The use of mannitol in cardiopulmonary bypass prime solution-Prospective randomized double-blind clinical trial.
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
04
05
2019
revised:
13
06
2019
accepted:
24
06
2019
pubmed:
10
7
2019
medline:
11
11
2020
entrez:
10
7
2019
Statut:
ppublish
Résumé
The optimal prime solution for the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol is widely used in the priming solution for CPB despite the fact that there is no clear consensus on the role of mannitol in cardiac surgery. The aim of this study was to investigate the effect of mannitol in the CPB prime solution. This prospective, randomized, double-blind study included 40 patients with normal cardiac and renal functions, who underwent coronary artery bypass grafting. One group received a prime based on Ringer's acetate (n = 20), and the other a prime consisting of Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality, acid-base status, electrolytes, and renal-related parameters were monitored. No significant differences were found in osmolality between the Ringer's acetate group and the mannitol group at any time. The mannitol group showed a pronounced decrease in sodium, from 138.7 ± 2.8 mmol/L at anaesthesia onset, to 133.9 ± 2.6 mmol/L after the start of CPB (P < .001). No differences were seen in the renal parameters between the groups, apart from a short-term effect of mannitol on peroperative urine production (P = .003). We observed no effects on osmolality of a prime solution containing mannitol compared to Ringer's acetate-based prime in patients with normal cardiac and renal function. The use of mannitol in the prime resulted in a short-term, significant decrease in sodium level.
Sections du résumé
BACKGROUND
The optimal prime solution for the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol is widely used in the priming solution for CPB despite the fact that there is no clear consensus on the role of mannitol in cardiac surgery. The aim of this study was to investigate the effect of mannitol in the CPB prime solution.
METHODS
This prospective, randomized, double-blind study included 40 patients with normal cardiac and renal functions, who underwent coronary artery bypass grafting. One group received a prime based on Ringer's acetate (n = 20), and the other a prime consisting of Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality, acid-base status, electrolytes, and renal-related parameters were monitored.
RESULTS
No significant differences were found in osmolality between the Ringer's acetate group and the mannitol group at any time. The mannitol group showed a pronounced decrease in sodium, from 138.7 ± 2.8 mmol/L at anaesthesia onset, to 133.9 ± 2.6 mmol/L after the start of CPB (P < .001). No differences were seen in the renal parameters between the groups, apart from a short-term effect of mannitol on peroperative urine production (P = .003).
CONCLUSION
We observed no effects on osmolality of a prime solution containing mannitol compared to Ringer's acetate-based prime in patients with normal cardiac and renal function. The use of mannitol in the prime resulted in a short-term, significant decrease in sodium level.
Identifiants
pubmed: 31287556
doi: 10.1111/aas.13445
pmc: PMC6852169
doi:
Substances chimiques
Chlorides
0
Isotonic Solutions
0
Ringer's acetate
0
Mannitol
3OWL53L36A
Sodium
9NEZ333N27
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1298-1305Subventions
Organisme : Lundgrens Foundation for Medical Research
ID : 87101
Pays : International
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
J Extra Corpor Technol. 2015 Dec;47(4):228-30
pubmed: 26834285
Anaesth Intensive Care. 2009 Sep;37(5):767-72
pubmed: 19775041
Thorac Cardiovasc Surg. 1999 Feb;47(1):58-62
pubmed: 10218625
Toxicol Pathol. 1999 Jul-Aug;27(4):427-35
pubmed: 10485823
Am J Med Sci. 2010 Jun;339(6):561-7
pubmed: 20453633
Anesthesiology. 2000 Nov;93(5):1170-3
pubmed: 11046201
Scand J Urol Nephrol. 2012 Jun;46(3):212-22
pubmed: 22250974
Acta Anaesthesiol Scand. 2019 Nov;63(10):1298-1305
pubmed: 31287556
Clin J Am Soc Nephrol. 2018 Jul 6;13(7):984-992
pubmed: 29871886
World Neurosurg. 2016 Jul;91:672.e5-9
pubmed: 27086258
Yakugaku Zasshi. 2007 Jan;127(1):173-82
pubmed: 17202798
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1351-5
pubmed: 24189318
Perfusion. 2002 Sep;17(5):315-9
pubmed: 12243433
Clin Chem Lab Med. 2014 Jun;52(6):815-24
pubmed: 24334413
Ann Intern Med. 1998 Feb 1;128(3):194-203
pubmed: 9454527
J Neurosurg. 2014 Jun;120(6):1340-8
pubmed: 24484224
Anesth Analg. 2017 Dec;125(6):1871-1877
pubmed: 28614119
Perfusion. 2019 Mar;34(2):130-135
pubmed: 30114960
Acta Anaesthesiol Belg. 2003;54(3):207-15
pubmed: 14598617
Ren Fail. 2010 Jul;32(6):673-9
pubmed: 20540634
J Cardiothorac Vasc Anesth. 2004 Aug;18(4):429-37
pubmed: 15365922
Rev Port Cir Cardiotorac Vasc. 2017 Jul-Dec;24(3-4):154
pubmed: 29701385
N Engl J Med. 2000 May 25;342(21):1581-9
pubmed: 10824078
J Extra Corpor Technol. 2014 Mar;46(1):77-83
pubmed: 24779123
Medicine (Baltimore). 2015 Nov;94(47):e2032
pubmed: 26632702
Crit Care. 2012 Aug 17;16(4):R159
pubmed: 22901953
Clin Biochem. 2015 May;48(7-8):529-33
pubmed: 25794428
J Thorac Cardiovasc Surg. 2006 Aug;132(2):283-90
pubmed: 16872951
J Lab Clin Med. 1979 Nov;94(5):683-92
pubmed: 501197
Anaesthesia. 2008 Jun;63(6):576-82
pubmed: 18477268
Can J Anaesth. 1987 Sep;34(5):442-6
pubmed: 3117392
Anesth Pain Med. 2016 Jan 18;6(1):e30326
pubmed: 27110527
Perfusion. 1998 May;13(3):181-6
pubmed: 9638715
Ann Thorac Surg. 2000 Feb;69(2):501-6
pubmed: 10735688
Anesth Analg. 2003 Nov;97(5):1222-9
pubmed: 14570627
J Anesth. 2005;19(1):75-7
pubmed: 15674521
J Am Coll Surg. 2013 Jun;216(6):1135-43, 1143.e1
pubmed: 23623219
Stroke. 1998 Dec;29(12):2631-40
pubmed: 9836777