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Canadian Journal of Anesthesia, Vol 19, 498-516, Copyright © 1972 by Canadian Anesthesiologists' Society

Effects on Divalent Cations of a Haemodilution Technique using ACD Blood in Paediatric Patients Undergoing Bypass Open-Heart Operations

A. E. JOHNSTON M.D., F.R.C.P(C)1, I. C. RADDE M.D., PH.D., F.R.C.P(C)1, H.I. A. NISBET M.B, CH.B., F.R.A.R.C.S.(ENG.), C.R.C.P.(C)1, and J. TAYLOR B.SC.1

1 Departments of Anaesthesia and Paediatric Research, The Research Institute, The Hospital for Sick Children, Toronto, Canada

Divalent cation concentration (Ca++, Mg++) in plasma and their urinary excretion rates were measured during and for 48 hours following cardiopulmonary bypass in children undergoing open-heart operations. The patients were assigned to three treatment groups depending on the priming fluid used: ACD blood + calcium gluconate or calcium chloride and heparinized blood. The diluent in each case was 5 percent dextrose in 0.2 per cent sodium chloride.

Calcium gluconate in the prime failed to provide sufficient calcium ions to overcome the calcium-chelating effect of the citrate. The use of heparinized blood also led to decrease in plasma levels of both ionic and total calcium and of total magnesium but not out of proportion to the degree of haemodilution.

Total calcium levels were high when the prime contained ACD blood and calcium chloride, normal when it contained ACD blood and calcium gluconate and low when it contained heparinized blood.

The hypercalcaemia in terms of total calcium in patients receiving ACD blood with CaCl2 led to the expected increased secretion rates of calcium and magnesium during bypass, but was also followed by decreased excretion rates of the two ions (compared to the other two patient groups) in the second 24-hour period of observation.

We advocate the routine addition of 5 ml of 10 per cent calcium chloride per unit of ACD blood as it minimizes the adverse effects of low ionized and high total calcium. When heparinized blood is used in the haemodiluted prime, calcium chloride (1 ml of 10 per cent CaCl2 per unit of blood) should be added. Addtion of magnesium salts may also be beneficial.






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Copyright © 1972 by the Canadian Anesthesiologists' Society.