The purpose of this study is to examine how the heart functions when a calculated amount of
blood is removed and how two fluids, Lactated Ringer's (considered the standard replacement
fluid) and Hypertonic Saline, re-expand the vascular system.
This investigator-initiated, single-center, prospective, randomized, clinical experimental
design will enroll 30 patients scheduled for elective radical prostatectomy, cystectomy, or
cystoprostatectomy, and anterior/posterior spinal fusions, which includes routine acute
normovolemic hemodilution (ANH) as a technique to decrease the need for banked blood
transfusions. The purpose of this study is to compare two methods of volume replacement
during the ANH procedure. Patients will be randomized to receive either standard crystalloid
replacement with Lactated Ringers (LR) or 5% hypertonic saline. Selected measurements will
be obtained by transesophageal echocardiography (TEE) for assessing changes in left
ventricular volume and function associated with blood loss and replacement. This study will
use the Accuson Cypress Cardiovascular System and the V5M transesophageal echocardiography
probe (Siemens Medical Solutions, Malvern, PA). The TEE measurements will be recorded on
magnetic optical discs and assessed off-line by the researcher after the data collection is
completed using the proprietary software included in the ultrasound system. In addition,
stroke volume variation measurement (SVV), Cardiac Output (CO), Cardiac Index (CI), and
Stroke Volume Index (SVI) will be measured using the Vigileo (TM) arterial pressure monitor
with the FloTrac (TM) sensor (Edwards Lifesciences, Irvine, CA).
- Elective surgical patients requiring acute normovolemic hemodilution
- Contraindication for hemodilution
- Contraindication for TE echo
Neal W. Fleming, M.D., Ph.D.
Director, Cardiovascular and Thoracic Anesthesiology, UC Davis, Department of Anesthesiology and Pai