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Canadian Journal of Anesthesia, Vol 19, 517-528, Copyright © 1972 by Canadian Anesthesiologists' Society

Effects of Alterinc Calcium in Haemodiluted Pump Primes on Sodium and Potassium in Chilren Undergoing 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)2, H.I. A. NISBET M.D., CH.B., D.A.(ENG.), F.F.A.R.C.S.(ENG.), C.R.C.P.(C)3, and J. TAYLOR B.SC.

1 Department of Anaesthesia, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario
2 Research Institue, The Hospital for Sick Children, and Department of Paediatrics and Pharmacology, University of Toronto, Toronto, Ontario
3 Research Institue, The Hospital for Sick Children

The effects of low or normal calcium ion concentrations in the haemodiluted prime on plasma levels and urinary excretion of monovalent cations were contrasted in 32 children undergoing open-heart operations with cardiopulmonary bypass (CPB).

In patients in whom ionic calcium had been maintained near normal during bypass (Groups B and D, CaCl2 in prime), the intra-operative incidence of hyperkalaemia and hyponatraemia was less than in patients whose ionic hypocalcaemia had not been adequately corrected (Groups A and C, calcium gluconate or heparnized blood in prime). An adequate intra-operative diuresis and natriuresis was also seen in patients with normal ionic clacium during cardio pulmonary bypass in contrast to patients with low ionic calcium.

During the first 12 postoperative hours most patients became hypokalaemic, but this abnormality was less marked with respect to values below 3.0 mEq/1 in patients with normal ionic calcium during bypass (Groups B and D) than in patients with ionic hypocalcaemia (Group A).

Potassum chloride therapy (2 mEq/kg body weight/24 hours) during the first postoperative day correct the hypokalaemia seen in Patients of group D after the first 12 postoperative hours only but the effect continued until the end of the obsercation period oc 48 postoperative hours.

Alomost all children of groups A and C and two thirds of those of group B became hyponatraemic during the second half of the first postoperative day. In contrast two-thirds of patients treated with potassium chloride (Group D) were able to maintain their plasma sodium concentrations within the normal range from the 12th to the 24th postoperative hour.

Thus, we emphasize the importance of maintaining normal ionic calcium concentrations in plasma during cardiopulmonary bypass by addition of sufficient amounts of CaCl2 to ACD and heparinized blood primes. This treatment will minimize intraoperative and early postoperative eletrolyte disturbances and will contribute significantly to an adequate diuresis and natriuresis during this time. Postoperatively, potassium chloride should be administered in the recommended dose (2 mEq/kg body weight/23 h) during the first and second day. This treatment will reduce the incidence of hypokalaemia starting during the later part of the first postoperative day and will minimize the hyponatraemia and the alkalosis which may be associated with hypokalaemia.






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Copyright © 1972 by the Canadian Anesthesiologists' Society.