Anesth Pain Med.  2017 Jan;12(1):15-22. 10.17085/apm.2017.12.1.15.

Does acute normovolemic hemodilution affect intraoperative value of serum-creatinine concentration in patients undergoing cardiac surgery

• Hong SW
• Lee DK
• Lee JY
• Shin SH
• Chon JY
• Kim TY

• KMID: 2369660
• DOI: http://doi.org/10.17085/apm.2017.12.1.15

Abstract

BACKGROUND
The possible impact of hemodilution during acute normovolemic hemodilution (ANH) using hydroxyethyl starch (HES) on intraoperative serum concentration of creatinine (s-Cr) has not been well investigated.
METHODS
Patients undergoing cardiac surgery were randomly allocated into Group-ANH (n = 15) or Group-C (control; n = 17). In Group-ANH, 5 ml/kg whole blood was collected, and they were administered 5 ml/kg of HES 130/0.4 after anesthesia induction and before initiating cardiopulmonary bypass (CPB). In both groups, moderate hypothermic CPB was initiated using 1,600-1,800 ml of bloodless priming solution. The changes of s-Cr, blood urea nitrogen, hematocrit (Hct), electrolytes, and osmolality were determined before ANH administration (T1), after administering ANH 5 ml/kg (T2), 30 and 60 s after the initiation of CPB (T3, T4), and at the end of surgery (T5).
RESULTS
In Group-ANH, the s-Cr values at T2 (median [IQR25-75%], 0.83 [0.71-1.00] mg/dl) were not significantly different compared to those at T1 (0.84 [0.64-1.00] mg/dl), while those at T3 and T4 (0.68 [0.61-0.80] and 0.76 [0.59-0.92] mg/dl, respectively) were significantly lower than those at T2 (0.83 [0.71-1.00] mg/dl, P < 0.001). Hct at T3, T4 and T5 were significantly lower than those of T1 in both groups, and those at T2 and T4 of Group-ANH were significantly lower than those of Group-C (P < 0.001). There was no significant inter-group difference in all other parameters.
CONCLUSIONS
Intraoperative s-Cr was not affected by the administration of ANH 5 ml/kg, although it reduced transiently at the beginning of CPB. Further study is needed to determine the clinical relevancy of our results.

Keyword

Acute normovolemic hemodilution; Creatinine; Hemodilution

MeSH Terms

Anesthesia
Blood Urea Nitrogen
Cardiopulmonary Bypass
Creatinine
Electrolytes
Hematocrit
Hemodilution*
Humans
Osmolar Concentration
Starch
Thoracic Surgery*
Creatinine
Electrolytes
Starch

Figure

• 

  Fig. 1 Scheme of patient recruitment. Group-C: patients in control group, Group-ANH: patients underwent ANH. ANH: acute normovolemic hemodilution, Preop: preoperative, Intraop: intraoperative, Hct: hematocrit, SvO2: mixed venous O2 saturation, CO: cardiac output.

• 

  Fig. 2 Changes in s-Cr. Box represents median (Q1-Q3) and whiskers represents maximum and minimum values inside fence. Upper fence is Q3 + 1.5 × (Q3-Q1) and lower fence is Q1 - (Q3-Q1). Dot tepresents outlier otude fence. Group-C: patients in control group, Group-ANH: patients underwent ANH. ANH: acute normovolemic hemodilution, s-Cr: serum creatinine, BUN: blood urea nitrogen, Hct: hematocrit. T1: before ANH, T2: after ANH of 5 ml/kg or before the initiation of cardiopulmonary bypass (CPB), T3 and T4: 30 and 60 seconds after the initiation of CPB, T5: at the end of surgery. *P < 0.05 vs. T2, †P < 0.05 vs. T3, ‡P < 0.05 vs. T4.

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