The Impact of Routine Norepinephrine Infusion on Hemodilution and Blood Transfusion in Cardiac Surgery
- *Corresponding Author:
- Dr. David J Canty, MBBS (Hons), PhD, FANZCA
PGDipEcho Specialist Cardiothoracic Anaesthetist
Royal Melbourne Hospital and Monash Medical Centre Lecturer
Department of Surgery, University of Melbourne, Australia
Tel: +61 3 8344 5673
Fax: +61 3 8344 5193
E-mail: [email protected]
Received date: April 28, 2013; Accepted date: August 24, 2013; Published date: August 27, 2013
Citation: Canty DJ, Kim M, Royse CF, Andrews D, Botrell S, et al. (2013) The Impact of Routine Norepinephrine Infusion on Hemodilution and Blood Transfusion in Cardiac Surgery. J Anesthe Clinic Res 4:342. doi: 10.4172/2155-6148.1000342
Copyright: © 2013 Canty DJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Hemodilution and blood transfusion are associated with poor outcome after cardiac surgery. We hypothesized that routine norepinephrine infusion commenced prior to anesthesia induction during on-bypass cardiac surgery would reduce intraoperative hemodilution and red cell transfusion.
Methods: Two cohorts of consecutive cardiac surgery patients at different time periods were retrospectively reviewed for perioperative hemoglobin, creatinine concentrations and units of red cells transfused. Patients in group NE (n=72, in 2010) all received standardized hemodynamic management by a single anesthesiologist with low dose norepinephrine infusion commenced at 3-5 μg.min-1 (18-30 nmol.min-1, 0.24-0.4 nmol.kg-1.min-1) commencing prior to anesthetic induction and continued into the postoperative period. In the absence of blood loss, hemodynamic stability was achieved using vasopressors and inotropes rather than fluid administration, in an attempt to reduce hemodilutional anemia and trigger for red cell transfusion. Controls (n=94, in 2005) received selective norepinephrine infusion post cardiopulmonary bypass for persistent hypotension and vasodilation. There were no major changes to surgical or perfusion technique in the time period between cohorts, and the transfusion trigger remained the same at Hb<70 g/L.
Results: Intraoperatively, hemoglobin concentrations were higher in group NE compared with controls (p<0.0001) despite lower baseline values (139 ± 19 vs 133 ± 15, P=0.028). Additionally, fewer units of red cells were transfused in the NE group intraoperatively (0.2 ± 0.6 units/patient) compared with controls (0.53 ± 1.47, p=0.041). Maximum postoperative rise in serum creatinine concentration (μmol.L-1) was not significantly different (NE 26 ± 32, controls 30 ± 57, p=0.49 and at discharge 3 ± 53 vs. 5 ± 30, p=0.39). NE group patients were at increased risk of bleeding, having received more extensive surgery (p=0.042), longer clamp-time (p=0.009) and no aprotinin compared to 74% of controls.
Conclusions: This study shows proof of concept that during on-bypass cardiac surgery, routine low dose norepinephrine infusion is associated with reduced hemodilution and intraoperative red cell transfusion without increasing postoperative serum creatinine.