Document Detail

Evidence for myocardial defects under extreme acute normovolemic hemodilution with hydroxyethyl starch and lactated ringer's solution.
MedLine Citation:
PMID:  16205326     Owner:  NLM     Status:  MEDLINE    
Acute normovolemic hemodilution (ANH) has been proposed to avoid the risks of allogenic transfusion. In reference to its cellular effects, ANH reports in the literature are scarce. Using electron microscopy (EM), we evaluated the effects of ANH on cardiac function and myocardial structure. Twenty-five dogs were prospectively randomized to a control group (n = 5) or to undergo ANH with 6% hydroxyethyl starch (HES; n = 10) or lactated Ringer's solution (LR; n = 10) administered, respectively, at a ratio of 1:1 or 1:3 to the volume of blood removed. Animals were gradually hemodiluted to a hematocrit of 10%, which was accomplished in 80 min. Pulmonary artery catheter and echocardiography were used to evaluate cardiac function. Myocardial samples were taken after the last time point for electron microscopy analysis. Data were obtained during five different stages of ANH, with a mean 20-min interval between each time point. Cardiac index increased significantly in both groups during ANH. A significant decrease in oxygen delivery and oxygen consumption, as well as an increase in oxygen extraction was verified in the LR group. Echocardiography demonstrated a decline in systolic function in the LR group at the end of the experiment. Electron microscopy analysis of the myocardium revealed slight lesions in cardiac cells in the HES group, and moderate-to-significant lesions in the LR group. In this animal species, ANH with HES resulted in better preservation of cardiac function, which was demonstrated by maintenance of systolic function and oxygenation parameters. Minor loss of cellular integrity with HES, in the presence of very low levels of hemoglobin, reinforces these findings.
Adilson de Oliveira Fraga; Denise Tabacchi Fantoni; Denise Aya Otsuki; Carlos Augusto Pasqualucci; Maria Cristina Donadio Abduch; Jose Otavio Costa Auler Junior
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  24     ISSN:  1073-2322     ISO Abbreviation:  Shock     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-05     Completed Date:  2006-02-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  388-95     Citation Subset:  IM    
Department of Anesthesia, Heart Institute (Incor)-Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.
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MeSH Terms
Blood Transfusion / methods*
Body Weight
Hetastarch / pharmacology*
Isotonic Solutions / pharmacology*
Microscopy, Electron
Muscle Cells / pathology,  ultrastructure
Myocardium / pathology*
Oxygen / chemistry,  metabolism
Oxygen Consumption
Plasma Substitutes / chemistry
Spleen / pathology
Time Factors
Transplantation, Homologous / methods
Reg. No./Substance:
0/Isotonic Solutions; 0/Plasma Substitutes; 7782-44-7/Oxygen; 8022-63-7/Ringer's lactate; 9005-27-0/Hetastarch

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