Intraoperative Volume Replacement: Crystalloids Versus Colloids In Surgical Myocardial Revascularization Without Cardiopulmonary Bypass (CPB)

Abstract

The use of crystalloids or colloids for volume replacement in large size surgeries is controversial. The objective of this study was to compare the effects of the intraoperative administration of crystalloids (normal saline - NS) with those of colloids (modified fluid gelatin) for surgical myocardial revascularization (SMR) without cardiopulmonary bypass (CPB). Forty patients undergoing SMR without CPB were randomly divided in two similar groups. The first group received modified fluid gelatin and NS and the second group received only NS. Urine output, hemoglobin level, intra- and postoperative bleeding, blood glucose levels, and intraoperative lactate in four distinct measurements were recorded. Postoperative morbidity and mortality, length of stay in the intensive care unit (ICU), and length of hospitalization were analyzed. Time to extubation in the gelatin group was 6.6 hours versus 7.3 hours in the NS group. The length of stay in the ICU was 2.4 days in the gelatin group versus 3.3 days in the NS group. The length of hospitalization was 10.3 days in the gelatin group versus 6.8 days in the NS group. The incidence of renal and respiratory complications, cardiac arrhythmias, myocardial infarctions, infections, reintubations, blood transfusions, and reoperation was the same in both groups. The use of colloids represented here by modified fluid gelatin associated with crystalloids or the use of crystalloids alone did not change the postoperative prognosis of patients undergoing SMR without CPB. Perhaps maintenance of the hemodynamic balance during the surgery is more important than the type of fluid administered.