Advertisement

Safe Limits of Hemodilution in Patients with Coronary Artery Disease

  • J. F. Baron
  • M. Moutafis
  • P. Viars
Chapter
  • 10 Downloads
Part of the Anaesthesiologie und Intensivmedizin / Anaesthesiology and Intensive Care Medicine book series (A+I, volume 222)

Abstract

Intentional hemodilution has been introduced into surgery because transfusions using donor blood are associated with significant risks. The appearance of acquired immunodeficiency syndrome (AIDS) and its possible transmission via transfusion, despite donor selection, is a very sensitive problem for patients and physicians [1]. However, AIDS ist probably not the major problem, since the risk of non-A non-B hepatitis transmission is quantitatively more important. In addition, the evidence that transfusion of homologous blood can induce immunosuppression and thereby impair the host resistance of surgical patients is a new cause of concern [12]. These problems with homologous transfusion have promoted the use of all techniques of autotransfusion. Among these, intentional hemodilution is the one which has probably enjoyed the greatest development, since it is the simplest and least expensive.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bove JR (1984) Transfusion associated AIDS–a cause for concern. N Engl J Med 310: 115–116PubMedCrossRefGoogle Scholar
  2. 2.
    Brazier J, Cooper N, Maloney JV, Buckberg C (1974) The adequacy of myocardial oxygen delivery in acute normovolemic anemia. Surgery 75: 508–516PubMedGoogle Scholar
  3. 3.
    Carey JS (1975) Determinants of cardiac output during experimental therapeutic hemodilution. Ann Surg 18: 196–202CrossRefGoogle Scholar
  4. 4.
    Davies MJ, Cronin KD, Domaingue C (1982) Haemodilution for major vascular surgery using 3, 5% polygeline ( Haemaccel ). Anaesth Intensive care 10: 265–270PubMedGoogle Scholar
  5. 5.
    Geha AS (1976) Coronary and cardiovascular dynamics and oxygen availability during acute normovolemic anemia. Surgery 80: 47–53PubMedGoogle Scholar
  6. 6.
    Gisselsson L, Rosberg B, Ericsson M (1982) Myocardial blood flow, oxygen uptake and carbon dioxide release of the human heart during hemodilution. Acta Anaesthesiol Scand 26: 589–591PubMedCrossRefGoogle Scholar
  7. 7.
    Glick G, Plauth WH, Braunwald E (1964) Role of the autonomic nervous system in the circulatory response to acutely induced anemia in anesthetized dogs. J Clin Invest 43: 2112–2124PubMedCrossRefGoogle Scholar
  8. 8.
    Guyton AC, Richardson TQ (1961) Effect of hematocrit on venous return. Circ Res 9: 157–161PubMedGoogle Scholar
  9. 9.
    Hagl S, Heimlich W, Meisner H, Erben R, Baum M, Mendier N (1977) The effect of hemodilution of regional function in the presence of coronary stenosis. Basis Res Cardiol 72: 344–364CrossRefGoogle Scholar
  10. 10.
    Hatcher JD; Chiu KL, Jennings DB (1978) Anemia as a stimulus to aortic and carotid chemoreceptors in the cat. J Appl Physiol 44: 696–702PubMedGoogle Scholar
  11. 11.
    Hint H (1968) The pharmacology of dextran and physiological background of the clincal use of Rheomacrodex. Acta Anaesthesiol Belg 19: 119–138PubMedGoogle Scholar
  12. 12.
    Horsey PF (1989) Blood transfusion and surgery. Br Med J 291: 291–234Google Scholar
  13. 13.
    Jan KM, Chien S (1977) Effect of hematocrit variations on coronary hemodynamics and oxygen utilisation. Am J Physiol 233: H106 - H113PubMedGoogle Scholar
  14. 14.
