Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (4): 287-392 ➤ Инфузионные растворы, применяемые при операциях аортокоронарного шунтирования без искусственного кровообращения

Infusion solutions used in off-pump coronary artery bypass

Authors: Khinchagov D.Ya., Rybka M.M., Mumladze K.V., Solovyov N.A., Yudin G.V., Ibragimov R.M., Aidashev Yu.Yu.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-4-361-371

UDC: 616.12-005.4-036.12-089.86:615.451.232

Link: Clinical Physiology of Blood Circulaiton. 2022; 4 (19): 361-371

Quote as: Khinchagov D.Ya., Rybka M.M., Mumladze K.V., Solovyov N.A., Yudin G.V., Ibragimov R.M., Aidashev Yu.Yu. Infusion solutions used in off-pump coronary artery bypass. Clinical Physiology of Circulation. 2022; 19 (4): 361–71 (in Russ.). DOI: 10.24022/1814-6910-2022-19-4-361-371

Keywords:  off-pump coronary artery bypass (OPCAB) infusion solutions

Received / Accepted:  19.11.2022 / 24.12.2022

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Abstract

Objective. To compare infusion therapy with crystalloids and/or their combinations with colloid solutions during the intraoperative period, fluid balance and oxygenating lung function.

Material and methods. Single-center retrospective study including 388 patients with off-pump coronary artery bypass (OPCAB) operated between 2017 and 2018. All patients were divided into 3 groups depending on the infusion solutions used intraoperatively: group 1 with crystalloid-based infusion therapy (CIT) – 197 patients, group 2 with infusion therapy using crystalloids and albumin (AIT) – 47 patients, group 3 with infusion therapy using crystalloids and gelatin (GIT) – 144 patients. A comparison was made of oxygenating lung function, blood lactate concentration, biochemical parameters, mechanical ventilation duration, cardiotonic support, and intraoperative balance.

Results. According to the results of our study, the intraoperative balance in the CIT group was 1358 ± 619 ml, in the AIT group – 1000 (750; 1500) ml, and in the GIT group – 1600 (1063; 2100), which did not reveal significant differences between the CIT and AIT groups, but the CIT and AIT groups were statistically significantly different from the GIT group. By the end of the operation on vasopressor support – doses of norepinephrine, the groups did not differ, despite the use of albumin and gelofusin, which have the effect of increasing plasma volume. The values of partial pressure of arterial blood with oxygen (PaO2) in the postoperative period did not differ significantly in the groups: CIT – 316 (255; 383) mm Hg, AIT – 285.3 ± 91.2 mm Hg, GIT – 310 (253; 355) mm Hg. In the intergroup comparison, no statistically significant difference in the duration of mechanical ventilation (h) was obtained: CIT – 6 (4; 9), AIT – 5 (4; 7) and GIT – 6 (4; 9). Lactate values (mmol/l) by the time of the skin suture were within the acceptable range: KIT – 1.4 (1.1; 1.8), AIT-1.6 (1.2; 2.0) and GIT – 1.5 (1.1; 2.1).

Conclusion. Infusion solutions (crystalloid solutions, albumin and gelatin solutions) used in OPCAB, against the background of minimal blood loss, do not adversely affect the patient's condition, oxygenating lung function and the duration of mechanical ventilation.

