Reposição volêmica intraoperatória: cristaloides versus coloides em revascularização cirúrgica do miocárdio sem circulação extracorpórea

Raquel Reis Soares; Leonardo Ferber; Michelle Nacur Lorentz; Marjorie Taboada Soldati

doi:10.1590/S0034-70942009000400006

Scientific Article

Reposição volêmica intraoperatória: cristaloides versus coloides em revascularização cirúrgica do miocárdio sem circulação extracorpórea

Intraoperative volume replacement: crystalloids versus colloids in surgical myocardial revascularization without cardiopulmonary bypass

Raquel Reis Soares; Leonardo Ferber; Michelle Nacur Lorentz; Marjorie Taboada Soldati

http://dx.doi.org/10.1590/S0034-70942009000400006 Braz J Anesthesiol, vol.59, n4, p.439-451, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de cristaloides ou coloides na reposição volêmica de intervenções cirúrgicas de grande porte é assunto controverso. O objetivo deste trabalho foi comparar os efeitos do cristaloide (solução fisiológica a 0,9% SF) com coloide (gelatina fluida modificada) quando administrados no intraoperatório de revascularização cirúrgica do miocárdio (RVCM) sem circulação extracorpórea (CEC). MÉTODO: Quarenta pacientes submetidos à RVCM sem CEC foram divididos aleatoriamente em dois grupos similares. O primeiro grupo recebeu gelatina fluida modificada e SF e o segundo grupo recebeu somente SF. Registrou-se a diurese, nível da hemoglobina, sangramentos intra e pós-operatórios, valores de glicemia e lactato do intraoperatório em quatro medidas distintas. Foram avaliados a morbimortalidade pós-operatória, o tempo de internação na unidade de terapia intensiva (UTI) e o tempo de internação hospitalar. RESULTADOS: O tempo de extubação do grupo da gelatina foi de 6,6 horas contra 7,3 horas do grupo do SF. O tempo de internação no CTI foi de 2,4 dias no grupo da gelatina contra 3,3 dias no grupo do SF. O tempo de internação hospitalar no grupo da gelatina foi de 10,3 dias contra 6,8 dias no grupo do uso exclusivo de SF. A ocorrência de complicações renais, respiratórias, disritmias cardíacas, infartos, infecções, reintubações, transfusões sanguíneas e reoperações foi a mesma. CONCLUSÕES: O uso de coloides, representados pela gelatina fluida modificada associada a cristaloides ou o uso de cristaloides exclusivamente não alterou o prognóstico pós-operatório de pacientes submetidos à RVCM sem CEC nos pacientes estudados. Talvez mais importante que o tipo de líquido administrado ao paciente cirúrgico seja a manutenção de estabilidade hemodinâmica adequada durante o procedimento.

Palavras-chave

CIRURGIA, Cardíaca, CIRURGIA, Cardíaca, VOLEMIA, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: The use of crystalloids or colloids for volume replacement in large size surgeries is controversial. The objective of this study was to compare the effects of the intraoperative administration of crystalloids (normal saline - NS) with those of colloids (modified fluid gelatin) for surgical myocardial revascularization (SMR) without cardiopulmonary bypass (CPB). METHODS: Forty patients undergoing SMR without CPB were randomly divided in two similar groups. The first group received modified fluid gelatin and NS and the second group received only NS. Urine output, hemoglobin level, intra- and postoperative bleeding, blood glucose levels, and intraoperative lactate in four distinct measurements were recorded. Postoperative morbidity and mortality, length of stay in the intensive care unit (ICU), and length of hospitalization were analyzed. RESULTS: Time to extubation in the gelatin group was 6.6 hours versus 7.3 hours in the NS group. The length of stay in the ICU was 2.4 days in the gelatin group versus 3.3 days in the NS group. The length of hospitalization was 10.3 days in the gelatin group versus 6.8 days in the NS group. The incidence of renal and respiratory complications, cardiac arrhythmias, myocardial infarctions, infections, reintubations, blood transfusions, and reoperation was the same in both groups. CONCLUSIONS: The use of colloids represented here by modified fluid gelatin associated with crystalloids or the use of crystalloids alone did not change the postoperative prognosis of patients undergoing SMR without CPB. Perhaps maintenance of the hemodynamic balance during the surgery is more important than the type of fluid administered.

Keywords

SURGERY, Cardiac, SURGERY, Cardiac, VOLEMIA, VOLEMIA

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Reposição volêmica intraoperatória: cristaloides versus coloides em revascularização cirúrgica do miocárdio sem circulação extracorpórea

Intraoperative volume replacement: crystalloids versus colloids in surgical myocardial revascularization without cardiopulmonary bypass

Raquel Reis Soares; Leonardo Ferber; Michelle Nacur Lorentz; Marjorie Taboada Soldati

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