Acute preoperative hemodilution in surgical patients.
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Biomedical subjects
Publications and source records attributed to F Jesch.
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Total body wash out (hct less than 1%) with circulatory arrest of 30 to 60 minutes in deep hypothermia (esoph.temp. at 14 degrees C) was performed in 17 mongrel dogs by exchange against modified Ringer's Lactat-Solution. During rewarming the pump fluid was partly replaced by homologous packed red cells for readjustment of the hematocrit. After perfusion with a colloidfree perfusate all animals died under signs of massive interstitial edema. 8 out of 13 animals were long term survivors after exchange perfusion with colloid containing perfusate (dextran 60, 25 g/1). It has been demonstrated that a sanguineous circulatory arrest in deep hypothermia can be tolerated for 30 to 60 minutes if the formation of interstitial edema is prevented by use of an oncotically active perfusate.
In 20 patients undergoing open-heart surgery, 2,3-diphosphoglycerate (2,3-DPG) concentrations, oxygen affinity of hemoglobin (Po2 at half saturation of hemoglobin with oxygen [P50]), hemoglobin concentration, and pH were measured repeatedly. Measurements were made before and at various times after open-heart surgery and replacement of blood loss with blood stored in acid-citrate-dextrose (ACD) or citrate-phosphate-dextrose (CPD) solutions for less than 72 hours (10 cases per group). Infusion of ACD blood caused P50 and 2,3-DPG concentration to decrease significantly after the operation. The infusion of blood stored in CPD did not significantly increase the oxygen affinity. No significant changes in hemoglobin concentration or pH were observed immediately after the operation in either group. To compensate for the increased oxygen affinity, there must be a rise in cardiac output or more likely a decrease in venous Po2. The transfusion of CPD blood, therefore, is more favorable in terms of oxygen supply, particularly in patients who have had cardiac surgery.
Isovolaemic haemodilution to a hematocrit of 10% was achieved by stepwise exchange of blood against 6% hydroxyethyl starch (HES) in 11 splenectomized dogs. All animals survived the actuely performed extreme haemodilution; one animal died 5 days later due to massive bilateral pneumonia. Blood volume as determined by 51Cr-tagged red cells was unchanged at hematocrit 10%; 2 and 5 hours after reaching the minimum haematocrit, blood volume was reduced by 7 and 15% of control. At day 3 after dilution, blood volume was normal again. Thus under conditions of extreme isovolaemic haemodilution the volume effect of hydroxyethyl starch was found inferior to that of dextran 60. Haemodilution with HES was associated with a presistent augmentation of the serum concentration alpha-amylase.