Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000500006
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos hemodinâmicos e metabólicos imediatos determinados pelas soluções de cloreto de sódio a 7,5% e de sua associação ao dextran 70 a 6% na reanimação do choque hemorrágico: estudo experimental em cães

Immediate hemodynamic and metabolic effects of 7.5% sodium chloride and its association with 6% dextran 70 in hemorragic shock resuscitation: an experimental study in dogs

José Fernando Amaral Meletti; José Reinaldo Cerqueira Braz; Norma Sueli Pinheiro Módolo

http://dx.doi.org/10.1590/S0034-70942006000500006 Braz J Anesthesiol, vol.56, n5, p.478-494, 2006
PDF Português
PDF English
Downloads: 0
Views: 742

Resumo

JUSTIFICATIVA E OBJETIVOS: O dextran associado à solução hipertônica de cloreto sódio a 7,5% apresenta efeitos hemodinâmicos benéficos no controle prolongado da reanimação no choque hemorrágico. O objetivo deste estudo foi verificar se a associação do dextran à solução de cloreto de sódio a 7,5% apresentaria vantagens na avaliação imediata dos parâmetros hemodinâmicos e metabólicos na reanimação em modelo de choque hemorrágico controlado em cães. MÉTODO: Foram estudados 16 cães submetidos à hemorragia controlada até que a pressão arterial média atingisse 40 mmHg e permanecesse assim por até 30 minutos. Estes foram divididos em G1, com administração de NaCI a 7,5%, e G2, com administração NaCI a 7,5% combinada com dextran 70 a 6%, no volume de 4 mL.kg-1, durante três minutos. Foram avaliados os parâmetros hemodinâmicos e metabólicos. Consideraram-se quatro momentos: M1 - 10 minutos após o preparo cirúrgico, M2 - obtido na metade da fase de choque, M3 - obtido dois minutos após o final da administração das soluções, M4 - 30 minutos após o início da reanimação. RESULTADOS: Após a reanimação, não houve diferença significativa dos valores da FC, PAM, PCP e IRVS. O G2 apresentou valores maiores do IC em M4. Os valores da SvO2 foram menores no G1, final do experimento. A C(a-v)O2 foi maior no G1 nos momentos M3 e M4. Os valores do VO2 aumentaram nos dois grupos em M4 e os valores do lactato plasmático aumentaram progressivamente até M3 e diminuíram em M4. Houve aumento dos valores do Na plasmático e redução do hematócrito nos dois grupos. CONCLUSÕES: O G2 mostrou melhor desempenho hemodinâmico principalmente após 30 minutos do início da reanimação. Observou-se, também, maior expansão plasmática e melhor perfusão tecidual na associação do dextran ao NaCl a 7,5%.

Palavras-chave

ANIMAIS, CHOQUE, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: Dextran associated with 7.5% sodium chloride has positive hemodynamic effects in the long term control of hemorrhagic shock. The objective of this study was to verify whether the association of dextran with 7.5% chloride solution would be advantageous in the immediate hemodynamic evaluation of controlled hemorrhagic shock in dogs. METHODS: This study included 16 dogs submitted to controlled hemorrhage until their mean arterial blood pressure reached 40 mmHg, being maintained at this level for 30 minutes. They were divided in two groups: G1 received 7.5% NaCl and G2 received 7.5% NaCl in 6% dextran 70; in both groups, 4 mL.kg-1 of the solutions were administered for three minutes. Hemodynamic and metabolic parameters were evaluated in four different phases: M1 - 10 minutes after preparation for surgery, M2 - obtained in the middle of the shock phase. M3 - two minutes after the administration of the IV solutions, M4 - 30 minutes after the beginning of the resuscitation. RESULTS: After the resuscitation, there were no significant differences in HR, MAP, PCP, and SVRI. G2 presented the highest CI values in M4. G1 showed the smaller SvO2 values at the end of the experiment; and the C(a-v)O2 was higher in M3 and M4. For both groups, VO2 values increased in M4, and lactate plasma values increased progressively until M3, decreasing in M4. Both groups also presented increased Na plasma values and decreased hematocrit. CONCLUSIONS: G2 showed the best hemodynamic performance, especially 30 minutes after the beginning of resuscitation. Plasma expansion and tissue perfusion were also better with 7.5% NaCl in dextran.

Keywords

ANIMALS, SHOCK, VOLEMIA

References

Penfield WG. The treatment of severe and progressive hemorrhage by intravenous injections. Am J Physiol. 1919;48:121-128.

Baue AE, Tragus ET, Parkins WM. Effects of sodium chloride and bicarbonate in shock with metabolic acidosis. Am J Physiol. 1967;212:54-60.

Gazitua S, Scott JB, Chou CC. Effect of osmolarity on canine renal vascular resistance. Am J Physiol. 1969;217:1216-1223.

