Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Cardiovascular Anesthesia
INTRODUCTION: Early extubation after open heart surgery is associated with better ventilatory and hemodynamic stability, a shorter hospital stay, and reduced costs [1,2]. Fluid shifts during the first 4 postoperative hours may limit the ability to extubate patients. Composition of the prime solutions used in the bypass pump may play a significant role in the fluid shifts. We compared the crystalloid requirements during CPB with and without the addition of albumin to the pump prime.
METHODS: One hundred eighteen (118) consecutive adults undergoing coronary artery bypass graft were studied. The CPB machine was primed with 1810 cc's of fluid, which consisted of 1700 cc's of plasmalyte A, 50 cc's of mannitol (12.5g), 50 cc's of NaHCO3, and 10 cc's of heparin (10,000 units). This volume provided 800 cc's of the priming solution in the venous reservoir. In 56 cases, 100 cc's of 25% albumin was added to the venous reservoir immediately before initiation of CPB. During CPB, fluid was added to maintain the level at 600-800 cc's. Fluid balance was determined as the 800 cc initial volume plus volume added before and during CPB minus the volume remaining in the venous reservoir at the end of CPB. Values with and without albumin were compared with a simple paired t-test.
RESULTS: (Table 1) The addition of albumin reduced the positive fluid balance by two thirds, from 923 cc's to 327 cc's. Furthermore, the number of patients requiring crystalloid solutions during CPB was 67% without versus 23% with albumin. While the cross clamp times and pump times were statistically longer in the group without albumin, differences were small and probably not clinically significant.
CONCLUSION: The addition of albumin to the pump prime may reduce the amount of fluid given to the patient during CPB. Further studies need to address whether this influences the timing of extubation.
1. J Cardiothorac Vasc Anesth 1992; 6:448
2. Can J Anaesth 1993; 40:1178