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****
  1. Miller T.E., Myles P.S. Perioperative fluid therapy for major surgery. Anesthesiology. 2019; 130: 825–32. DOI: 10.1097/ALN.0000000000002603
  2. Malbrain M.L.N.G., Langer T., Annane D., Gattinoni L., Elbers P., Hahn R.G. et al. Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Ann. Intensive Care. 2020; 10: 64. DOI: 10.1186/s13613-020-00679-3
  3. Mitra S., Khandelwal P. Are all colloids same? How to select the right colloid? Indian Journal of Anaesthesia. 2009; 53: 592–607. PMID: 20640110; PMCID: PMC2900092.
  4. Joshi G.P. Intraoperative fluid management. UpToDate. Feb 03.2020.
  5. Черний В.И. Роль и место альбумина в современной инфузионно-трансфузионной терапии. Медицина неотложных состояний. 2017; 1 (80): 23–31. Cherniy V.I. The role and place of albumin in modern infusion-transfusion therapy. Emergency medicine. 2017; 1 (80): 23–31 (in Russ.).
  6. Romagnoli S., Rizza A., Ricci Z. Fluid status assessment and management during the perioperative phase in adult cardiac surgery patients. J. Cardiothorac. Vasc. Anesth. 2016; 30 (4): 1076–84. DOI: 10.1053/j.jvca. 2015.11.008
  7. Feldheiser A., Pavlova V., Bonomo T., Jones A., Fotopoulou C., Sehouli J. et al. Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm. Br. J. Anaesth. 2013; 110 (2): 231–40. DOI: 10.1093/bja/aes377
  8. Lobo D.N., Stanga Z., Aloysius M.M., Wicks C., Nunes Q.M., Ingram K.L. et al. Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Critical care medicine. 2010; 38 (2): 464–70. DOI: 10.1097/CCM.0b013e3181bc80f1
  9. Yates D.R., Davies S.J., Milner H.E., Wilson R.J. Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery. Br. J. Anaesth. 2014; 112 (2): 281–9. DOI: 10.1093/bja/aet307
  10. Dubois M.J., Vincent J.L. Colloid fluids. In: Hahn R.G., Prough D.S., Svensen C.H. (ed.). Perioperative Fluid Therapy. 1st edition. New York: Wiley; 2007.
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  14. Farooque S., Kenny M., Marshall S.D. Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. Anaesthesia. 2019; 74 (2): 174–9. DOI: 10.1111/anae.14497
  15. Wigmore G.J., Anstey J.R., St John A., Greaney J., Morales-Codina M., Presneill J.J. et al. 20% Human albumin solution fluid bolus administration therapy in patients after cardiac surgery (the HAS FLAIR Study). J. Cardiothorac. Vasc. Anesth. 2019; 33 (11): 2920–7. DOI: 10.1053/j.jvca.2019.03.049
  16. Lewis S.R., Pritchard M.W., Evans D.J., Butler A.R., Alderson P., Smith A.F., Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database Syst. Rev. 2018; 3; 8 (8): CD000567. DOI: 10.1002/14651858.CD000567.pub7 17.
  17. Milford E.M., Reade M.C. Resuscitation fluid choices to preserve the endothelial glycocalyx. Crit. Care. 2019; 23: 77. DOI: 10.1186/s13054-019-2369-x
  18. Moodley S. OPCAB the secrets of the beating heart. University of KwaZulu-Natal, Durban; 2015.
  19. Joosten A., Delaporte A., Ickx B., Touihri K., Stany I., Barvais L. et al. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: a randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology. 2018; 128: 55. DOI: 10.1097/ALN.0000000000001936
  20. Joosten A., Delaporte A., Mortier J., Ickx B., Van Obbergh L., Vincent J.L. et al. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery. Anesthesiology. 2019; 130: 227. DOI: 10.1097/ALN.0000000000002501
  21. Kabon B., Sessler D.I., Kurz A. Crystalloid–Colloid Study Team. Effect of intraoperative goal-directed balanced crystalloid versus colloid administration on major postoperative morbidity: a randomized trial. Anesthesiology. 2019; 130: 728. DOI: 10.1097/ALN.0000000000002601
  22. Hanley C., Callum J., Karkouti K., Bartoszko J. Albumin in adult cardiac surgery: a narrative review. Can. J. Anaesth. 2021; 68 (8): 1197–213. DOI: 10.1007/s12630-021-01991-7
  23. Laine G.A., Hu B.Y., Wang S., Thomas Solis R., Reul G.J. Jr. Isolated high lactate or low central venous oxygen saturation after cardiac surgery and association with outcome. J. Cardiothorac. Vasc. Anesth. 2013; 27 (6): 1271–6. DOI: 10.1053/j.jvca.2013.02.031
  24. Hu B.Y., Laine G.A., Wang S., Solis R.T. Combined central venous oxygen saturation and lactate as markers of occult hypoperfusion and outcome following cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2012; 26 (1): 52–7. DOI: 10.1053/j.jvca.2011.07.021
  25. American Diabetes Association 15. Diabetes care in the hospital: standards of medical care in diabetes-2020. Diabetes Care. 2020; 43: 193–202. DOI: 10.2337/dc20-S015
  26. Kim S., Park J., Kim H., Yang K., Choi J.H., Kim K. et al. Intraoperative hyperglycemia may be associated with an increased risk of myocardial injury after noncardiac surgery in diabetic patients. J. Clin. Med. 2021; 10 (22): 5219. DOI: 10.3390/jcm10225219
  27. Muller L., Lefrant J. Metabolic effects of plasma expanders. Transfusion Alternatives in Transfusion Medicine. 2010; 11 (3): 10–21. DOI: 10.1111/j.1778-428X.2010.01137.x

About Authors

  • Dzhumber Ya. Khinchagov, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology and Intensive Care Unit; ORCID
  • Koba V. Mumladze, Anesthesiologist-Intensivist; ORCID
  • Nycolay A. Solovyov, Anesthesiologist-Intensivist; ORCID
  • Gennady V. Yudin, Cand. Med. Sci., Head of the Department of Resuscitation and Intensive Care; ORCID
  • Rustam M. Ibragimov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Yuris Yu. Aidashev, Anesthesiologist-Intensivist; ORCID

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