the individual titration of HHT-HES no negative side effects occurred (especially no hypotension).
authors.affiliation: Institute of Anesthesiology and Intensive Therapy, Klinikum Mannheim University of Heidelberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Ellinger
authors.forename: M
authors.initials: M
authors.lastname: Fähnle
authors.forename: M
authors.initials: M
authors.lastname: Schroth
authors.forename: D M
authors.initials: DM
authors.lastname: Albrecht
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D001810:Blood Volume / Q000187:drug effects / Q000502:physiology; D002302:Cardiac Output / Q000187:drug effects; D006152:Cyclic GMP / Q000097:blood; D004341:Drug Evaluation; D006331:Heart Diseases / Q000601:surgery* / Q000628:therapy; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D006982:Hypertonic Solutions / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D009994:Osmolar Concentration; D010100:Oxygen / Q000378:metabolism; D011292:Premedication; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D013599:Systole / Q000502:physiology; D013997:Time Factors; D014690:Venous Pressure / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects; D016278:Ventricular Function, Right / Q000187:drug effects
chemical_list: D006982:Hypertonic Solutions; D009320:Atrial Natriuretic Factor; D012964:Sodium; D006152:Cyclic GMP; D010100:Oxygen