    Laks H, Pilon RN, Klovekorn WP, Anderson W, McCallum JR, O’Connor NE (1974) Acute hemodilution: its effect on hemodynamics and oxygen transport in anesthetized man. Ann Surg 180: 103–109PubMedCrossRefGoogle Scholar
  15. 15.
    Laxenaire MC, Aug F, Voisin C, Chevreaud C, Bauer P, Bertrand A (1986) Effects of haemodilution on ventricular function in coronary heart disease patients: Ann Fr Anesth Reanim 5: 218–222PubMedGoogle Scholar
  16. 16.
    Leone BJ, Saphn DR, McRae RL, Smith LR (1990) Effects of hemodilution on regional function of compromised myocardium. Anesthesiology [Suppl] 73: A596Google Scholar
  17. 17.
    Linden P van der, Baron JF, Philipp I et al. (1987) Normovolemic hemodilution in anesthetized patients with coronary artery disease: effects on hemodynamic and left ventricular function. Anesthesiology [Suppl] 67: A135CrossRefGoogle Scholar
  18. 18.
    Linden P van der, Baron JF, Philipp I et al. (1987) Normovolemic hemodilution in anesthetized patients with coronary artery disease: hemodynamic and metabolic responses to recovery. Anesthesiology [Suppl] 67: A79CrossRefGoogle Scholar
  19. 19.
    Messmer K, Sunder-Plassmann L, Jesch F, Gormandt L, Sinagowitz E, Kessler M (1973) Oxygen supply to the tissues during normovolemic hemodilution. Respir Exp Med 159: 152–166CrossRefGoogle Scholar
  20. 20.
    Messmer K, Kreimeier U, Intaglietta M (1986) Present state of intentional hemodilution. Eur Surg Res 18: 254–263PubMedCrossRefGoogle Scholar
  21. 21.
    Niinikoski J, Lassksonen V, Meretoja O, Jalonen J, Inberg MV (1981) Oxygen transport to tissue under normovolemic moderate and extreme hemodilution during coronary bypass operation. Ann Thorac Surg 31: 134–143PubMedCrossRefGoogle Scholar
  22. 22.
    Race D, Dedichen H, Schenk WG (1967) Regional blood flow during dextran-induced normovolemic hemodilution in the dog. J Thorac Cardiovasc Surg 53: 578–586PubMedGoogle Scholar
  23. 23.
    Rodriguez JA, Chamorro GA, Rapaport E (1974) Effect of isovolumic anemia on ventricular performance at rest and during exercise. J Appl Physiol 36: 28–33PubMedGoogle Scholar
  24. 24.
    Rose D, Coussofides T (1981) Intraoperative normovolemic hemodilution. J Surg Res 31: 375–381PubMedCrossRefGoogle Scholar
  25. 25.
    Shah DM, Prichard MN, Newell JC, Karmody AM, Scovill WA, Powers SR (1980) Increased cardiac output and oxygen transport after intraoperative isovolumic hemodilution. A study in patients with peripheral vascular disease. Arch Surg 115: 597–600PubMedGoogle Scholar
  26. 26.
    Stucker O, Trouve R, Vicaut E et al. (1983) Effects of different hematocrits on the isolated working rabbit heart perfused after ischemia. Int J Microcirc Clin Exp 2: 325–335PubMedGoogle Scholar
  27. 27.
    Sunder-Plassmann L, Klovekorn WP, Holper K, Hase U, Messmer K (1971) The physiological significance of acutely induced hemodilution. In: Ditzel J, Lewis DH (eds) 6th European Conference on Microcirculation. Karger, Basel, pp 23–28Google Scholar
  28. 28.
    Vicaut E, Stucker O, Teisseire B, Duvelleroy M (1987) Changes in systemic hematocrit and red cell fluxes at capillary bifurcations in rat cremaster muscles. Int J Microcirc Clin Exp 6: 225–235PubMedGoogle Scholar
  29. 29.
    Yoshikawa H, Powell J, Bland JHL, Lowenstein E (1973) Effects of acute anemia on experimental myocardial ischemia. Am J Cardiol 32: 670–678PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • J. F. Baron
  • M. Moutafis
  • P. Viars

There are no affiliations available

Personalised recommendations