Document Detail


Oxygen consumption and cardiovascular function in children during profound intraoperative normovolemic hemodilution.
MedLine Citation:
PMID:  7818103     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The clinically acceptable limit of acute normovolemic, normothermic hemodilution, a standard procedure in scoliosis surgery, is not yet well defined. Eight ASA class I patients undergoing idiopathic scoliosis correction were administered a standard anesthetic with 100% oxygen and controlled ventilation. Hemodilution was accomplished by exchanging whole blood for 5% albumin in 0.9% saline. Blood gases, acid-base status, and circulatory variables were recorded prior to and after hemodilution, and every 30 min throughout surgery. The impact of hemodilution was judged by mixed venous oxygen saturation which was maintained at > or = 60%, while intravascular volume was maintained with the 5% albumin solution. Reinfusion of the autologous blood was completed by the end of surgery. In the eight controlled cases in which normovolemic hemodilution was studied, hemoglobin levels decreased from 10.0 +/- 1.6 g/dL to 3.0 +/- 0.8 g/dL. Mixed venous oxygen saturation decreased from 90.8% +/- 5.4% to 72.3% +/- 7.8%. Oxygen extraction ratio increased from 17.3% +/- 6.2% to 44.4% +/- 5.9%. Oxygen delivery decreased from 532.1 +/- 138.1 mL.min-1.m-2 to 260.2 +/- 57.1 mL.min-1.m-2, while global oxygen consumption did not decrease and plasma lactate did not appreciably increase. Central venous pressure increased and peripheral resistance decreased during hemodilution. Cardiac index increased, heart rate remained essentially constant, and left ventricular stroke work index did not decrease significantly. No patients suffered clinically adverse outcomes. Global oxygen transport and myocardial work can be maintained at extreme normovolemic anemia. Our evidence suggests that stages of normovolemic hemodilution more severe than previously reported may be clinically acceptable for young, healthy patients during normocarbic anesthesia.
Authors:
J L Fontana; L Welborn; P D Mongan; P Sturm; G Martin; R Bünger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  80     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1995 Feb 
Date Detail:
Created Date:  1995-02-09     Completed Date:  1995-02-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  219-25     Citation Subset:  AIM; IM    
Affiliation:
Children's National Medical Center, Washington, DC.
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MeSH Terms
Descriptor/Qualifier:
Adaptation, Physiological / physiology*
Adolescent
Blood Volume / physiology
Child
Female
Hematocrit
Hemodilution / methods*
Hemodynamics / physiology*
Hemoglobins / analysis*
Humans
Intraoperative Period
Male
Oxygen / blood
Oxygen Consumption / physiology*
Scoliosis / blood,  physiopathology,  surgery*
Time Factors
Chemical
Reg. No./Substance:
0/Hemoglobins; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Anesth Analg. 1995 Dec;81(6):1313-4   [PMID:  7486132 ]
Anesth Analg. 1995 Feb;80(2):217-8   [PMID:  7818102 ]
Anesth Analg. 1995 Nov;81(5):1115-6   [PMID:  7486068 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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