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CARDIOVASCULAR ANESTHESIA

Influence of Rate and Volume of Infusion on the Kinetics of 0.9% Saline and 7.5% Saline/6.0% Dextran 70 in Sheep

Lance P. Brauer, MD^*, Christer H. Svensén, MD PhD^*, Robert G. Hahn, MD PhD, Sadik Kilicturgay, MD^*, George C. Kramer, PhD^*, and Donald S. Prough, MD^*

*Department of Anesthesiology, University of Texas Medical Branch, Galveston; and Department of Anesthesiology and Intensive Care, Stockholm Söder Hospital and the Karolinska Institute, Sweden

Address correspondence and reprint requests to Donald S. Prough, MD, Department of Anesthesiology, Suite 2-A, John Sealy Annex, 301 University Blvd., Galveston, TX 77555–0591. Address e-mail to dsprough{at}utmb.edu

We examined whether volume kinetic variables obtained during infusion of a short bolus of 0.9% saline (NS) or 7.5% saline/6.0% dextran 70 (HSD) predict the dilution-time curve resulting from a 20-min infusion of the same fluid. Each of six conscious, splenectomized sheep (mean body weight, 36 ± 3 kg), on 4 different days, in a random order, received each of 4 IV boluses: NS at a rate of 1.2 mL · kg^-1 · min^-1 over 5 min or 20 min or 4.0 mL/kg of HSD over 2 min or 20 min. One, 2, and 3-volume kinetic models were fitted to the dilution of the arterial hemoglobin concentration and the urinary excretion as sampled during 180 min. The maximum dilution of arterial plasma at the end of the 5-min and 20-min infusions of NS was approximately 10% and 22%, respectively, and after the 2-min and 20-min infusions of HSD, maximum dilution was 24% and 21%, respectively. The median absolute performance error was virtually identical when the mean variable estimates from the 5-min infusion of NS were used to predict the individual dilution-time curves of the 5-min (mean, 0.027 dilution units) and 20-min (mean, 0.027) infusions and when the 2-min infusion of HSD was used to predict the dilution during the individual 2-min (mean, 0.050) and 20-min infusions (mean, 0.047). Computer simulations indicated that the difference at the end of infusion between the volume effects of NS and HSD is larger after longer infusions. We concluded that the volume kinetic variables obtained during a short infusion can be used to predict the outcome of a longer one, even if the longer infusion also delivers a larger volume.

IMPLICATIONS: Kinetic analysis of a short infusion of 7.5% saline/6% dextran or 0.9% saline accurately predicts the effects of a longer infusion of the same volume (7.5% saline/6% dextran) or of a larger volume (0.9% saline).

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