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Osmolal excretion after open heart surgery.

D H Read, J M Manners

    Anaesthesia
    |November 1, 1983
    PubMed
    Summary

    Peri-operative fluid and solute balance in open heart surgery patients shows significant water and solute retention post-surgery. Despite diuresis, solute retention exceeded water retention, impacting patient recovery.

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    Area of Science:

    • Nephrology
    • Cardiovascular Surgery
    • Critical Care Medicine

    Background:

    • Peri-operative fluid and osmolal balance is crucial for patient outcomes.
    • Open heart surgery patients experience significant fluid shifts and hormonal changes.
    • Understanding water and solute handling is vital for managing surgical stress.

    Purpose of the Study:

    • To investigate water and osmolal balance during the peri-operative period in open heart surgery patients.
    • To quantify fluid and solute loads administered during cardiopulmonary bypass.
    • To characterize the pattern of water and solute excretion post-surgery.

    Main Methods:

    • Studied twenty unselected adult patients undergoing open heart surgery.
    • Measured urine and osmolal output on the day before surgery.
    • Utilized a haemodilution cardiopulmonary bypass technique.
    • Monitored fluid and solute balance in the immediate post-operative period.

    Main Results:

    • Pre-operative mean urine output was 1.13 L/sq m/24h and osmolal output was 430 mOs/sq m/24h.
    • Patients received 2.62 L/sq m and 792 mOs/sq m during surgery via cardiopulmonary bypass.
    • Post-operative assessment revealed a positive water and solute balance.
    • Solute retention exceeded water retention, even with significant diuresis.

    Conclusions:

    • Patients remain in positive fluid and solute balance on the day after open heart surgery.
    • Cardiopulmonary bypass contributes significantly to peri-operative fluid and solute overload.
    • Post-operative management should address both water and solute retention for optimal recovery.

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