Volume Kinetics of Ringer Solution, Dextran 70, and Hypertonic Saline in Male Volunteers

Svensén, Christer; Hahn, Robert G.

doi:10.1097/00000542-199708000-00006

Cited by 155 publications

(167 citation statements)

References 8 publications

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“…TM The figure used for dextran 3% was taken to be half-way between that previously obtained for dextran 6% and Ringer's solution. 9 Differences with respect to patient group and whether or not spinal anaesthesia had been induced were studied by repeated-measures (two-way) analysis of variance. Correlations between parameters were evaluated by linear regression analysis.…”

Section: Calculationsmentioning

confidence: 99%

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Hahn

Resby

1998

Can J Anaesth

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Purpose: To study how the body handles fluid given intravenously during the onset of spinal anaesthesia in women scheduled for Caesarean section. Methods: The effect of spinal anaesthesia on the volume kinetics of a constant-rate infusion of 25 ml.kg -l of Ringer's solution (n = I I) and I 0 ml'kg -I of dextran 3% 60 (n = 8) was studied before elective Caesarean section. Measurements of the blood haemoglobin concentration and urine excretion served as input variables in calculations of the size(s) of the body fluid spaces expanded by the infused fluid. The blood glucose level was also monitored, Results: When a one-volume kinetic model were fitted to the data, spinal anaesthesia reduced the size of the expanded body fluid space by 30% (Ringer's) and 58% (dextran) (P < 0.02) When a two-volume model was statistically justified, anaesthesia reduced the rate of fluid equilibration between the two expanded body fluid spaces by 47% and 19%, respectively (P < 0.04) The baseline volume for the primary (central) fluid space was smaller than the expected plasma volume; 1.5 I for Ringer's solution and 0.9 1 for dextran. Only small changes in the blood glucose concentration were found. Conclusion: The onset of spinal anaesthesia induces acute changes in the body's handling of infused fluid that can be described by volume kinetic analysis.Objectis : l~tudier le devenir des liquides administrEs par voie intraveineuse durant l'induction de l'anesth&ie rachidienne chez des parturientes subissant une cEsarienne. M&hodes : Les effets de la rachianesthEsie sur la cinEtique volum&rique d'une infusion ~ debit constant de 25 ml'kg -t de solution de Ringer (n= I I) ou de I0 ml.kg -I de dextran 60 en solution ~ 3% (n=8) ont &E EtudiEs avant la c&arienne Elective. Les mesures du taux d'hEmoglobine sanguin et du debit urinaire ont servi comme entrees variables dans le calcul de l'expansion volEmique par le liquide infuse des diffErents compartiments corporels. La glycEmie a aussi EtE mesurEe, l~sultats : Lorsque les donnEes &aient rapportEes ~ un modEle cin&ique ~ un seul compartiment, l'anesthEsie rachidienne entra?nait une reduction du compartiment corporel dEj~ distendu de 30% pour le Ringer et de 58% pour le dextran (P 0,02). Lorsqu'un modEle ~ deux compartiments apparaissait justifiE d'un point de vue statistique, l'anesth&ie entra~nait une reduction du taux d'Equilibration entre les deux compartiments corporels dEj~ distendus de 47% et de 1996 respectivement (P 0,04). Le volume de base pour le compartiment primaire (central) &ait plus petit que le volume plasmatique prEvu: 1,5L pour le Ringer et 0,9L pour le dextran. La glycEmie a peu variE. Conclusion : l'induction de l'anesthEsie rachidienne entra?ne des modification aigu~s de la gestion par le corps humain des liquides infuses, ces modifications pouvant &re d&rites par des analyses de cinEtique volumEtrique.

