Oxygen transport to tissue under normovolemic moderate and extreme hemodilution during coronary bypass operation

Oxygen transport to tissue was studied in 12 patients undergoing coronary bypass operation under normovolemic moderate and extreme hemodilution. Normovolemic moderate hemodilution (15 ml per kilogram of body weight), carried out immediately after induction of anesthesia, decreased the mean hematocrit from 0.43 to 0.33. Simultaneously, the cardiac index and the left ventricular filling pressure increased slightly but the systemic oxygen transport was reduced by 20%. The subcutaneous tissue oxygen tension (PO2) was approximately 40 mm Hg after induction of anesthesia and underwent a transient increase during moderate hemodilution. During cardiopulmonary bypass and extreme hemodilution, the mean hematocrit declined to 0.16. Concurrently, the mean tissue PO2 fell sharply and reached a minimum of 14 mm Hg at deepest hypothermia. After decannulation and reinfusion of autologous blood, the PO2 rose to 30 mm Hg. In general, total-body oxygen consumption changed along with tissue PO2. Blood lactate concentration underwent a clear increase in the early phase of extracorporeal circulation and remained rather stationary thereafter. No perioperative myocardial infarctions were encountered, and each patient made an uneventful recovery.