Intraoperative Management Of Htk-solution: Clinical And Neurological Outcome In Standard And Minimal Invasive Cardiac Surgery
Azieda Ospedaliero-Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy.
OBJECTIVE: In adult patients, the administration of high volume single-shot histidine-tryptophane-ketoglutarate (HTK) solution for myocardial preservation during cardiac surgery is a standard procedure, above all in Minimal Invasive Cardiac Surgery (MICS). The aim of this study is to determine the impact of HTK infusion on cristalloid and colloid balance and its impact on neurological outcome of patients undergoing open heart surgery.
METHODS: In this prospective observational study, between March 2015 and June 2015, we analyzed 121 consecutive patients undergoing open heart procedures who received HTK solution. We created two groups according to interventions performed. Group 1 (45 patients) includes patients who received ultrafiltration and/or aspiration of cardioplegic solution (active management); Group 2 (76 patients) includes patients with passive management of HTK solution. We performed perioperative balance of cristalloid and colloid infusion. At the end, we analized the neurological responsiveness of the patient measuring Richmond Agitation-Sedation Scale (RASS). In all patients we examined single variables like age, body surface area (BSA), lower natriemia, maximum change of natriemia (delta max), aspiration of HTK, ultrafiltration, administration of therapies like albumin and bicarbonate in relation to sodium fluctuation and neurological impairment.
RESULTS: In both groups we observed a rapid decrease of natriemia after HTK administration (129,2 ±5,5) and a progressive return to original state three hours after the end of surgery. No significant difference of RASS value at 6 and 24 hours in the two groups. No significant difference in neurological impairment at 6, 12 and 24 hours concern to sodium fluctuation like lower natremia and maximum change of natremia and aspiration of HTK, ultrafiltration, bicarbonate and/or albumin infusion in all patients.
CONCLUSIONS: Rapid decrease of natremia after administration of a HTK solution could be a risk factor for the development of postoperative neurological impairment. Our data demonstrate that acute iponatremia, provoked by HTK administration, doesn’t determine a worse neurological outcome. Therapeutic maneuvers aimed to actively restoring the physiological serum osmolarity, like ultrafiltration and aspiration of HTK or therapies like bicarbonate and albumin do not seem to have a protective effect.
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