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Canadian Journal of Anesthesia, Vol 43, 714-723, Copyright © 1996 by Canadian Anesthesiologists' Society
ARTICLES |
T Standl, P Horn, S Wilhelm, C Greim, M Freitag, U Freitag, A Sputtek, E Jacobs and J Schulte am Esch
Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
PURPOSE: This study compares the effects of stored red cells, freshly donated blood and ultrapurified polymerized bovine haemoglobin (HBOC) on haemodynamic variables, oxygen transport capacity and muscular tissue oxygenation after acute and almost complete isovolaemic haemodilution in a canine model. METHODS: Following randomization to one of three groups, 24 anaesthetized Foxhounds underwent isovolaemic haemodilution with 6% hetastarch to haematocrit levels of 20%, 15% and 10% before they received isovolaemic stepwise augmentation of 1 g.dl-1 haemoglobin. In Group 1, animals were given autologous stored red cells which they had donated three weeks before. In Group 2, animals received freshly donated blood harvested during haemodilution. In Group 3, animals were infused with HBOC. Skeletal muscle tissue oxygen tension was measured with a polarographic 12 mu needle probe. RESULTS: In all groups, heart rate and cardiac index were increased with decreasing vascular resistance during haemodilution (P < 0.05). Haemodynamic variables showed a reversed trend during transfusion when compared to haemodilution but remained below baseline (P < 0.05). Arterial and venous oxygen content were changed in parallel to changes of haematocrit and haemoglobin concentrations but were lower in Group 3 than in Groups 1 and 2 (P < 0.05) during transfusion. In contrast, the oxygen extraction ratio was higher in Group 3 (59 +/- 8%, P < 0.01) at the end of transfusion than in Group 1 (37 +/- 13%) and 2 (32 +/- 5%). In Group 3, mean tissue oxygen tension increased from 16 +/- 5 mmHg after haemodilution to 56 +/- 11 mmHg after transfusion (P < 0.01) and was higher than in Group 1 (41 +/- 9, P < 0.01) and Group 2 (29 +/- 11, P < 0.01). While in Group 3 an augmentation of 0.7 g.dl-1 haemoglobin resulted in restoring baseline tissue oxygenation, higher doses of 2.7 g.dl-1 and 2.1 g.dl-1 were needed in Groups 1 and 2 to reach this level (P < 0.01). CONCLUSION: The results show a higher oxygenation potential of HBOC than with autologous stored red cells because of a more pronounced oxygen extraction.
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