EFFECTS OF HYPERTONIC SALINE-HYPERONCOTIC HYDROXYETHYL STARCH INFUSION PRIOR TO CORONARY-ARTERY BYPASS-GRAFTING (CABG)

Objectives: To determine the efficacy and safety of intravascular volu me augmentation with a hypertonic saline-hyperoncotic HES solution pri or to CABG. Design: Randomized, double-blind, clinical trial. Patients : consecutive sample of 37 patients scheduled for elective CABG; mean age 64.5 (41-80; range) years and weight 74 (51-111) kg. Interventions : Continuous, central-venous infusion of either 250 ml (approx. 3.5 ml /kg) HES (0.9 % NaCl/10 % hydroxyethyl starch 200.000/0.5) or HT-HES ( 7,5 % NaCl/10 % hydroxyethyl starch 200.000/0.5) in 15 minutes, follow ing induction of anesthesia. Measurements and main results: Groups wer e similar with respect to age, weight, and sex. 15 min. after fluid lo ading, cardiac index, pulmonary artery pressure, and wedge pressure ha d increased from baseline in both groups (p < 0.05), with a greater in crease in the HT-HES-group (p < 0.05). In eight out of 18 patients, wh o had received HT-HES, transient drops in arterial blood pressure (mea n 20 % from baseline, range 10-35 %) were observed during the first 5 minutes of infusion. Seven of the HT-HES-group patients developed tran sient left ventricular failure, predominantly 5-20 min. after infusion . No incidence of initial hypotension or LVF was observed in the HES-g roup. Conclusions: In patients with coronary artery disease, volume au gmentation with hypertonic-hyperoncotic solutions may induce transient hypotension and post-infusion hypervolemic left heart failure.