Isoflurane but not mechanical ventilation promotes extravascular fluid accumulation during crystalloid volume loading

Cara M. Connolly, George C. Kramer, Robert G. Hahn, Neil F. Chaisson, Christer H. Svensén, Robert A. Kirschner, Dennis A. Hastings, David L. Chinkes, Donald S. Prough

    Research output: Contribution to journalArticle

    56 Citations (Scopus)

    Abstract

    Background: The combination of isoflurane anesthesia and mechanical ventilation reduces urinary output and promotes redistribution of a crystalloid bolus into the extravascular space. The authors hypothesized that mechanical ventilation rather than isoflurane causes this alteration. Methods: The fate of a 25-ml/kg, 20-min, 0.9% saline fluid bolus was studied in four different experiments per sheep: while conscious and spontaneously ventilating (CSV), while conscious and mechanically ventilated (CMV), while anesthetized with isoflurane and mechanical ventilated (ISOMV), and while anesthetized with isoflurane and spontaneously ventilating (ISOSV). Results: By calculations based on the indicator dilution and mass balance principles, plasma expansion was similar between protocols. Isoflurane but not mechanical ventilation reduced urinary output and increased interstitial fluid volume (P < 0.001): At 180 min, mean total urinary outputs were 15.6 ± 2.1 and 15.9 ± 2.9 ml/kg in the CSV and CMV protocols and 2.7 ± 0.6 and 3.1 ± 1.1 ml/kg in the ISOSV and ISOMV protocols, respectively. The net changes in extravascular volume, assumed to be interstitial fluid volume, were 8.6 ± 3.3 and 8.1 ± 3.1 ml/kg, and 22.5 ± 1.5 and 22.1 ± 1.6 ml/kg in the corresponding protocols. Volume kinetic analysis demonstrated extravascular fluid accumulation associated with isoflurane anesthesia similar to the calculated interstitial accumulation of 20.2 ± 0.5 and 26.5 ± 0.3 ml/kg in the ISOSV and ISOMV protocols, respectively. Conclusion: Isoflurane, but not mechanical ventilation, decreased urinary excretion and increased interstitial fluid volume. Volume kinetic analysis indicated "third-space" losses due to isoflurane. Perioperative fluid retention may be associated not only with surgical tissue manipulation, but with anesthesia per se.

    Original languageEnglish
    Pages (from-to)670-681
    Number of pages12
    JournalAnesthesiology
    Volume98
    Issue number3
    DOIs
    StatePublished - Mar 1 2003

    Fingerprint

    Isoflurane
    Artificial Respiration
    Extracellular Fluid
    Anesthesia
    crystalloid solutions
    Sheep

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine

    Cite this

    Isoflurane but not mechanical ventilation promotes extravascular fluid accumulation during crystalloid volume loading. / Connolly, Cara M.; Kramer, George C.; Hahn, Robert G.; Chaisson, Neil F.; Svensén, Christer H.; Kirschner, Robert A.; Hastings, Dennis A.; Chinkes, David L.; Prough, Donald S.

    In: Anesthesiology, Vol. 98, No. 3, 01.03.2003, p. 670-681.

    Research output: Contribution to journalArticle

    Connolly, Cara M. ; Kramer, George C. ; Hahn, Robert G. ; Chaisson, Neil F. ; Svensén, Christer H. ; Kirschner, Robert A. ; Hastings, Dennis A. ; Chinkes, David L. ; Prough, Donald S. / Isoflurane but not mechanical ventilation promotes extravascular fluid accumulation during crystalloid volume loading. In: Anesthesiology. 2003 ; Vol. 98, No. 3. pp. 670-681.
    @article{edd83ed4135e459db2b142e8755d32a0,
    title = "Isoflurane but not mechanical ventilation promotes extravascular fluid accumulation during crystalloid volume loading",
    abstract = "Background: The combination of isoflurane anesthesia and mechanical ventilation reduces urinary output and promotes redistribution of a crystalloid bolus into the extravascular space. The authors hypothesized that mechanical ventilation rather than isoflurane causes this alteration. Methods: The fate of a 25-ml/kg, 20-min, 0.9{\%} saline fluid bolus was studied in four different experiments per sheep: while conscious and spontaneously ventilating (CSV), while conscious and mechanically ventilated (CMV), while anesthetized with isoflurane and mechanical ventilated (ISOMV), and while anesthetized with isoflurane and spontaneously ventilating (ISOSV). Results: By calculations based on the indicator dilution and mass balance principles, plasma expansion was similar between protocols. Isoflurane but not mechanical ventilation reduced urinary output and increased interstitial fluid volume (P < 0.001): At 180 min, mean total urinary outputs were 15.6 ± 2.1 and 15.9 ± 2.9 ml/kg in the CSV and CMV protocols and 2.7 ± 0.6 and 3.1 ± 1.1 ml/kg in the ISOSV and ISOMV protocols, respectively. The net changes in extravascular volume, assumed to be interstitial fluid volume, were 8.6 ± 3.3 and 8.1 ± 3.1 ml/kg, and 22.5 ± 1.5 and 22.1 ± 1.6 ml/kg in the corresponding protocols. Volume kinetic analysis demonstrated extravascular fluid accumulation associated with isoflurane anesthesia similar to the calculated interstitial accumulation of 20.2 ± 0.5 and 26.5 ± 0.3 ml/kg in the ISOSV and ISOMV protocols, respectively. Conclusion: Isoflurane, but not mechanical ventilation, decreased urinary excretion and increased interstitial fluid volume. Volume kinetic analysis indicated {"}third-space{"} losses due to isoflurane. Perioperative fluid retention may be associated not only with surgical tissue manipulation, but with anesthesia per se.",
    author = "Connolly, {Cara M.} and Kramer, {George C.} and Hahn, {Robert G.} and Chaisson, {Neil F.} and Svens{\'e}n, {Christer H.} and Kirschner, {Robert A.} and Hastings, {Dennis A.} and Chinkes, {David L.} and Prough, {Donald S.}",
    year = "2003",
    month = "3",
    day = "1",
    doi = "10.1097/00000542-200303000-00015",
    language = "English",
    volume = "98",
    pages = "670--681",
    journal = "Anesthesiology",
    issn = "0003-3022",
    publisher = "Lippincott Williams and Wilkins",
    number = "3",

