doiSerbia

Effect of infusion of hypertonic-hyperoncotic solution on cardiovascular function in surgery of the abdominal aorta during the perioperative period

Šoškić Ljiljana (Odeljenje anestezije i intenzivne terapije, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Miličić Biljana (Služba polikliničke anestezije, Institut za anesteziju i reanimaciju, Klinički centar Srbije, Beograd)
Milaković Branko (Odeljenje anestezije i intenzivne terapije, Institut za neurohirurgiju, Klinički centar Srbije, Beograd)
Davidović Lazar (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Vranić Ivana (Klinika za kardiologiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Simić Tijana (Odeljenje anestezije i intenzivne terapije, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Kovačević-Kostić Nataša (Odeljenje anestezije i intenzivne terapije, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Velinović Miloš (Odeljenje anestezije i intenzivne terapije, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Sinđelić Radomir (Odeljenje anestezije i intenzivne terapije, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

Introduction. When blood flow is decreased, as in prolonged hypovolaemia and hypotension, or in the course of transversal clamping of the aorta during aortic reconstruction, nutritive tissue perfusion can also fall below the critical level. Aim. The objective of this study was to analyse the effects of hypertonic-hyperoncotic solution on cardiovascular function during reconstruction of the abdominal aorta. Method. This prospective randomised study included 40 patients. All patients underwent surgery of the abdominal aorta under general endotracheal anaesthesia. Based on the type of solution infused from the time of clamping to the moment of the removal of the transversal aortic clamp, the patients were divided into two groups of 20. The study group was infused with a small volume of hypertonic-hyperoncotic solution, while the controls were administered infusions of isotonic solution. Patients with a preoperative creatinine level over 130 μmol L-1 and an ejection fraction of less than 40% were excluded from the study. Results. Cardiac output increased from 5.67±2.95 to 7.05±3.39 L min-1 in the study group, in comparison to the controls, where it increased from 4.98±2.06 to 5.99±3.02 L min-1 (p=0.004). Central venous pressure increased from 8.75±3.67 to 9.30±2.77 mm Hg in the study group, in comparison to the controls, where the values decreased from 6.84±2.73 to 6.45±2.50 mm Hg (p=0.022). Diastolic pulmonary artery pressure increased from 15.92±5.61 to 16.65±6.53 mm Hg in the study group, in comparison to the controls, where it decreased from 12.65±4.28 to 11.85±3.91 mm Hg (p=0.021). The amount of given crystalloids 24 hours after the removal of the aortic clamp totalled 2562.5±485.82 mL in the study group, versus 3350±727.29 mL in the control group (p=0.000). The amount of given human albumins 24 hours after the removal of the aortic clamp totalled 30±49.74 mL in the study group versus 100±4.34 mL in the control group (p=0.001). Conclusion. Haemodynamic stability of patients and adequate organ perfusion during surgery are achieved through the infusion of hypertonic-hyperoncotic solution, which maintains optimal values of: cardiac output, mixed venous oxygen saturation, and delivery of oxygen, while reducing alveolo-arterial oxygen difference. The balance of fluids, 24 hours after the removal of the aortic clamp, was maintained with the aid of hypertonic-hyperoncotic solution, while isotonic solution produced an excess of over 1000 mL of fluid in the control patients. Hypertonic-hyperoncotic solution increases cardiac output considerably more than does isotonic solution, and its application significantly reduces the accumulation of crystalloid solutions and human albumins.

Keywords: hypertonic saline, haemodynamics, abdominal aorta, dextran, intravascular volume