|
Sign In to gain access to subscriptions and/or personal tools.
|
Changing the priming solution from Ringer’s to Hartmann’s solution is associated with less metabolic acidosis during cardiopulmonary bypass
RP Alston
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
C Theodosiou
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
K Sanger
Cardiothoracic Surgery Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
Background and objective: Previously, it was noted that changing the solutions used for priming and intravascular volume replacement from Hartmann’s to Ringer’s resulted in a more profound metabolic acidosis developing during cardiopulmonary bypass (CPB). The aim of this study was to examine the effects of changing the solutions back to Hartmann’s on metabolic acidosis that develops during CPB in patients undergoing heart surgery. Methods: Two groups of patients were studied sequentially: the first received Ringer’s (n = 63) and the second Hartmann’s solution (n = 66). Arterial blood samples were taken before induction of anaesthesia and towards the end of CPB. Samples were analysed in a blood gas analyser. Results: Hydrogen ion concentration increased from 38 (4) to 41 (7) mm/L in the Ringer’s group, but decreased from 38 (5) to 36 (6) mmol L-1 in the Hartmann’s group. Changes in PaCO2 (0.77, p < 0.001) and volume of fluid administered (r = 0.23, p < 0.01) were significant univariate correlates of change in hydrogen ion concentration, but haemoglobin concentration was not (r < 0.01, p = 0.97). Analysis of variance for repeated measures found significant between subject effects on the change in hydrogen ion concentration during CPB caused by the choice of intravascular solution used (p < 0.001) and PaCO2 (p = 0.001), but not as a result of the volume of solution administered (p > 0.10). Conclusions: Changing the solutions used for priming and intravascular volume replacement from Ringer’s to Hartmann’s was associated with a reduction in metabolic acidosis that developed during CPB.
Key Words: Bypass • Cardiopulmonary • Isotonic solutions • Ringer’s lactate • Ringer’s solution: acid-base imbalance • acidosis
References
- 1 Millar SAAlston RPSouter MJAndrews PJD. Aerobic, anaerobic and combination estimates of cerebral hypoperfusion during and after cardiac surgery. Br J Anaesth 1999; 81: 936–939.
- 2 Alston RPCormack LCollinson C. Metabolic acidosis developing during cardiopulmonary bypass is related to a decrease in strong ion difference. Perfusion 2004; 19: 145–152.[Abstract/Free Full Text]
- 3 Liskaser FJBellomo RHayhoe M. Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis. Anesthesiol 2000; 93: 1170–1173.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 4 Himpe DNeels HDe Hert SVan Cauwelaert P. Adding lactate to the prime solution during hypothermic cardiopulmonary bypass: a quantitative acid-base analysis. Br J Anaesth 2003; 90: 440–445.[Abstract/Free Full Text]
- 5 Hayhoe MBellomo RLiu G. The aetiology and pathogenesis of cardiopulmonary bypass-associated metabolic acidosis using polygeline pump prime. Intensive Care Med 1999; 25: 680–685.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 6 Stewart PA;. How to understand acid-base: a quantitative acid-base primer for biology and medicine. Elsevier North Holland 1981.
- 7 Millar SAAlston RPAndrews PJSouter MJ. Cerebral hypoperfusion in the immediate postoperative period following coronary artery bypass grafting, heart valve and abdominal aortic surgery. Br J Anaesth 2001; 87: 229–236.[Abstract/Free Full Text]
- 8 Williams ELHildebrand KLMcCormick SABedel MJ. The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers.[Comment]. Anesth Analg 1999; 88: 999–1003.[Abstract/Free Full Text]
- 9 McFarlane CLee A. A comparison of Plasmalyte 148 and 0.9% saline for intra-operative fluid replacement. Anaesthesia 1994; 49: 779–781.[Web of Science][Medline]
[Order article via Infotrieve]
- 10 Story DA. Hyperchloraemic acidosis: another misnomer? Crit Care Resusc 2004; 6: 188–192.[Medline]
[Order article via Infotrieve]
- 11 Lilley A. The selection of priming fluids for cardiopulmonary bypass in the UK and Ireland. Perfusion 2002; 17: 315–319.[Abstract/Free Full Text]
- 12 Ryan TBalding JMcGovern EM. Lactic acidosis after cardiac surgery is associated with polymorphisms in tumor necrosis factor and interleukin 10 genes. Ann Thorac Surg 2002 Jun; 73: 1905–1909; discussion 1910–1911.[Abstract/Free Full Text]
- 13 Rehm MFinsterer U. Treating intraoperative hyperchloremic acidosis with sodium bicarbonate or tris-hydroxymethyl aminomethane: a randomized prospective study. Anesth Analg 2003; 96: 1201–1208.[Abstract/Free Full Text]
Perfusion, Vol. 22, No. 6,
385-389 (2007)
DOI: 10.1177/0267659108089142
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
|
|
