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Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial.

Hosseinzadeh Maleki M, Derakhshan P, Rahmanian Sharifabad A, Amouzeshi A - Anesth Pain Med (2016)

Bottom Line: GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation.Platelet count difference and postoperative bleeding were significantly lower in Albumin group.Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

View Article: PubMed Central - PubMed

Affiliation: Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran.

ABSTRACT

Background: The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate.

Objectives: In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients.

Patients and methods: Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU.

Results: GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group.

Conclusions: Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

No MeSH data available.


Related in: MedlinePlus

Flowchart of the Study Participants
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fig25671: Flowchart of the Study Participants

Mentions: Sixty patients scheduled for elective coronary artery bypass grafting (CABG) surgery between January 2012 and November 2013 were involved in this double blind clinical trial study. These patients were classified by the American Society of Anesthesiology (ASA) as classes II and III. The study was approved by “Birjand university of medical sciences ethics committee” (institutional review board of Birjand university of medical sciences) and all patients gave their informed consent before surgery. The study was registered in the Iranian registry of clinical trials (IRCT) by number IRCT2015011620112N4. The exclusion criteria were emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. Preoperative ASA 80 (mg/day) and Atorvastatin 20 (mg/day) were continued in all patients. Angiotensin II receptor antagonist and angiotensin converting enzyme inhibitors were discontinued 24 hours before the operation in all patients. By considering inclusion and exclusion criteria, 60 isolated CABG cases were studied (Figure 1). Based on the study of Tiryakioglu et al. (21) considering α = 0.05, β = 0.01, 99% power, allowable difference (µ2 - µ1) = 0.26 and population variance = 0.0361 postoperative INR at the 24th hour, the sample size was calculated from the below formula:


Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial.

Hosseinzadeh Maleki M, Derakhshan P, Rahmanian Sharifabad A, Amouzeshi A - Anesth Pain Med (2016)

Flowchart of the Study Participants
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834664&req=5

fig25671: Flowchart of the Study Participants
Mentions: Sixty patients scheduled for elective coronary artery bypass grafting (CABG) surgery between January 2012 and November 2013 were involved in this double blind clinical trial study. These patients were classified by the American Society of Anesthesiology (ASA) as classes II and III. The study was approved by “Birjand university of medical sciences ethics committee” (institutional review board of Birjand university of medical sciences) and all patients gave their informed consent before surgery. The study was registered in the Iranian registry of clinical trials (IRCT) by number IRCT2015011620112N4. The exclusion criteria were emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. Preoperative ASA 80 (mg/day) and Atorvastatin 20 (mg/day) were continued in all patients. Angiotensin II receptor antagonist and angiotensin converting enzyme inhibitors were discontinued 24 hours before the operation in all patients. By considering inclusion and exclusion criteria, 60 isolated CABG cases were studied (Figure 1). Based on the study of Tiryakioglu et al. (21) considering α = 0.05, β = 0.01, 99% power, allowable difference (µ2 - µ1) = 0.26 and population variance = 0.0361 postoperative INR at the 24th hour, the sample size was calculated from the below formula:

Bottom Line: GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation.Platelet count difference and postoperative bleeding were significantly lower in Albumin group.Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

View Article: PubMed Central - PubMed

Affiliation: Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran.

ABSTRACT

Background: The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate.

Objectives: In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients.

Patients and methods: Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU.

Results: GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group.

Conclusions: Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

No MeSH data available.


Related in: MedlinePlus