Hypertonic saline and dextran after coronary artery surgery mobilises fluid excess and improves cardiorespiratory functions

Background: Extracorporeal circulation induces increased capillary permeability with fluid leakage into the interstitial space, resulting in positive fluid balance and intravascular hypovolaemia. Hypertonic saline 75 mg.ml(-1) in dextran 70, 60 mg.ml(-1) (HSD) seems to be of benefit in patients with impaired perfusion. The purpose of the study was to investigate the effects of HSD infusion on fluid balance and cardiorespiratory functions just after the end of cardiac surgery. Material and methods: Twenty patients with 3-vessel coronary artery disease undergoing elective coronary artery bypass surgery were studied. A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. The patients were allocated to receive just after the end of surgery either HSD or isotonic saline (4 ml.kg(-1) during 30 min) at random in a double-blind single infusion. Ringer's acetate solution was added as needed to stabilise haemodynamics postoperatively. Results: HSD caused mobilisation of the retained intraoperative fluid excess, and increased diuresis. Despite reduced need for extra fluid and a decreased cumulative fluid balance, after HSD infusion patients had increased filling pressures of the heart and improved cardiac output. HSD infusion also induced reduced intrapulmonary venous admixture and improved PaO2 in the early postoperative period. Conclusions: The present study documents that infused hypertonic saline with dextran just after the end of cardiac surgery resulted in mobilisation of the intraoperative fluid excess with increased urine output in the early postoperative period and improved gas exchange. Despite reduced need for extra i.v. fluid and decreased cumulative fluid balance, after HSD infusion the patients had increased filling pressures of the heart with improved cardiac output. (C) Acta Anaesthesiologica Scandinavica 42 (1998).