ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
A comparison of the hemodynamic, metabolic, renal and hemostatic effects of the use of Ringer solution and adjuvant 6% hydroxyethyl starch 130/0.4 as a pump prime solution in coronary artery bypass grafting
Ertan Damar1, Murat Aksun1, Senem Girgin1, Tayfun Göktoğan2, Engin Yılmaz1, Gülçin Aran1, Atilla Şencan1, Ali Gürbüz2, Nagihan Karahan1
1İzmir Atatürk Eğitim ve Araştırma Hastanesi, 2. Anesteziyoloji ve Reanimasyon Kliniği, İzmir
2İzmir Atatürk Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İzmir
DOI : 10.5606/tgkdc.dergisi.2012.004
Background: In this study, we compared the hemodynamic, metabolic and renal effects and postoperative hemorrhagic complications of the use of Ringer solution and adjuvant 6% hydroxyethyl starch (HES) 130/0.4 as pump prime solution in coronary artery bypass grafting (CABG).

Methods: Sixty patients in class ASA I-II (range 20 to 80 years) who were scheduled to undergo elective CABG were included in the study. Patients were randomly divided into two subgroups, including those who were randomized to 1500 mL of Ringer solution alone (group 1) and those who were randomized to 1000 mL of Ringer solution plus 500 mL of 6% HES 130/0.4 (group 2). Twenty percent mannitol (200 mL) was also added into both groups.

Results: The ratio of the patients who were given dopamine and adrenalin during weaning from cardiopulmonary bypass (CPB) and at 24 hours after surgery was significantly higher in group 1, compared to group 2 (p<0.05). The ratio of the patients who were given dobutamine at 24 hours after surgery was significantly higher in group 1, compared to group 2 (p<0.05). The incidence of the use of crystalloids during CPB, weaning from CPB, and at 24 hours after surgery was also significantly higher in group 1, compared to group 2 (p<0.05). No difference was seen between the groups in terms of the use of blood products (p>0.05). There is no significant difference between the groups in terms of fluid balance after weaning from CPB and in postoperative 24th hour (p>0.05). No significant difference was also found in the postoperative bleeding rate, PT, INR, Na, K, urea, creatinine and pH value between the groups (p>0.05). Platelet counts at 6 and 24 hours after surgery were significantly higher in group 2, compared to group 1 (p<0.05). Lactate levels at 12 hours after surgery were significantly higher in group 1, compared to group 2 (p<0.05). Time to extubation and the duration of intensive care unit (ICU) stay were significantly prolonged in group 1 compared to group 2 (p<0.05).

Conclusion: We conclude that prime solution of HES 130/0.4 thanks to its low molecular weight and ability to substitute is promising in cardiac surgery, by reducing additional crystalloid use during CPB, exerting neutral effect on renal and bleeding function, decreasing demand for inotropic support and shortening time to extubation and duration of ICU stay.

Keywords : 6% HES 130/0.4; cardiac surgery; priming solutions
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