First use of hypertonic saline dextran in children: a study in safety and effectiveness for atrial septal defect surgery.
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.
Rocha-E-Silva
Roberto
R
Division of Surgery, São Paulo University School of Medicine, São Paulo, Brazil 05403-900. rors@terra.com.br
Canêo
Luiz F
LF
Lourenço Filho
Domingos D
DD
Jatene
Marcelo B
MB
Barbero-Marcial
Miguel
M
Oliveira
Sérgio A
SA
Rocha-E-Silva
Maurício
M
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
D003911:Dextrans; C104375:hypertonic saline-dextran solution; D012965:Sodium Chloride; D012964:Sodium