Hypertonic saline and dextran after coronary artery surgery mobilises fluid excess and improves cardiorespiratory functions

Töllöfsrud, Stein; Noddeland, Harald

doi:10.1111/j.1399-6576.1998.tb05101.x

Cited by 54 publications

(35 citation statements)

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“…Auch in den Bereichen der 37,41,45] und Gefäß-chirurgie [12,38] sowie bei Intensivpatienten mit "systemic inflammatory response syndrome" (SIRS)/Sepsis [19] oder erhöh-tem intrakraniellen Druck [20, 22] konnten vorteilhafte Effekte eines hypertonen Volumenersatzes -allerdings bei deutlich verlängerten Infusionszeiten von 15-30 min -verzeichnet werden. Ähnlich wie im traumatisch-hypovolä-mischen Schock spielt das Ischämie/Reperfusionsereignis in der Kardiochiurgie (Aortencrossclamping) eine herausragende Rolle in der Entstehung einer systemisch inflammatorischen Antwort.…”

Section: Hämodynamische Reaktionen Nach Präoperativer Hypervolämi-schunclassified

“…Auch in den Bereichen der Kardio- [7,37,41,45] und Gefäß-chirurgie [12,38] sowie bei Intensivpatienten mit "systemic inflammatory response syndrome" (SIRS)/Sepsis [19] oder erhöh-tem intrakraniellen Druck [20,22] konnten vorteilhafte Effekte eines hypertonen Volumenersatzes -allerdings bei deutlich verlängerten Infusionszeiten von 15-30 min -verzeichnet werden.…”

Section: Hämodynamische Reaktionen Nach Präoperativer Hypervolämi-schunclassified

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H�modynamische Reaktionen nach pr�operativer hypervol�mischer H�modilution mit hyperton-hyperonkotischen Kolloiden bei Koronarbypassoperationen

et al. 2003

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Compared to isotonic saline solution, preoperative volume replacement with hyperoncotic colloids improves haemodynamic conditions during the pre-bypass period in patients with normal left ventricular function undergoing coronary artery bypass grafting. Additionally intraoperative crystalloid solution requirements are reduced. The volume saving effects are increased with administration of hyperoncotic colloids in a preparation with hypertonic saline solution, whereas the choice of the colloid, either hydroxyethyl starch or dextran seems to be of minor importance.

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Section: Hämodynamische Reaktionen Nach Präoperativer Hypervolämi-schunclassified

H�modynamische Reaktionen nach pr�operativer hypervol�mischer H�modilution mit hyperton-hyperonkotischen Kolloiden bei Koronarbypassoperationen

et al. 2003

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“…2 Studies have shown that hypertonic solutions whether combined with colloids such as dextran or 6% hydroxyethyl starch or not promote a negative water balance, improved cardiac output, decreased systemic vascular resistance and reduce the need for blood products. [3][4][5][6][7][8][9] These benefits have also been shown for volume replacement with hypertonic solutions during the postoperative period following off-pump coronary artery bypass grafting. 10 Off-pump coronary artery bypass grafting reduces blood losses, myocardial infarction, acute renal failure, mediastinitis, stroke and prolonged orotracheal intubation particularly in subgroups of higher-risk patients.…”

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confidence: 99%

Safety and efficacy of hypertonic saline versus isotonic saline solution in off-pump coronary artery bypass grafting

et al. 2014

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OBJECTIVES: Off-pump coronary artery bypass grafting occurrence increases constantly. However transient low cardiac output events occur during this procedure requiring aggressive volume replacement, which may lead to hypervolemia and its complications. METHOD: This study evaluates the safety and efficacy of a hypertonic-hyperoncotic NaCl solution (6% hydroxyethylamide + 7.5% sodium chloride) versus isotonic saline during the creation of anastomosis in the lateral wall of the left ventricle. In each case, 250 ml of solution was administered from coded bags at the start of the grafting procedure. All staff directly connected with the surgical procedure and post-operative management of patients was blinded to the coding. The primary objective was the determination of post-surgery complications. Secondary objectives were the determination of mean arterial blood pressure and central venous pressure during anastomotic grafting. RESULTS: Primary objectives showed no difference between hypertonic versus isotonic saline in post-operatory surgery complication. Significant increases of mean arterial pressure and central venous pressure in the Hypertonic Saline group versus normal saline patients during grafting were observed. CONCLUSION: The use of hypertonic saline during off-pump coronary artery bypass grafting on the lateral posterior wall of the left ventricle led to no complications and improved arterial and central venous pressure, favoring the creation of anastomosis in this wall.

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“…[11][12][13][14][15][16][17][18][19][20][21] Furthermore, the positive fluid balance, incurred due to fluid administration, is also reduced. This is the result of improved renal function with an accompanying increase in urine output.…”

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confidence: 99%

Hypertonic Solutions

Wade

2003

Transfus Alt Transfus Med

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are of the patient with hypotension due to acute blood loss requires control of bleeding and subsequent expansion of blood volume to assure adequate oxygen delivery. The use of hypertonic/hyperoncotic solutions has provided a means of early intervention that is safe and appears to be of benefit. These solutions are also finding use in intraoperative settings that require volume expansion or replacement.Hypertonic/hyperoncotic solutions are a class of solutions formulated to move fluid from the extravascular space into the vascular space down an osmotic gradient. This is usually achieved by the use of hypertonic saline at 7.5% at an osmolality of 2,400 mOsm/kg H2O. When infused these solutions increase plasma osmolality by about 10 to 15 mOsm/kg H2O and plasma sodium concentration by 10 to 12 mmol. 1 The addition of hyperoncotics to the solutions allows extended maintenance of the volume within the vascular space.The advantage of these solutions is the ability to administer a small volume of solution with a resultant greater expansion of blood volume. They also increase cardiac output and improve oxygen delivery. For a given type of solution, the extent and duration of volume can be calculated. Using volume kinetics, Hahn and coworkers 2-5 were able to model the distribution between various fluid compartments within the body, thereby allowing an accurate assessment of the magnitude of volume expansion and the rate of disappearance of a solution. For isotonic solutions, the infusion of one milliliter results in the expansion of blood volume by about 0.2 mL. The use of an oncotic solution produces an expansion of 0.6 mL per mL administered. Hypertonic/hyperoncotic (Dextran 70) solutions result in an expansion of 1.4 to 2.5 mL per mL administered. Furthermore, the expansion using hypertonic/hyperoncotic solutions is sustained for a longer period. The amount of volume expansion may be greater in the presence of hypovolemia or hypotension.

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Hypertonic saline and dextran after coronary artery surgery mobilises fluid excess and improves cardiorespiratory functions

Cited by 54 publications

References 17 publications

H�modynamische Reaktionen nach pr�operativer hypervol�mischer H�modilution mit hyperton-hyperonkotischen Kolloiden bei Koronarbypassoperationen

H�modynamische Reaktionen nach pr�operativer hypervol�mischer H�modilution mit hyperton-hyperonkotischen Kolloiden bei Koronarbypassoperationen

Safety and efficacy of hypertonic saline versus isotonic saline solution in off-pump coronary artery bypass grafting

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