Gazitua S, Scott JB, Swindall B. Resistance response to local changes in plasma osmolality in three vascular beds. Am J Physiol. ;1971:220.

Velasco IT, Pontieri V, Rocha e Silva M Jr. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239:H664- H673.

Rocha e Silva M, Negraes GA, Soares AM. Hypertonic resuscitation from severe hemorrhagic shock: patterns of regional circulation. Circ Shock. 1986;19:165-175.

Rocha e Silva M, Velasco IT, Nogueira da Silva RI. Hyperosmotic sodium salts reverse severe hemorrhagic shock: other solutes do not. Am J Physiol. 1987;253:H751- H762.

Smith GJ, Kramer GC, Perron P. A comparison of several hypertonic solutions for resuscitation of bled sheep. J Surg Res. 1985;39:517-528.

Kramer GC, Perron PR, Lindsey DC. Small-volume resuscitation with hypertonic saline dextran solution. Surgery. 1986;100:239-247.

Velasco IT, Rocha e Silva M, Oliveira MA. Hypertonic and hyperoncotic resuscitation from severe hemorrhagic shock in dogs: a comparative study. Crit Care Med. 1989;17:261-264.

Kramer GC, Walsh JC, Perron PR. Comparison of hypertonic saline/dextran versus hypertonic saline/hetastarch for resuscitation of hypovolemia. Braz J Med Biol Res. 1989;22:279-282.

Wade C, Hannon J, Bossone C. Superiority of hypertonic saline/dextran over hypertonic saline during the first 30 min of resuscitation following hemorrhagic hypotension in conscious swine. Resuscitation. 1990;20:49-56.

Holcroft JW, Vassar MJ, Turner J. 3% NaCl and 7.5% Na/Cl/dextran 70 in the resuscitation of severely injured patients. Ann Surg. 1987;206:276-288.

Mattox KL, Maningas PA, Moore EE. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The USA Multicenter Trial. Ann Surg. 1991;213:482-491.

Vassar MJ, Holcroft JW. Use of hypertonic-hyperosncotic fluids for resuscitation of trauma patients. J Intensive Care Med. 1992;7:189-198.

Younes RN, Ching CT, Goldenberg DC. Hypertonic saline-dextran in the treatment of hemorrhagic shock: clinical trial in the emergency room. Proceedings of the. .

Rocha e Silva M. Hypertonic saline resuscitation. Medicina (B Aires). 1998;58.

Curi PR. Metodologia e Análise da Pesquisa em Ciências Biológicas. 1998.

Morrison DF. Multivariate Statistical Methods. 1967.

Gilmore JP. Pentobarbital sodium anesthesia in the dog. Am J Physiol. 1965;209:404-408.

Olmsted F, Page IH. Hemodynamic changes in dogs caused by sodium pentobarbital anesthesia. Am J Physiol. 1966;210:817-820.

Priano LL, Traber DL, Wilson RD. Barbiturate anesthesia: an abnormal physiologic stimulation. J Pharmacol Exp Ther. 1969;165:126-135.

Ogino R, Suzuki K, Kohno M. Effects of hypertonic saline and dextran 70 on cardiac contractility after hemorrhagic shock. J Trauma. 1998;44:59-69.

Hotvedt R, Platou ES, Koppang ER. Pentobarbital plasma concentration and cardiac eletrophysiology during prolonged pentobarbital infusion anesthesia in the dog. Acta Anaesthesiol Scand. 1982;26:638-642.

Welte M, Goresch T, Frey L. Hypertonic saline dextran does not increase cardiac contractile function during small volume resuscitation from hemorrhagic shock in anesthetized pigs. Anesth Analg. 1995;80:1099-1107.

Sato JK. Efeitos hemodinâmicos da isradipina em cães submetidos a pinçamento aórtico infra renal. .

Wiggers CJ, Werle JN. Exploration of a method for standarding hemorragic. Proc Soc Biol Med. 1942;49:604-606.

Dillon AR, Hankes GH, Nachreiner RF. Experimental hemorrhage in splenectomized and nosplenectomized dogs. Am J Vet Res. 1980;41:707-711.

Scalea TM, Holman M, Fuortes M. Central venous blood oxygen saturation: an early, accurate measurement of volume during hemorrhage. J Trauma. 1988;28:725-732.

Pianim NA, Liu SY, Dubecz S. Tissue oxygenation in hypovolemic shock. J Surg Res. 1993;55:338-343.

Hands R, Holcroft J, Perron P. Comparison of peripheral and central infusions of 7.5% NaCl/6% dextran 70. Surgery. 1988;103:684-689.

Onarheim H, Missavage AE, Kramer GC. Effectiveness of hypertonic saline-dextran 70 for initial fluid resuscitation of major burns. J Trauma. 1990;30:597-603.

