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Ann Thorac Surg 1991;51:610-615
© 1991 The Society of Thoracic Surgeons

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Articles

Cardiorespiratory responses to hypertonic saline solution in cardiac operations

Department of Anesthesiology and Intensive Care Medicine and Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Giessen, Germany

Accepted for publication December 17, 1990.

^_* Address reprint requests to Dr Boldt, Department of Anesthesiology and Intensive Care Medicine, Klinikstr 29, Justus-Liebig-University Giessen, D-6300 Giessen, Germany.

Infusion of small volumes of hypertonic saline solution (HS) seems to be of benefit in patients with impaired perfusion. The cardiorespiratory response to a 7.2% NaCl solution prepared in hydroxyethylstarch (HES) solution was investigated prospectively in patients undergoing prolonged cardiopulmonary bypass (CPB) (HS-HES group; n = 15); 6% HES 200/0.5 solution was infused in a control group (HES group; n = 15). Volume was given preoperatively to double low pulmonary artery occlusion pressure (< 4 mm Hg) within 20 minutes. Hemodynamics, oxygen transport variables, and pulmonary gas exchange were studied before and after infusion as well as before and after CPB. Significantly less HS-HES solution (3.06 ± 0.2 ml/kg) than 6% HES 200/0.5 solution (10.3 ± 0.9 mL/kg) was necessary to double baseline pulmonary artery occlusion pressure. Fluid balance during CPB was negative in the HS-HES patients (–0.05 mL/kg · min CPB) and was lowest in this group even 5 hours after CPB. Mean arterial pressure, pulmonary arterial pressure, and heart rate were without differences between the groups. Changes in cardiac index (+40%) and total systemic resistance (–25%) were significantly most pronounced in the HS-HES patients, continuing even until the end of operation. Pulmonary gas exchange (arterial oxygen tension, intrapulmonary right-to-left shunting) was least compromised in these patients, particularly after bypass. Oxygen consumption was without difference between the groups; oxygen delivery increased significantly more in the HS-HES patients due to the larger increase in cardiac output. It can be concluded that preoperative infusion of the new HS-HES solution was of advantage for our patients: hemodynamics were improved significantly, fluid requirement during CPB was reduced, and pulmonary gas exchange was less compromised after CPB in these patients. Thus, hypertonic solutions might offer a valuable aspect for volume replacement in cardiac surgery patients.

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