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

Abstract

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.

Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature

“…This relative increase in intravascular volume serves to increase preload 61,65,67,68 . Thus, when compared with equivalent volumes of NS, resuscitation with HS results in a more profound increase in MAP, CO, and stroke volume in those who are critically ill 65,69 . Beyond its hemodynamic effects, resuscitation with HS may also have an impact on systemic inflammation 67 .…”

Cardiovascular effects of shock and trauma in experimental models. A review

“…It is consequently safe to state that hypertonic acetate is not an adequate resuscitative solution. In the only report cited in this review which is not an animal model, Mola et al [ 47 ] tested the safety and efficacy of hypertonic saline vs isotonic saline in off-pump coronary artery bypass grafting and found that the solution is safe and raised venous pressure return during the critical period of arterial anastomosis. As reported above, Dekker et al [ 38 ] found that treatment of traumatic brain injury plus hemorrhage with hypertonic saline + hydroxyethylstarch is less effective that normal saline treatment.…”

Fluid Resuscitation after Cardiac surgery: Is Hypertonic Saline or Hyperoncotic Albumin the Future?

“…This relative increase in intravascular volume serves to increase preload [60,74,76,77]. Thus, when compared to equivalent volumes of NS, resuscitation with HS results in a more profound increase in MAP, CO and stroke volume in those who are critically ill [74,78].…”