Does removing Mannitol and Voluven from the priming fluid of the cardiopulmonary bypass circuit have clinical effects?

The Auckland Hospital cardiothoracic unit recently removed Mannitol and Voluven from its Plasma-lyte-based cardiopulmonary bypass (CPB) priming fluid. Like with any change to practice, a comprehensive audit should be performed to identify positive or negative effects. The aim of this retrospective analysis was to investigate the effect of changing the CPB prime constituents on fluid balance and clinical outcome parameters. Clinical records were reviewed for 100 consecutive patients undergoing primary, isolated coronary artery bypass grafting (CABG), 50 patients before the prime change and 50 after. All data were collated into a central database for analysis. Mean arterial pressure while on bypass was higher in the new prime group (61.5 mmHg versus 57.5 mmHg, p = .002). There was no significant difference in hematocrit, hemoglobin, serum sodium, serum potassium, or creatinine postoperatively between groups. In regard to important outcomes such as postoperative weight and fluid balance, time on ventilation, length of stay in the intensive care unit (ICU) or hospital, and mortality, there were no significant differences. Interestingly, new prime group spent a smaller proportion of their time in the ICU on mechanical ventilation (23% versus 36%, p = .022). Mannitol and Voluven, like with all drugs, carry their own potential adverse effects. This study demonstrates that removing Mannitol and Voluven from priming fluid did not have any detrimental effect on electrolytes, fluid status, and other important outcomes in this consecutive series of patients having primary isolated CABG surgery. The risk-benefit balance combined with the obvious economic benefit clearly favors removing Mannitol and Voluven from priming fluids.

Preparation, investigation of metal ion removal and flocculation performances of grafted hydroxyethyl starch.

Ceric ion induced graft copolymerization of N,N-dimethyl acrylamide (DMA) and acryl amide (AM) were carried out onto the hydroxyethyl starch (HES). These grafted copolymers were used for the removal of metal ions from their aqueous solutions. Flocculation performances of the synthesized graft copolymers were evaluated in 1.0 wt% silica suspensions. A comparative study of the flocculation performances of the synthetic graft copolymers was also made. The different factors affecting metal ion absorption, namely pH, treatment time, temperature and polymer dose were studied. A comparative study of the metal ion removal capacity of the two synthetic graft copolymers was also made in five metal ions namely Ni(II), Zn(II), Cu(II), Pb(II) and Hg(II). The metal ion removal capacity follows the order Hg(II)>Cu(II)>Zn(II)>Ni(II)>Pb(II) in both the two synthetic polymers. Between the two graft copolymers, graft copolymer based on AM shows better performance than that based on DMA in all the metal solutions. But the flocculation performance of DMA based graft copolymer showed better performances than that AM based graft copolymer. The former also performed best when compared to the commercial flocculants in the same suspension.

Preparation and high-performance size-exclusion chromatographic (HPSEC) analysis of fluorescein isothiocyanate-hydroxyethyl starch: macromolecular probes of the blood-lymph barrier.

A procedure is described for the preparation of fluorescein isothiocyanate-labeled hydroxyethyl starch (FITC-HES). Chromatographic techniques for the purification and analysis of FITC-HES that include the development of a high-performance size-exclusion chromatographic (HPSEC) technique with a fluorescence spectrophotometer-computer detection system are described. FITC-HES macromolecules have a wide range of hydrodynamic radii (ae greater than 120- less than 10 A) and the substitution ratio of FITC to the size-selected HES macromolecules remains constant throughout the chromatographic range. The predominant isoelectric point (pI) of the multiple acidic isomers of FITC-HES is 4.6. In vitro, the very large FITC-HES macromolecules (greater than 100 A) are rapidly degraded (15 sec) by alpha-amylase in control dog plasma. While most of the large molecules (100-20 A) remain intact for greater than 24 hr, this degradation is not associated with the loss of FITC from HES. In vivo, the rate of this reaction appeared to be accelerated and the degradation of FITC-HES between 0.1 and 12 hr was small. Illustration of the HPSEC quantitation of the spectrum of FITC-HES macromolecules in "near steady-state" lymph (L) and plasma (P) samples and the L/P ratio show that this technique can be used to describe the size selectivity of the blood-lymph barrier under conditions of unaltered capillary pressure. We propose that the size-selected solvent-drag reflection coefficient (sigma f) curves for the anionic FITC-HES under conditions of elevated capillary pressure is a measure of macromolecular convective permeability of the blood-lymph barrier.