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Section: Calculationsmentioning

confidence: 99%

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Hahn

Resby

1998

Can J Anaesth

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“…It was likely due to the passage of saline into the interstitial space. It is well-known that crystalloid solutions are not the best option for volume expansion, since one-fifth of the non-excreted volume remains in the plasma after equilibrium and demands the infusion of large volumes 12 at least 2 to 3 times the estimated volume lost. In addition, studies have demonstrated that after 120 minutes even this volume is no longer in the intravascular space 13 .…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

et al. 2009

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Purpose: To investigate hemodynamic response to volume replacement with saline solution and hypertonic hydroxyethyl starch in hypovolemic dogs. Methods: Forty dogs under general anesthesia and hemodynamic monitoring, following measurements at baseline, were bled 20 ml.Kg -1 and parameters were measured again after 10 minutes. The animals were randomly divided in two groups and volume replacement was performed with saline solution twice the volume removed or 4 ml.Kg -1 of hypertonic hydroxyethyl starch. Hemodynamic data were again measured after 5, 15, 30, 45 and 60 minutes. Results: With both solutions values returned to satisfactory hemodynamic levels. With saline solution, there was a greater amplitude in variations that tended to decrease progressively. With hypertonic hydroxyethyl starch, the parameters studied returned more rapidly to levels similar to those at baseline and varied less. Conclusion: Both solutions proved to be efficient at replacing volume in the short period studied, although hypertonic hydroxyethyl starch produced more stable results. Key words: Hemodynamics. Hypovolemia. Hetastarch. Saline Solution, Hypertonic. Dogs. RESUMOObjetivo: Avaliar em cães hipovolêmicos as respostas hemodinâmicas da reposição volêmica com solução salina e hidroxi-etil amido hipertônico. Métodos: Quarenta cães sob anestesia geral e monitorização hemodinâmica, após medidas em repouso foram sangrados 20 ml.Kg -1 e tiveram os parâmetros novamente medidos após 10 minutos. Os animais foram aleatoriamente divididos em dois grupos nos quais foi realizada reposição volêmica com solução fisiológica duas vezes o volume retirado ou 4 ml.Kg -1 de hidroxi-etil amido hipertônico e os dados hemodinâmicos medidos novamente após 5, 15, 30, 45 e 60 minutos. Resultados: A reposição volêmica com as duas soluções fez os valores retornarem a níveis hemodinâmicos satisfatórios, a amplitude das variações com solução fisiológica foi maior, mas tendeu a diminuir progressivamente, com o hidroxi-etil amido hipertônico os parâmetros estudados retornaram a semelhantes ao repouso mais rapidamente e variaram menos. Conclusão: Ambas soluções se mostraram eficientes na reposição volêmica, o hidroxi-etil amido hipertônico proporcionou resultados mais estáveis.

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“…The studies comprised 6% dextran 70 [32], 5% albumin [33], and HES [25]. The pooled data from all 32 volunteers has now been recalculated by using modern kinetic software for nonlinear mixed effects (Phoenix NLME, Pharsight, St. Louis, MO).…”

Section: Volume Kinetics Of Colloid Fluidsmentioning

confidence: 99%

Must hypervolaemia be avoided? A critique of the evidence

Hahn¹

2015

Anaesthesiol Intensive Ther

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Anaesthetists are cautioned to avoid hypervolaemia in their patients. The most cited reason is that hypervolaemia elicits the release of atrial natriuretic peptides that damage the endothelial glycocalyx layer. Although shedding of the glycocalyx causes extravasation of protein in inflammatory disorders, it is more uncertain whether hypervolaemia alone is enough to cause clinically important shedding. This review scrutinises the methodology used in two key papers that propose such a link. The most cited one reports that hydroxyethyl starch and 5% albumin, when creating a hypervolaemic state, only expands the plasma by 40% of the infused volume. This result was obtained by comparing measurements of the plasma volume performed with the indocyanine green (ICG) dye method before and after the infusion. However, the transit time of the dye, as well as inequality in the concentration between vascular beds, both act to underestimate the plasma volume, particularly as times were extrapolated backwards to time zero instead of to (the more correct) 1 minute. A re-calculation based on theoretical ICG data, taking account of the transit time, shows the plasma volume expansion was closer to 100% than to 40% of the infused volume. This figure is supported by the dilution of the reported blood haemoglobin and plasma protein concentrations, as well as by other sources. In conclusion, only weak evidence supports a fluid-induced release of atrial peptides of sufficient size to alter the kinetics of colloid fluid by shedding of the endothelial glycocalyx layer.

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Volume Kinetics of Ringer Solution, Dextran 70, and Hypertonic Saline in Male Volunteers

Cited by 155 publications

References 8 publications

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

Must hypervolaemia be avoided? A critique of the evidence

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