Low serum sodium level during cardiopulmonary bypass predicts increased risk of postoperative stroke after coronary artery bypass graft surgery

Munoz, Elizandro; Briggs, H; Tolpin, Daniel A.; Lee, Vei-Vei; Crane, Terry; Elayda, MacArthur A.; Collard, Charles D.; Pan, Wei

doi:10.1016/j.jtcvs.2013.09.034

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…(Mangano et al, 1998) Mannitol has been shown to enhance blood flow to the kidneys, which may benefit renal function in cases of acute kidney damage that occur after heart surgery (Bragadottir et al, 2012;Sirivella et al, 2000) However, a number of studies show that mannitol causes enhanced endothelial cell death and that this might be detrimental in cases of acute renal damage (Malek et al, 1998;Moreira et al, 2017;Zhang et al, 1999 (Manninen et al, 1987) Our data supported these conclusions by demonstrating that, after CABG, the Mannitol group's sodium concentration was noticeably lower. Mannitol inhibits the reabsorption of sodium in the tubules of the kidney in addition to the plasma sodium dilution action, which may lead to the onset of low sodium levels during CBP (Wong et al, 1979) Research indicates that hyponatremia carries a risk of cerebral edema and is, hence, potentially harmful (Adrogué and Madias, 2000;Crestanello et al, 2013;Munoz III et al, 2014) The result following heart surgery may be improved by reducing the risk of hyponatremia (Crestanello et al, 2013); in particular, avoiding hyponatremia during CPB is crucial. Using a prime solution devoid of mannitol might help accomplish this objective.…”

Section: Resultsmentioning

confidence: 99%

Effect of Mannitol on Electrolytes and Its Relation With Kidney Injury in Cardiopulmonary Bypass

SALEEM,

AWAN,

MUSHTAQ

2023

Biol Clin Sci Res J

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The optimal composition of the priming solution used in cardiopulmonary bypass (CPB) during human cardiac surgery is still uncertain. Mannitol is a common component of CPB priming solutions, but its efficacy is debated. To clarify the effect of mannitol on CPB prime solutions, a prospective, randomized, double-blind trial was conducted on 40 patients with sound cardiac and renal functions who were undergoing coronary artery bypass grafting. The trial included two groups: one received Ringer's acetate-based prime (n = 20), and the other received a combination of Ringer's acetate and 200 mL mannitol as prime (n = 20). The study examined changes in renal-related parameters, electrolytes, osmolality, and acid-base balance. Interestingly, no significant differences in osmolality were observed between the Mannitol and Ringer's acetate groups. However, the Mannitol group showed a significant decrease in sodium levels from 138.7±2.8 mmol/L at the start of anesthesia to 133.9±2.6 mmol/L after the initiation of CPB (p <0.001). Renal parameters remained consistent across groups, except for a temporary effect of mannitol on post-surgery urine output (p = 0.003). In conclusion, this study found no significant differences in osmolality between Ringer's acetate-based prime and Mannitol-based prime in individuals with healthy cardiac and renal function. However, the addition of mannitol to the prime resulted in a significant, albeit short-term, reduction in sodium levels. These findings contribute to the ongoing discourse on optimizing CPB prime solutions, especially in cardiac surgical procedures involving mannitol inclusion.

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Section: Resultsmentioning

confidence: 99%

Effect of Mannitol on Electrolytes and Its Relation With Kidney Injury in Cardiopulmonary Bypass

SALEEM,

AWAN,

MUSHTAQ

2023

Biol Clin Sci Res J

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“…Because an average serum sodium level<130 mEq/mL after crossclamp is independently associated with an increased risk of postoperative stroke in patients undergoing coronary artery bypass grafting. 13 differences in occurrence of serum sodium levels 130 mEq/L after aortic crossclamp and seizures between the 2 groups were reported in terms of odds ratios (OR) and 95% confidence interval (CI). Logistic regression analyses were used to identify risk factors for serum sodium levels <130 mEq/L after aortic crossclamp.…”

Section: Discussionmentioning

confidence: 99%

Scavenging right atrial Bretschneider histidine-tryptophan-ketoglutarate cardioplegia: Impact on hyponatremia and seizures in pediatric cardiac surgery patients

Turner

Ruzmetov

Niu

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Apart from the plasma sodium dilution effect, mannitol causes inhibition of sodium reabsorption in renal tubules, which may contribute to the development of hyponatremia during CBP. It has been shown that hyponatremia is a potentially dangerous condition associated with the risk of brain edema . Another serious condition, central pontine myelinolysis, may occur when hyponatremia is treated rapidly .…”

Section: Discussionmentioning

confidence: 99%

The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial

Ljunggren

Sköld

Dardashti

et al. 2019

Acta Anaesthesiol Scand

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BackgroundThe optimal prime solution for the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol is widely used in the priming solution for CPB despite the fact that there is no clear consensus on the role of mannitol in cardiac surgery. The aim of this study was to investigate the effect of mannitol in the CPB prime solution.MethodsThis prospective, randomized, double‐blind study included 40 patients with normal cardiac and renal functions, who underwent coronary artery bypass grafting. One group received a prime based on Ringer's acetate (n = 20), and the other a prime consisting of Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality, acid‐base status, electrolytes, and renal‐related parameters were monitored.ResultsNo significant differences were found in osmolality between the Ringer's acetate group and the mannitol group at any time. The mannitol group showed a pronounced decrease in sodium, from 138.7 ± 2.8 mmol/L at anaesthesia onset, to 133.9 ± 2.6 mmol/L after the start of CPB (P < .001). No differences were seen in the renal parameters between the groups, apart from a short‐term effect of mannitol on peroperative urine production (P = .003).ConclusionWe observed no effects on osmolality of a prime solution containing mannitol compared to Ringer's acetate‐based prime in patients with normal cardiac and renal function. The use of mannitol in the prime resulted in a short‐term, significant decrease in sodium level.

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Low serum sodium level during cardiopulmonary bypass predicts increased risk of postoperative stroke after coronary artery bypass graft surgery

Abstract: An average serum sodium level of less than 130 mEq/L during cardiopulmonary bypass is independently associated with an increased risk of postoperative stroke in patients who undergo primary coronary artery bypass grafting.

Cited by 9 publications

References 22 publications

Effect of Mannitol on Electrolytes and Its Relation With Kidney Injury in Cardiopulmonary Bypass

Effect of Mannitol on Electrolytes and Its Relation With Kidney Injury in Cardiopulmonary Bypass

Scavenging right atrial Bretschneider histidine-tryptophan-ketoglutarate cardioplegia: Impact on hyponatremia and seizures in pediatric cardiac surgery patients

The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial

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