Document Detail


Effect of 7.2% hypertonic saline/6% hetastarch on left ventricular contractility in anesthetized humans.
MedLine Citation:
PMID:  7540812     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although a positive inotropic effect of hypertonic saline has been demonstrated in isolated cardiac tissue as well as in animal preparations, no information exists about a possible positive inotropic action of hypertonic saline in humans. The aim of this investigation was to determine whether a clinically relevant positive inotropic effect can be demonstrated in humans. METHODS: Twenty-six patients without cardiovascular disease were randomized to receive 4 ml/kg of either 7.2% hypertonic saline/6% hetastarch or 6% hetastarch (control) at a rate of 1 ml.kg-1.min-1 while under general endotracheal anesthesia. Transesophageal echocardiography was used to evaluate left ventricular function. Arterial pressure, heart rate, and left ventricular end-systolic and end-diastolic diameter, area, and wall thickness were measured immediately before and after administration of either solution. Fractional area change, end-systolic wall stress, and the area under the end-systolic pressure-length relationship curve (ESPLRarea) were calculated. ESPLRarea was used to assess left ventricular contractility. RESULTS: Administration of hypertonic saline/hetastarch resulted in a significant decrease of mean arterial pressure and end-systolic wall stress from 77 +/- 14 (mean +/- SD) to 64 +/- 17 mmHg (P < 0.01) and from 52 +/- 14 to 32 +/- 11 10(3) dyne/cm2 (P > 0.01), respectively. End-diastolic area and fractional area change increased from 16.5 +/- 2.9 to 21.7 +/- 3.3 cm2 (P < 0.01) and from 0.53 +/- 0.07 to 0.70 +/- 0.06 (P < 0.01), respectively, whereas there was only a minor change of ESPLRarea from 38 +/- 13 to 44 +/- 13 mmHg.cm (P < 0.05). CONCLUSIONS: The apparent improvement of left ventricular systolic function in response to hypertonic saline/hetastarch is caused mainly by the combined effect of increased left ventricular preload and reduced left ventricular afterload. A possible positive inotropic action of hypertonic saline/hetastarch is not likely to be clinically relevant.
Authors:
A W Goertz; T Mehl; K H Lindner; M G Rockemann; U Schirmer; B Schwilk; M Georgieff
Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  82     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1995 Jun 
Date Detail:
Created Date:  1995-07-21     Completed Date:  1995-07-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1389-95     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, University of Ulm, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, General*
Female
Hetastarch / pharmacology
Humans
Male
Middle Aged
Myocardial Contraction / drug effects*
Saline Solution, Hypertonic / pharmacology*
Ventricular Function, Left / drug effects*
Chemical
Reg. No./Substance:
0/Saline Solution, Hypertonic; 9005-27-0/Hetastarch
Comments/Corrections
Comment In:
Anesthesiology. 1996 Feb;84(2):474-5   [PMID:  8602686 ]

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