    }

    TY - JOUR

    T1 - Isoflurane but not mechanical ventilation promotes extravascular fluid accumulation during crystalloid volume loading

    AU - Connolly, Cara M.

    AU - Kramer, George C.

    AU - Hahn, Robert G.

    AU - Chaisson, Neil F.

    AU - Svensén, Christer H.

    AU - Kirschner, Robert A.

    AU - Hastings, Dennis A.

    AU - Chinkes, David L.

    AU - Prough, Donald S.

    PY - 2003/3/1

    Y1 - 2003/3/1

    N2 - Background: The combination of isoflurane anesthesia and mechanical ventilation reduces urinary output and promotes redistribution of a crystalloid bolus into the extravascular space. The authors hypothesized that mechanical ventilation rather than isoflurane causes this alteration. Methods: The fate of a 25-ml/kg, 20-min, 0.9% saline fluid bolus was studied in four different experiments per sheep: while conscious and spontaneously ventilating (CSV), while conscious and mechanically ventilated (CMV), while anesthetized with isoflurane and mechanical ventilated (ISOMV), and while anesthetized with isoflurane and spontaneously ventilating (ISOSV). Results: By calculations based on the indicator dilution and mass balance principles, plasma expansion was similar between protocols. Isoflurane but not mechanical ventilation reduced urinary output and increased interstitial fluid volume (P < 0.001): At 180 min, mean total urinary outputs were 15.6 ± 2.1 and 15.9 ± 2.9 ml/kg in the CSV and CMV protocols and 2.7 ± 0.6 and 3.1 ± 1.1 ml/kg in the ISOSV and ISOMV protocols, respectively. The net changes in extravascular volume, assumed to be interstitial fluid volume, were 8.6 ± 3.3 and 8.1 ± 3.1 ml/kg, and 22.5 ± 1.5 and 22.1 ± 1.6 ml/kg in the corresponding protocols. Volume kinetic analysis demonstrated extravascular fluid accumulation associated with isoflurane anesthesia similar to the calculated interstitial accumulation of 20.2 ± 0.5 and 26.5 ± 0.3 ml/kg in the ISOSV and ISOMV protocols, respectively. Conclusion: Isoflurane, but not mechanical ventilation, decreased urinary excretion and increased interstitial fluid volume. Volume kinetic analysis indicated "third-space" losses due to isoflurane. Perioperative fluid retention may be associated not only with surgical tissue manipulation, but with anesthesia per se.

    AB - Background: The combination of isoflurane anesthesia and mechanical ventilation reduces urinary output and promotes redistribution of a crystalloid bolus into the extravascular space. The authors hypothesized that mechanical ventilation rather than isoflurane causes this alteration. Methods: The fate of a 25-ml/kg, 20-min, 0.9% saline fluid bolus was studied in four different experiments per sheep: while conscious and spontaneously ventilating (CSV), while conscious and mechanically ventilated (CMV), while anesthetized with isoflurane and mechanical ventilated (ISOMV), and while anesthetized with isoflurane and spontaneously ventilating (ISOSV). Results: By calculations based on the indicator dilution and mass balance principles, plasma expansion was similar between protocols. Isoflurane but not mechanical ventilation reduced urinary output and increased interstitial fluid volume (P < 0.001): At 180 min, mean total urinary outputs were 15.6 ± 2.1 and 15.9 ± 2.9 ml/kg in the CSV and CMV protocols and 2.7 ± 0.6 and 3.1 ± 1.1 ml/kg in the ISOSV and ISOMV protocols, respectively. The net changes in extravascular volume, assumed to be interstitial fluid volume, were 8.6 ± 3.3 and 8.1 ± 3.1 ml/kg, and 22.5 ± 1.5 and 22.1 ± 1.6 ml/kg in the corresponding protocols. Volume kinetic analysis demonstrated extravascular fluid accumulation associated with isoflurane anesthesia similar to the calculated interstitial accumulation of 20.2 ± 0.5 and 26.5 ± 0.3 ml/kg in the ISOSV and ISOMV protocols, respectively. Conclusion: Isoflurane, but not mechanical ventilation, decreased urinary excretion and increased interstitial fluid volume. Volume kinetic analysis indicated "third-space" losses due to isoflurane. Perioperative fluid retention may be associated not only with surgical tissue manipulation, but with anesthesia per se.

    UR - http://www.scopus.com/inward/record.url?scp=0037371806&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=0037371806&partnerID=8YFLogxK

    U2 - 10.1097/00000542-200303000-00015

    DO - 10.1097/00000542-200303000-00015

    M3 - Article

    C2 - 12606911

    AN - SCOPUS:0037371806

    VL - 98

    SP - 670

    EP - 681

    JO - Anesthesiology

    JF - Anesthesiology

    SN - 0003-3022

    IS - 3

    ER -