Cardiac Surgery

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.

J Cardiothorac Vasc Anesth. 2006 Dec;20(6):812-8.

Arya VK, Nagdeve NG, Kumar A, Thingnam SK, Dhaliwal RS.

Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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. Design: Prospective, randomized study. Setting: Postgraduate teaching hospital.

Participants: Thirty patients undergoing coronary artery bypass graft surgery (CABG) (hemoglobin >12 g/dL, on chronic beta-blocker therapy). Interventions: 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. Measurements and Main 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.

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