Benefits of a glucose-containing priming solution for cardiopulmonary bypass

• Published in: Anesthesia and analgesia Vol. 72; no. 4; pp. 428 - 434
• Main Authors: METS, S, KEATS, A. S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.04.1991
• Subjects: Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Glucose; Cardiopulmonary Bypass; Glucose - administration & dosage; Glucose - metabolism; Humans; Intraoperative Period; Isotonic Solutions - administration & dosage; Isotonic Solutions - metabolism; Medical sciences; Osmolar Concentration; Postoperative Period; Ringer's Lactate; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Water-Electrolyte Balance; Cardiopulmonary bypass; Human; Aortocoronary; Bypass; Perfusion; Surgery; General anesthesia; Cardiovascular disease; Glucose
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199104000-00003

Benefits from the use of glucose-containing intravenous and priming solutions during coronary artery bypass operation have not been documented, but an increased risk of postoperative neurologic deficit by hyperglycemia has been suggested. To determine benefits, 107 patients undergoing coronary artery bypass operation were managed identically except that one group (n = 54) received 5% dextrose in lactated Ringer's solution (D5LR) as the sole intravenous and priming solution during operation and a second group (n = 53) received the same solution without glucose (LR). During cardiopulmonary bypass, the D5LR group required significantly less additional crystalloid to maintain safe oxygenator levels and flow (1.8 +/- 3.3 vs 15.8 +/- 20.9 mL.kg-1.h-1) and produced more urine (3.5 +/- 3.2 vs 1.2 +/- 1.4 mL.kg-1.h-1). By 24 h after operation, fluid balance in the LR group was approximately 2 L more positive than in the D5LR group. Five days after operation, the D5LR group weighed less than preoperatively (-0.8 +/- 2.6 kg), whereas the LR group gained weight (+1.0 +/- 2.8 kg). We conclude that use of glucose-containing solutions during coronary artery bypass operation benefits patients by decreasing perioperative fluid requirements and postoperative fluid retention. Because embolism is the cause of most postoperative neurologic deficits, any increased risk by hyperglycemia is small.