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Ann Surg. 1989 Jun; 209(6): 651–661.
doi: 10.1097/00000658-198906000-00001
PMCID: PMC1494120
PMID: 2730178

Fractional change in blood volume following normal saline infusion in high-risk patients before noncardiac surgery.

R J Mullins and R N Garrison
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Abstract

Patients with multiple-system disease were considered to be at high-risk to develop cardiac complications when undergoing an elective noncardiac surgical procedure. Their operative risk was prospectively assessed by a protocol that included recording the presence of established clinical risk factors and measuring the hemodynamic response to an intravenous infusion of up to 2 L of normal saline given over a two-hour period. The day prior to their operations, 126 patients were admitted to the Surgical Intensive Care Unit, where pulmonary artery catheters were inserted without serious complications. One hundred and eleven patients tolerated the entire 2-L infusion. The hemoglobin concentration of blood was measured before and after the infusion. The fractional change in blood volume (BV after/BV before) calculated with hemoglobin data was 1.06 +/- 0.06 (mean +/- SD). A multivarient discriminant analysis showed that the fractional change in blood volume was a covariant with a higher correlation rank than the hemodynamic data in identifying patients at risk for an adverse outcome.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  • Garrison RN, Cryer HM, Howard DA, Polk HC., Jr Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 1984 Jun;199(6):648–655. [PMC free article] [PubMed] [Google Scholar]
  • Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O'Malley TA, Goroll AH, Caplan CH, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977 Oct 20;297(16):845–850. [PubMed] [Google Scholar]
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  • Gerson MC, Hurst JM, Hertzberg VS, Doogan PA, Cochran MB, Lim SP, McCall N, Adolph RJ. Cardiac prognosis in noncardiac geriatric surgery. Ann Intern Med. 1985 Dec;103(6 ):832–837. [PubMed] [Google Scholar]
  • Bunt TJ, Manczuk M, Varley KV. Nitroglycerine-induced volume loading. Surgery. 1988 May;103(5):513–519. [PubMed] [Google Scholar]
  • Bush HL, Jr, LoGerfo FW, Weisel RD, Mannick JA, Hechtman HB. Assessment of myocardial performance and optimal volume loading during elective abdominal aortic aneurysm resection. Arch Surg. 1977 Nov;112(11):1301–1305. [PubMed] [Google Scholar]
  • Bush HL, Jr, Huse JB, Johnson WC, O'Hara ET, Nabseth DC. Prevention of renal insufficiency after abdominal aortic aneurysm resection by optimal volume loading. Arch Surg. 1981 Dec;116(12):1517–1524. [PubMed] [Google Scholar]
  • Del Guercio LR, Cohn JD. Monitoring operative risk in the elderly. JAMA. 1980 Apr 4;243(13):1350–1355. [PubMed] [Google Scholar]
  • Manny J, Grindlinger GA, Dennis RC, Weisel RD, Hechtman HB. Myocardial performance curves as guide to volume therapy. Surg Gynecol Obstet. 1979 Dec;149(6):863–873. [PubMed] [Google Scholar]
  • Whittemore AD, Clowes AW, Hechtman HB, Mannick JA. Aortic aneurysm repair. Reduced operative mortality associated with maintenance of optimal cardiac performance. Ann Surg. 1980 Sep;192(3):414–421. [PMC free article] [PubMed] [Google Scholar]
  • Weisel RD, Berger RL, Hechtman HB. Current concepts measurement of cardiac output by thermodilution. N Engl J Med. 1975 Mar 27;292(13):682–684. [PubMed] [Google Scholar]
  • Mangano DT, Van Dyke DC, Ellis RJ. The effect of increasing preload on ventricular output and ejection in man. Limitations of the Frank-Starling Mechanism. Circulation. 1980 Sep;62(3):535–541. [PubMed] [Google Scholar]
  • Dill DB, Costill DL. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol. 1974 Aug;37(2):247–248. [PubMed] [Google Scholar]
  • DOYLE JT, WILSON JS, ESTES EH, WARREN JV. The effect of intravenous infusions of physiologic saline solution on the pulmonary arterial and pulmonary capillary pressure in man. J Clin Invest. 1951 Apr;30(4):345–352. [PMC free article] [PubMed] [Google Scholar]
  • Grindlinger GA, Vegas AM, Manny J, Bush HL, Mannick JA, Hechtman HB. Volume loading and vasodilators in abdominal aortic aneurysmectomy. Am J Surg. 1980 Apr;139(4):480–486. [PubMed] [Google Scholar]
  • Mullins RJ, Bell DR. Changes in interstitial volume and masses of albumin and IgG in rabbit skin and skeletal muscle after saline volume loading. Circ Res. 1982 Sep;51(3):305–313. [PubMed] [Google Scholar]
  • Cohen JL, Wender R, Maginot A, Cossman D, Treiman R, Foran R, Levin P, De Angelis J, Treiman G. Hemodynamic monitoring of patients undergoing abdominal aortic surgery. Am J Surg. 1983 Aug;146(2):174–177. [PubMed] [Google Scholar]
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