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CARDIOVASCULAR ANESTHESIA

The Dynamics of Vascular Volume and Fluid Shifts of Lactated Ringer’s Solution and Hypertonic-Saline-Dextran Solutions Infused in Normovolemic Sheep

Departments of Anesthesiology and Physiology, Resuscitation Research Laboratories, University of Texas, Medical Branch; and Shriners Burns Hospital, Galveston, Texas

Address correspondence to George C. Kramer, PhD, Resuscitation Research Laboratories, UTMB, Galveston, TX 77555-0801. Address reprint requests to Stein Tølløfsrud, MD, PhD, Department of Anesthesiology, Rikshospitalet, Sognsvannsveien 20, N-0027 Oslo, Norway.

Infusions of hyperosmotic-hyperoncotic solutions such as hypertonic saline dextran (HSD) are used in Europe for resuscitation of traumatic shock and perioperative volume support as an adjunct to conventional isotonic crystalloids. Whereas plasma volume expansion of HSD has been measured at single time points after the intravascular volume expansion, the detailed time course of fluid shifts during and after infusions have not been reported. We compared the time course of volume expansion during and after 30-min infusions of 4 mL/kg HSD and 25 mL/kg lactated Ringer’s solution (LR) in normovolemic conscious splenectomized sheep. Peak plasma volume (Evans blue and hemoglobin dilution) expansion was similar for HSD (7.8 ± 0.9 mL/kg) and the larger sixfold volume of LR (7.2 ± 0.5 mL/kg). However, 30 min after the 30-min infusion (T60), plasma expansion remained larger after HSD (5.1 ± 0.9 mL/kg) than after LR (1.7 ± 0.6 mL/kg). Both solutions caused an equivalent diuresis. Intravascular volume expansion efficiency (VEE), defined as milliliter plasma expansion/milliliter fluid infused at 0 (T30), 30 (T60), and 60 (T90) min after infusion ended was 1.8, 1.3, and 0.8, respectively for HSD, whereas LR provided a VEE of only 0.27, 0.07, and 0.07. The relative expansion efficiency of HSD versus LR, calculated as the ratio (VEE_HSD/VEE_LR), was 7-fold that of LR at the end of infusion T30, and 20-fold at T60, but decreased to 9-fold by T120. Intravascular volume dynamic studies of different volume expanders in animals and patients may provide anesthesiologists with a new tool for monitoring the effectiveness of fluid therapy.

IMPLICATIONS: Hypertonic saline dextran (HSD) is a new plasma expander recently approved for clinical use in Europe. We compared the plasma volume expansion of HSD versus lactated Ringers (LR) in normovolemic sheep. After a 30 min infusion, HSD was 7 times as effective at expanding volume as an equal volume of LR, but for the next 90 minutes the relative effectiveness of HSD increased to 10-20 times.

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