Epstein SE, Stampfer M, Beiser GD. Role of the capacitance and resistance vessels in vasovagal syncope. Circulation. 1968;37:524-533.

Greene NM. Reports of scientific meetings. Anesthesiology. 1971;34:104-105.

De Barros LF, Baena , Velasco IT. Efeitos hemodinâmicos imediatos da infusão rápida de solução hipertônica de cloreto de sódio-dextran-70 para tratamento de choque hemorrágico em cães. Arq Bras Cardiol. 1993;61:317-320.

Mouren S, Delayance S, Mion G. Mechanisms of increased myocardial contractility with hypertonic saline solutions in isolated blood-perfused rabbit hearts. Anesth Analg. 1995;81:777-782.

Guyton AC. Tratado de Fisiologia Médica. 1992.

Kim SI, Desai JM, Shoemaker WC. Sequence of cardiorespiratory alterations after gradual prolonged hemorrhage in conscious dogs. Am J Physiol. 1969;216:1044-1050.

Barash PG, Lawrence LP. Clinical Anaesthesia. 1993.

Shoemaker WC. Relation of oxygen transport patterns to the pathophysiology and therapy of shock states. Intensive Care Med. 1987;13:230-243.

Terzi RGG, Araújo S. Monitorização Hemodinâmica e Suporte Cardiocirculatório do Paciente Crítico. 1996.

Hannon JP, Wade CE, Bossone CA. Blood gas and acid-base status of conscious pigs subjected to fixed-volume hemorrhage and resuscitated with hypertonic saline dextran. Circ Shock. 1990;32:19-29.

Strecker U, Dick W, Madjidi A. The effect of type of colloid in the efficacy of hypertonic saline colloid mixture in hemorrhagic shock: dextran versus hydroxyethyl starch. Resuscitation. 1993;25:41-57.

Chiara O, Segala M, Volpi D. Hypertonic saline solutions in resuscitation in hemorrhagic shock: An experimental study. Minerva Chir. 1997;52:753-762.

Schwartz S, Frantz RA, Shoemaker WC. Sequential hemodynamic and oxygen transport responses in hypovolemia, anemia and hypoxia. Am J Physiol. 1981;241:H864-H871.

Dubick MA, Davis JM, Myers T. Dose response effects of hypertonic saline and dextran on cardiovascular responses and plasma volume expansion in sheep. Shock. 1995;3:137-144.

Moon PF, Kramer GC. Hypertonic saline-dextran resuscitation from hemorrhagic shock induces transient mixed acidosis. Crit Care Med. 1995;23:323-331.

Kramer GC, Elgjo GI, De Figueiredo LFP. Hypertonic-hyperoncotic solutions. Baillieres Clin Anaesth. 1997;2:143-161.

Nakayama S, Sibley L, Gunther R. Small-volume resuscitation with hypertonic saline (2,400 mOsm/liter) during hemorrhagic shock. Circ Shock. 1984;13:149-159.

Nakayama S, Kramer GC, Carlsen RC. Infusion of very hypertonic saline to bled rats: membrane potentials and fluid shifts. J Surg Res. 1985;38:180-186.

Matteucci MJ, Wisner DH, Gunther RA. Effects of hypertonic and isotonic fluid infusion on the flash evoked potential in rats: hemorrhage, resuscitation, and hypernatremia. J Trauma. 1993;34:1-7.

Mazzoni MC, Borgstrom P, Arfors KE. Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage. Am J Physiol. 1988;255:H629-H637.

Mazzoni MC, Lundgren E, Arfors KE. Volume changes of an endothelial monolayer on exposure to anisotonic media. . 1989;140:272-280.

Hunter M Lee J. Determination of fluid extraction and osmotic conductance sigma K in the lung with hypertonic NaCl infusion. II: Experiments. Microvasc Res. 1992;44:319-333.

Scalia SV, Taheri PA, Force S. Mesenteric microcirculatory changes in nonlethal hemorrhagic shock: the role of resuscitation with balanced electrolyte or hypertonic saline/dextran. J Trauma. 1992;33:321-325.

Bauer M, Marzi I, Ziegenfuss T. Comparative effects of crystalloid and small volume hypertonic hyperoncotic fluid resuscitation on hepatic microcirculation after hemorrhagic shock. Circ Shock. 1993;40:187-193.

Shackford SR, Fortlage DA, Peters RM. Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction. Surg Gynecol Obstet. 1987;164:127-136.

Shackford SR, Norton CH, Todd MM. Renal, cerebral, and pulmonary effects of hypertonic resuscitation in a porcine model of hemorrhagic shock. Surgery. 1988;104:553-560.

Dubick MA, Wade CE. A review of the efficacy and safety of 7.5% NaCl/6% dextran 70 in experimental animals and in humans. J Trauma. 1994;36:323-330.

5dd4242f0e88251211c63494 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections