title: First use of hypertonic saline dextran in children: a study in safety and effectiveness for atrial septal defect surgery.
abstract: Hypertonic saline dextran (7.5% NaCl + 6% Dextran-70) has been used in adults in several studies and shown beneficial effects in hypovolemic shock, trauma, cardiogenic shock, and cardiac surgery. There have never been studies of this solution in children. This work studies its effect in children undergoing surgery for the correction of atrial septal defects. Twenty-five children underwent correction of atrial septal defect using cardiopulmonary bypass with bloodless priming. Children were divided in five groups and each received an incremental hypertonic saline dextran dose of 0.1, 0.5, 1.0, 2.0, and 4.0 mL/kg, 5 min before the beginning of cardiopulmonary bypass. Collected data were fluid balance, amount of bleeding, blood/derivative transfusion occurrence, plasma sodium, and hematocrit. Patients were divided into low-dose (0-1 mL/kg) and high-dose (2-4 mL/kg) groups. Analysis of variance was used to determine differences in blood loss between groups. The fluid balance and blood/derivative requirements were compared through Student's t test and Fisher's exact test (2-tail), respectively. All patients were discharged from hospital with corrected atrial septal defect. No hypertonic saline dextran-related complications occurred. There were no differences in the amount of bleeding. The high-dose group exhibited a significant decrease in fluid balance and in blood/derivative requirements in comparison with the low-dose group. In this study, the use of hypertonic saline dextran in the pediatric population submitted to cardiopulmonary bypass is safe and does not raise the amount of bleeding. Its effective doses produce negative fluid balance and reduce blood/derivative requirements.
authors.affiliation: Division of Surgery, São Paulo University School of Medicine, São Paulo, Brazil 05403-900. rors@terra.com.br
authors.forename: Roberto
authors.initials: R
authors.lastname: Rocha-E-Silva
authors.forename: Luiz F
authors.initials: LF
authors.lastname: Canêo
authors.forename: Domingos D
authors.initials: DD
authors.lastname: Lourenço Filho
authors.forename: Marcelo B
authors.initials: MB
authors.lastname: Jatene
authors.forename: Miguel
authors.initials: M
authors.lastname: Barbero-Marcial
authors.forename: Sérgio A
authors.initials: SA
authors.lastname: Oliveira
authors.forename: Maurício
authors.initials: M
authors.lastname: Rocha-E-Silva
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003911:Dextrans / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: D003911:Dextrans; C104375:hypertonic saline-dextran solution; D012965:Sodium Chloride; D012964:Sodium