The Effect of Hydroxyethyl Starch and Crystalloid Solutions on Blood Loss and Transfusion Requirement in Patients with Recent Antiplatelet Therapy Undergoing Off-pump Coronary Bypass Surgery / 대한마취과학회지

BACKGROUND: Hydroxyethylstarch (HES) solutions are commonly used for intravascular volume expansion with varying effect on coagulation depending on molecular weight and mode of hydroxyl substitution.Clopidogrel and aspirin have been shown to reduce cardiovascular complications in patients with coronaryartery occlusive disease which renders patients to higher risk of bleeding complications who require surgery.The purpose of this study was to evaluate the effect of HES 200/0.5, 130/0.4 and crystalloid on blood loss and transfusion requirement in patients with recent antiplatelet therapy undergoing off-pump coronary bypass surgery (OPCAB) in a prospective, randomized trial. METHODS: Sixty patients scheduled for OPCAB, who received clopidogrel and aspirin within 5 days of surgery were randomly allocated into 3 groups:HES 200/0.5 (n = 20), HES 150/0.4 (n = 20), and Crystalloid (n = 20).Routine coagulation profile were measured before and 2 days after the surgery.Amount of perioperative blood loss, transfusion requirement and fluids input and output were recorded until 2 days postoperatively. RESULTS: The 3 groups were similar with regard to patients and operative characteristics.There were no significant differences in the amount of perioperative blood loss and transfusion requirement among the 3 groups. CONCLUSIONS: Both HES solutions were safe to use in terms of blood loss and transfusion requirement in patients undergoing OPCAB who received antiplatelet agents within 5 days of surgery.

Comparison of Clinical Characteristics in Controlled Ventilation and Spontaneous Breathing during Vital Capacity Inhalation Induction with Sevoflurane / 대한마취과학회지

BACKGROUND: Although controlled ventilation can shorten the induction time during vital capacity inhalation induction (VCII) with sevoflurane, it may associated with decrease in blood pressure and hyperventilation-related hyperdynamic responses such as hypertension and tachycardia. This study was designed to compare the clinical effects between controlled ventilation (CV) within acceptable ranges of PETCO2 and spontaneous breathing (SB) during VCII. METHODS: 100 patients were randomly allocated to the one of two groups. After the loss of consciousness during VCII with sevoflurane, controlled ventilation was applied in CV group within acceptable ranges of PETCO2 and spontaneous breathing was maintained in SB group. Alfentanil 4 mcg/kg was given i.v. 2 minutes prior to intubation. PETCO2, mean arterial pressure (MAP), heart rate (HR), SPO2, and BIS were measured at 1, 2 and 3 minute after the loss of consciousness (LOC). Clinical side effects were evaluated. RESULTS: MAP and HR were significantly decreased and increased in CV group compare to the baseline values at 1 minute after LOC. There were statistical differences of MAP and HR between two groups at 1 and 2 minutes after LOC. 46 of 50 (92%) showed delayed expiration with holding their breath > 20 s in SB group. No differences of other clinical side effects except hypotension between two groups. CONCLUSIONS: We conclude that spontaneous breathing provides a stable hemodynamic status and relatively acceptable ventilation profile compare to controlled ventilation during VCII.