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Related Experiment Videos

Hyperosmotic-hyperoncotic solutions during abdominal aortic aneurysm (AAA) resection

F Christ1, M Niklas, U Kreimeier

  • 1Department of Anesthesiology, Ludwig-Maximilians University Munich, Germany.

Acta Anaesthesiologica Scandinavica
|January 1, 1997
PubMed
Summary

Hyperosmotic-hyperonocotic solutions (HHS) reduce fluid requirements and improve hemodynamics during abdominal aortic aneurysm repair. This approach may prevent left ventricular failure and reduce patient morbidity.

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Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Positive perioperative fluid balance in abdominal aortic aneurysm (AAA) repair increases risk of left ventricular failure and morbidity.
  • Declamping shock is a significant concern during AAA repair, often necessitating substantial fluid administration.

Purpose of the Study:

  • To evaluate the efficacy of hyperosmotic-hyperonocotic solutions (HHS) in reducing perioperative fluid requirements during AAA repair.
  • To assess the safety and hemodynamic effects of HHS infusion during aortic clamping.
  • To determine if HHS prevents declamping shock and improves patient outcomes.

Main Methods:

  • Prospective study involving 12 patients receiving HHS (7.2% NaCl with Dextran or Hydroxyethylstarch) and 16 controls receiving standard crystalloids and HES.

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  • Invasive hemodynamic monitoring throughout the operation, with analysis of parameters relative to fluid loading during aortic clamping.
  • Assessment of plasma electrolytes, osmolality, pulmonary capillary wedge pressure, oxygen delivery, and systemic vascular resistance.

    • Main Results:

    • HHS infusion led to desired intravascular volume expansion, increased pulmonary capillary wedge pressure, and elevated oxygen delivery.
    • Systemic vascular resistance significantly decreased during clamping in the HHS group, unlike controls.
    • Patients receiving HHS had a significantly lower perioperative fluid balance (2471 ml) compared to controls (3387 ml).
    • One patient experienced an anaphylactoid reaction to HES; otherwise, HHS was well-tolerated with no observed adverse effects.

    Conclusions:

    • HHS infusion is effective in improving hemodynamic parameters and reducing fluid overload during AAA repair.
    • This approach offers a promising strategy for perioperative fluid management in AAA surgery, potentially decreasing edema formation and improving outcomes.
    • The beneficial microcirculatory effects of HHS may be particularly advantageous for high-risk surgical patients.