Hyperosmotic-hyperoncotic solutions during abdominal aortic aneurysm (AAA) resection.
A largely positive perioperative fluid balance during both elective and emergency abdominal aortic aneurysm repair (AAA) may put patients at risk of developing left ventricular failure and may thus contribute to morbidity. In the present paper we report on a prospective study using hyperosmotic-hyperonocotic solutions (HHS) infused during clamping of the aorta, for the prevention of declamping shock, and the associated reduction in perioperative fluid requirements. The major aim of this paper was to determine the efficacy of an HHS infusion when given over 20 minutes and to detect possible adverse effects of HHS. For perioperative fluid replacement 12 patients received crystalloid solutions with HHS [250 ml of 7.2% NaCl combined with either 6% Dextran (n = 3), 6% Hydroxyethylstarch (HES, n = 4) or 10% HES (n = 5)]. In 16 controls, crystalloids with 1000 ml of HES 10% were infused. Patients were invasively monitored and hemodynamic parameters frequently assessed during the operation, which were statistically analyzed in relation to the start of the fluid loading during clamping of the aorta. One patient showed an anaphylactoid reaction to HES, otherwise no side effects of HHS were observed during infusion (no hypotension, no pathological EKG changes). Plasma sodium and chloride concentration as well as osmolality rose resulting in an osmotic gradient and a desired intravascular volume expansion. Prior to declamping pulmonary capillary wedge pressure had increased to the desired value of > 13 mmHg and < 18 mmHg. Oxygen delivery was significantly elevated upon HHS and remained so post declamping, whereas no change was observed in controls. During clamping systemic vascular resistance was significantly decreased, but was unchanged in controls. The perioperative fluid balance of patients receiving HHS was 2471.0 +/- 948.6 ml, which was significantly less than + 3386.7 +/- 1247.9 ml of controls (P < 0.01). We suggest that HHS opens new perspectives in perioperative fluid management of both elective and emergency AAA repair, since hemodynamic parameters are improved and the overall fluid balance is less positive, thus decreasing the likelihood of edema formation. Moreover, the previously described positive microcirculatory effects of HHS may be particular beneficial in some high-risk patients.
Christ
F
F
Department of Anesthesiology, Ludwig-Maximilians University Munich, Germany.
Niklas
M
M
Kreimeier
U
U
Lauterjung
L
L
Peter
K
K
Messmer
K
K
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002712:Chlorides / Q000097:blood; D000077324:Crystalloid Solutions; D003911:Dextrans / Q000008:administration & dosage; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D006982:Hypertonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D007552:Isotonic Solutions / Q000008:administration & dosage; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D000077331:Ringer's Solution; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012769:Shock / Q000517:prevention & control; D012964:Sodium / Q000097:blood
D002712:Chlorides; D000077324:Crystalloid Solutions; D003911:Dextrans; D006895:Hydroxyethyl Starch Derivatives; D006982:Hypertonic Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D000077331:Ringer's Solution; D012964:Sodium