Comparison of hemodynamic changes after acute normovolemic hemodilution using Ringer's lactate versus 5% albumin in patients on beta-blockers undergoing coronary artery bypass surgery.
OBJECTIVE
Acute normovolemic hemodilution (ANH) is used cautiously in coronary artery disease (CAD) patients because of concerns of compromised coronary blood flow. This study aimed to compare hemodynamic changes by using either Ringer's lactate or albumin for ANH in CAD patients receiving beta-blockers.


METHODS
Prospective, randomized study.


METHODS
Postgraduate teaching hospital.


METHODS
Thirty patients undergoing coronary artery bypass graft surgery (CABG) (hemoglobin >12 g/dL, on chronic beta-blocker therapy).


METHODS
Monitoring, induction, and anesthesia followed a routine protocol for CABG surgery including pulmonary artery catheter placement. Patients were randomly included in group 1 (ANH by Ringer's lactate) or in group 2 (ANH by 5% albumin). A hemodynamic calculation software program was used for parameters recorded before and after ANH.


RESULTS
ANH could not be completed in 5 patients (33%) in group 1 because of a fall in mean arterial pressure (MAP) of more than 25% from baseline. In both groups posthemodilution MAP, heart rate, systemic vascular resistance, and oxygen delivery index decreased, whereas stroke volume index, cardiac index, and tissue oxygen extraction increased significantly as compared to baseline values (p < 0.05). Hemodynamic parameters were better maintained during the study period in group 2 than group 1.


CONCLUSIONS
Hemodynamic stability was better maintained by 5% albumin than Ringer's lactate for ANH in chronic beta-blocked CAD patients. Despite an increase in cardiac index, systemic oxygen delivery was decreased irrespective of the hemodiluting fluid used. ANH to a hemoglobin value of 10 g/dL in chronically beta-blocked CAD patients was well tolerated.
Arya
Virendra K
VK
Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. aryavk_99@yahoo.com
Nagdeve
Navanit G
NG
Kumar
Arun
A
Thingnam
Shyam K
SK
Dhaliwal
Rajinder S
RS
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000418:Albumins / Q000009:adverse effects / Q000627:therapeutic use*; D001784:Blood Gas Analysis / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects*; D001026:Coronary Artery Bypass / Q000379:methods*; D006339:Heart Rate / Q000187:drug effects*; D006438:Hemodilution / Q000009:adverse effects / Q000379:methods*; D006454:Hemoglobins / Q000187:drug effects; D006801:Humans; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010952:Plasma Substitutes / Q000627:therapeutic use; D011446:Prospective Studies; D000077325:Ringer's Lactate; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D000418:Albumins; D006454:Hemoglobins; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D010100:Oxygen