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Doctoral Thesis
DOI
10.11606/T.10.2004.tde-03022005-113414
Document
Author
Full name
Denise Aya Otsuki
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2004
Supervisor
Committee
Auler Junior, Jose Otavio Costa (President)
Fantoni, Denise Tabacchi
Fraga, Adilson de Oliveira
Galas, Filomena Regina Barbosa Gomes
Stopiglia, Angelo João
Title in Portuguese
Hemodiluição normovolêmica aguda: estudo experimental comparativo utilizando amido hidroxietílico a 6% ou solução de Ringer lactato
Keywords in Portuguese
amido
ecocardiografia
suínos
tonometria
Abstract in Portuguese
Hemodiluição normovolêmica aguda é um procedimento utilizado para diminuir a necessidade de transfusões sangüíneas em diversas cirurgias de grande porte. Poucos trabalhos avaliam as alterações hemodinâmicas e perfusão tecidual através de estudo ecocardiográfico e tonometria gástrica. Foram utilizados 23 porcos (peso 46.6 ± 6.0 kg) anestesiados com quetamina, fentanil e propofol e instrumentados para monitorização hemodinâmica convencional. Os animais foram randomizados em três grupos 30 minutos após estabilização da anestesia: Grupo I (Controle), Grupo II (amido hidroxietílico) e Grupo III (Ringer lactato). Os animais do grupo II e III foram submetidos ao protocolo de hemodiluição com hematócrito alvo de 15%. A retirada de sangue foi realizada em 30 minutos e a expansão plasmática feita simultaneamente com amido hidroxietílico ou Ringer lactato nas proporções de 1:1 ou 1:3 em relação ao sangue retirado. Os parâmetros hemodinâmicos e de oxigenação, pH gástrico, ecocardiografia transesofágica (fração de ejeção através do método Simpson) foram coletados antes da hemodiluição (T0), no fim do procedimento de hemodiluição (T1) e após uma e duas horas (T2, T3). Os dados foram submetidos a análise de variância para medidas repetidas, seguida pelo teste Tukey e teste T student. Resultados: Em relação aos parâmetros do grupo controle, não houve diferença significante durante todo o procedimento. No grupo II e grupo III, houve aumento no índice cardíaco após hemodiluição (T0=5,80±1,46; T1=10,64±1,69 L.min-1.m2 e T0=5,53±1,18, T1=7,91±1,40 L.min-1.m2 respectivamente), e diminuição do índice de resistência vascular sistêmica (T0=1753±336, T1=822±140 dina.s.cm-5.m-2 e T0=1673±566, T1=1026±190 dina.s.cm-5.m-2 respectivamente), ambos estatisticamente significante. A fração de ejeção apresentou aumento significativo após a hemodiluição no grupo II. O pH gástrico diminuiu significativamente no grupo III. O lactato arterial aumentou de forma significante no grupo III após a hemodiluição. A microscopia eletrônica do ventrículo esquerdo mostraram discreta destruição de miofilamentos no grupo II. Houve destruição importante nas miofibrilas no grupo III. Conclusão: Estes resultados sugerem que na hemodiluição moderada a grave, o amido hidroxietílico consegue preservar melhor a estabilidade hemodinâmica do que a solução de Ringer lactato.
Title in English
Acute normovolemic hemodilution: comparative evaluation with hydroxyethyl starch and Lactated Ringer’s
Keywords in English
echocardiograph
gastric tonometry
hydroxyethyl starch
lactated Ringer’s
pigs
Abstract in English
Normovolemic acute hemodilution is a procedure utilized to decrease the needs of blood transfusion during a variety of surgical procedures. Nevertheless, there are few works that evaluate its pulmonary effects as well as hemodynamic changes by means of echocardiography and tonometric evaluation. Methods: 23 anesthetized pigs (weight 46.6 ± 6.0 kg) were instrumented for standard hemodynamic monitoring. In order to prevent possible effects of inhaled anesthetics on pulmonary mechanics, intravenous anesthesia was chosen and consisted of ketamine, fentanyl and propofol administered throughout the study. Thirty minutes after anesthesia stabilization animals were randomized in three groups: Group I (Control), Group II (hydroxyethyl starch) and Group III (Lactated Ringer’s). Animals of group II and III were submitted to acute normovolemic hemodilution to reach a pre-established hematocrit around 15%. Blood withdrawal was accomplished in thirty minutes and plasma expansion was performed simultaneously with hydroxyethyl starch or Lactated Ringer’s administered in a proportion of 1:1 or 3:1 in relation to the amount of bloods withdrawn. Hemodynamic, gastric pH, transesophageal echography (ejection fraction, by Simpon method) and oxygen transport were measured before blood withdrawal (T0), at the end of hemodilution (T1), one and two hours after the end of hemodilution (T2, T3). Data were submitted to analysis of Variance for repeated measures followed by the Tukey test and also to a student T test. Results: In regard to all parameters of Group I (Control), there were no significant difference during the whole procedure. In Group II and Group III, there was an increase in cardiac index after hemodilution (T0=5.80±1.46; T1=10.64±1.69 L.min-1.m2 and T0=5.53±1.18, T1=7.91±1.40 L.min-1.m2), and a decrease in systemic vascular resistance index (T0=1753±336, T1=822±140 dyne.s.cm-5.m-2 and T0=1673±566, T1=1026±190 dyne.s.cm-5.m-2), both statistically significant. Ejection Fraction increased significantly after hemodilution in group II. Gastric pH decreased significantly in Group III, and arterial lactate increased significantly after hemodilution in group III. Electron microscopy of left ventricular bipsies showed a slight destruction in filament and preserved myofibrillar ultrastructure in group II. There was important destruction in myofibrillar ultrastructure in group III. Conclusion: These results suggest that in severe hemodilution, hydroxyethyl starch preserves hemonodynamic stability better than Lactate Ringer’s.
 
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Publishing Date
2005-06-01
 
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