Effects of hyperoncotic or hypertonic-hyperoncotic solutions on polymorphonuclear neutrophil count, elastase- and superoxide-anion production: a randomized controlled clinical trial in patients undergoing elective coronary artery bypass grafting.
BACKGROUND
Hypertonic-hyperoncotic solutions may be an effective treatment for systemic inflammatory response syndrome (SIRS). With regard to the immunomodulatory effects of these drugs, previous studies demonstrated controversial results. Therefore, the present study investigated the influence of different hyperoncotic and hypertonic-hyperoncotic solutions on polymorphonuclear neutrophil leukocyte (PMNL) count, elastase and superoxide-anion production in patients undergoing elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass.


METHODS
Fifty patients scheduled for elective CABG with cardiopulmonary bypass were randomly assigned to five groups: (i) NaCl 0.9%, 750 ml/m(2) body surface area (BSA); (ii) hydroxyethylic starch 10%, 250 ml/m(2) BSA and NaCl 0.9%, 400 ml/m(2) BSA; (iii) dextran 10%, 250 ml/m(2) BSA and NaCl 0.9%, 300 ml/m(2) BSA; (iv) hypertonic sodium chloride 7.2%/hyperoncotic hydroxyethylic starch 10%, 150 ml/m(2) BSA; and (v) hypertonic sodium chloride 7.2%/hyperoncotic dextran 10%, 150 ml/m(2) BSA. Blood samples were drawn from arterial, central venous and coronary artery sinus catheters peri-operatively. PMNL count, superoxide-anion production and elastase were recorded.


RESULTS
PMNL counts and elastase activity increased in all groups after reperfusion. Superoxide-anion production showed only minor changes. Between groups, no significant differences were demonstrated.


CONCLUSIONS
Infusion of clinically relevant doses of hypertonic-hyperoncotic solution did not affect PMNL count, elastase- or superoxide-anion production during elective CABG with cardiopulmonary bypass.
Molter
G P
GP
Department of Anesthesia and Intensive Care, Klinikum Leverkusen, Leverkusen, Germany.
Silomon
M
M
Bauer
C
C
Ziegeler
S
S
Soltesz
S
S
D000328:Adult; D000368:Aged; D000758:Anesthesia; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass; D005260:Female; D006400:Hematocrit; D006801:Humans; D006982:Hypertonic Solutions / Q000494:pharmacology*; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects* / Q000201:enzymology / Q000378:metabolism; D009994:Osmolar Concentration; D016877:Oxidants / Q000378:metabolism*; D010100:Oxygen / Q000097:blood; D012964:Sodium / Q000097:blood; D013481:Superoxides / Q000378:metabolism*; D014655:Vascular Resistance / Q000187:drug effects; D014882:Water-Electrolyte Balance / Q000187:drug effects
D006982:Hypertonic Solutions; D016877:Oxidants; D013481:Superoxides; D012964:Sodium; D019272:Leukocyte Elastase; D010100:Oxygen