Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs

L. B. McDaniel, T. Nguyen, J. B. Zwischenberger, R. Vertrees, T. Uchida, George Kramer

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Children and adults who develop neurologic deficits after cardiac surgery may experience cerebral ischemia during cardiopulmonary bypass. Increased intracranial pressure (ICP) may contribute to cerebral ischemia during bypass. Hypertonic saline dextran (HSD), a hyperosmotic, hyperoncotic resuscitation solution, decreases ICP in trauma resuscitation. We hypothesized that HSD would decrease ICP, reduce brain water, and reduce intravascular fluid requirements during bypass. Twelve swine were divided into two bypass groups: Group 1 (ISO = isotonic) received as prime 1 L of lactated Ringer's solution and 500 mL of 6% hydroxyethyl starch. Group 2 (HSD = hypertonic saline/dextran) received as prime 1 L of lactated Ringer's solution, 500 mL of 6% hydroxyethyl starch, and 1 mL/kg of 24% hypertonic saline/25% dextran. Normothermic bypass was instituted at 100 mL · kg-1 · min-1. ICP increased significantly during bypass with ISO prime but not with HSD. Brain water in the cerebrum did not differ between groups but was reduced in the cerebellum to 75.9% ± 1.4%. We conclude that HSD prevented any significant increase in ICP during normothermic bypass, and substantially improved fluid balance during bypass. In cardiac surgery patients in whom maintaining decreased ICP and reducing isotonic fluid administration is important, HSD may be a useful addition to the bypass prime solution.

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalAnesthesia and Analgesia
Volume78
Issue number3
StatePublished - 1994

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dextran - saline drug combination
Intracranial Pressure
Cardiopulmonary Bypass
Swine
Brain Ischemia
Resuscitation
Starch
Thoracic Surgery
Intracranial Hypertension
Water-Electrolyte Balance
Water
Brain
Cerebrum
Neurologic Manifestations
Cerebellum

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

McDaniel, L. B., Nguyen, T., Zwischenberger, J. B., Vertrees, R., Uchida, T., & Kramer, G. (1994). Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs. Anesthesia and Analgesia, 78(3), 435-441.

Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs. / McDaniel, L. B.; Nguyen, T.; Zwischenberger, J. B.; Vertrees, R.; Uchida, T.; Kramer, George.

In: Anesthesia and Analgesia, Vol. 78, No. 3, 1994, p. 435-441.

Research output: Contribution to journalArticle

McDaniel, LB, Nguyen, T, Zwischenberger, JB, Vertrees, R, Uchida, T & Kramer, G 1994, 'Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs', Anesthesia and Analgesia, vol. 78, no. 3, pp. 435-441.
McDaniel, L. B. ; Nguyen, T. ; Zwischenberger, J. B. ; Vertrees, R. ; Uchida, T. ; Kramer, George. / Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs. In: Anesthesia and Analgesia. 1994 ; Vol. 78, No. 3. pp. 435-441.
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