The Effect of Acute Normovolemic Hemodilution (ANH) on Myocardial Contractility in Anesthetized Dogs

Häbler, O.; Kleen, M.; Podtschaske, Armin; Hutter, Jörg; Tiede, M; Kemming, Gregor; Welte, M.; Corso, Carlos Otávio; Meßmer, K.

doi:10.1213/00000539-199609000-00002

Cited by 58 publications

(38 citation statements)

References 22 publications

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“…Our data contrast with those reported in patients free from cardiovascular diseases in whom a leftward/upper shift of the Starling pressure/flow curves characterizes the hemodynamic response to ANH as a result of the combined effects of increased venous return, enhanced intrinsic contractility, and reduced LV impedance and arterial elastance (5,13,(25)(26)(27)(28). Although ␤-adrenergic blockade and peripheral and coronary artery diseases might limit the capacity to recruit SV through reduced LV afterload and/or positive inotropic effects, an ANH-induced increase in SV has been demonstrated in animals with acute cardiac insufficiency or myocardial infarct as well as in pa- tients with CAD receiving ␤-adrenergic blockers (29 -33).…”

Section: Discussioncontrasting

confidence: 99%

Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography

Licker

Ellenberger

Sierra

et al. 2005

Critical Care Medicine

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Section: Discussioncontrasting

confidence: 99%

Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography

Licker

Ellenberger

Sierra

et al. 2005

Critical Care Medicine

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“…1) by exchanging blood with identical volumes of 6% hydroxyethyl starch (HES) having an average molecular weight of 200.000/0.5 (HAES-steril 6%, Fresenius, Bad Homburg, Germany). The effects of this level of ANH on myocardial perfusion and left ventricular function have been previously described in detail [17]. From the whole blood collected during the initial ANH, "units" of packed autologous RBC were prepared, each containing 8% of the pre-hemodilution whole-body erythrocyte volume (calculated based on total blood volume and Hct).…”

Section: Initial Hemodilutionmentioning

confidence: 99%

“…The detailed methodology has been described previously [17,18]. Briefly, after euthanizing the animals, the heart was removed, fixed for 3 days in 10% formalin and then dissected into 104 organ samples.…”

Section: Myocardial Blood Flowmentioning

confidence: 99%

“…At the beginning of each measurement, calibration for the conductivity of blood (σ) was performed in a sampling cuvette incorporated in the Leycom Sigma-5DF signal conditioner. Furthermore, correction for LV volume due to conductance arising from the surrounding tissues of the left ventricle ("parallel conductance") was performed using the "hypertonic saline technique" [1,17,27].…”

Section: Left Ventricular Functionmentioning

confidence: 99%

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IV Perflubron emulsion versus autologous transfusion in severe normovolemic anemia: effects on left ventricular perfusion and function

Häbler

Kleen

Hutter³

et al. 1997

Res. Exp. Med.

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Intact cardiac compensatory mechanisms are necessary to maintain adequate tissue oxygenation during acute normovolemic hemodilution (ANH). Left ventricular (LV) perfusion, oxygenation and function were analyzed in an experimental whole-body model of profound ANH (Hct 9%) and effectiveness of a perfluorocarbon-based oxygen carrier in maintaining myocardial oxygenation and function was evaluated. A total of 22 anesthetized dogs were hemodiluted to Hct 20% followed by a simulated, controlled blood-loss phase in which dogs were randomized to either: (1) 1:1 exchange of lost blood with autologous red blood cells (RBC-group), (2) 1:1 exchange with a colloid (control-group) and (3) 1:1 exchange with a colloid after a single dose of 1.8 g/kg BW perflubron i.v. (PFC-group). Myocardial oxygen delivery and consumption as well as endocardial perfusion were determined using radioactive microspheres. LV myocardial contractility (LV MC) was assessed from: (1) the relationship between maximum rate of LV pressure increase (LVdp/dtmax) and LV enddiastolic volume (LVEDV) and (2) analysis of the LV endsystolic pressure volume relationship (ESPVR). LV diastolic properties were reflected by (1) minimum rate of LV pressure increase (LVdp/dtmin), (2) slope and intercept of the enddiastolic pressure-volume relationship (EDPVR) and (3) the time-constant of isovolumic LV pressure decline "tau 1/2". Full sets of LV MC data were obtained from 18 dogs (n = 6 per group). LV MC (LVdp/dtmax-LVEDV relation) increased after perflubron administration. At the lowest Hct level, all parameters reflecting LV MC as well as LVdp/dtmin were significantly higher in the PFC-group than in the control-group. After profound normovolemic hemodilution (Hct 9%) superiority of LV MC and LV diastolic properties was found, when myocardial oxygenation was supported by i.v. perflubron emulsion, a temporary O2 carrier.

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“…Im Tierexperiment (Allgemeinanäs-thesie, intaktes Koronargefäßsystem) blieben spezifische Parameter der systolischen und diastolischen linksventrikulären Funktion bis zu sehr niedrigen Hb-Konzentrationen [Hb 5-7 g/dl (3,10-4,34 mmol/l)] unbeeinträchtigt [26,31,45]. Erst bei extremster Hämodilution [Hb <3 g/dl (<1,86 mmol/l)] manifestierten sich isolierte Veränderungen der diastolischen Ventrikelfunktion [28] bzw.…”

Section: Introductionunclassified

Perioperative Anämietoleranz

Häbler

Meier²,

Pape³

et al. 2006

Anaesthesist

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The expected cost explosion in transfusion medicine (increasing imbalance between donors and potential recipients, treatment of transfusion-associated complications) increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance to anemia enables 1) the tolerance of larger blood losses (loss of "diluted blood"), 2) the onset of transfusion to the time after surgical control of bleeding to be delayed and 3) the perioperative collection of autologous red blood cells. The present review article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. Under strictly controlled conditions (anesthesia, normovolemia, complete muscular relaxation, hyperoxemia, mild hypothermia) extremely low hemoglobin concentrations [Hb <3 g/dl (<1.86 mmol/l)] are tolerated without transfusion by individuals with no cardiopulmonary disease. In the clinical routine these situations are limited to borderline situations e.g. unexpected massive blood losses in Jehovah's Witnesses or unexpected shortcomings in blood supply. The current recommendations coincide to the effect that perioperative red blood cell transfusion 1) is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and 2) is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.

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The Effect of Acute Normovolemic Hemodilution (ANH) on Myocardial Contractility in Anesthetized Dogs

Cited by 58 publications

References 22 publications

Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography

Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography

IV Perflubron emulsion versus autologous transfusion in severe normovolemic anemia: effects on left ventricular perfusion and function

Perioperative Anämietoleranz

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