Gurin P. Infusion therapy during off-pump coronary artery bypass grafting surgery in the conditions of total inhalation anesthesia

The main result of the work is to develop a clinical decision-making algorithm during off-pump coronary artery bypass surgery, which allows each patient to determine the optimal tactic during the main stage of surgery (formation of distal anastomosis with coronary artery), which is based on complex analysis of hemodynamics and differentiated approach to medical correction. The work is based on the analysis of the results of treatment of patients who underwent elective off-pump coronary artery bypass grafting surgery. Patients were divided into 2 groups: study group (40 observations) - colloidal solutions (HES 130/0.4 or 4% gelatin) were used in the intraoperative period; comparison group (40 observations) - in the intraoperative period, only crystalloid solutions were used. The choice of a qualitative composition of infusion solutions in the perioperative period remains an unsolved problem. Compared to crystalloid solutions, colloidal solutions are more effective in maintaining intravascular volume due to the smaller volume of distribution. Colloidal solutions are better than by crystalloid in the degree of increase in cardiac output and, as a consequence, increase in oxygen delivery to organs and tissues. Hydroxyethyl starch solutions are most commonly used among other colloidal solutions for the correction of hypovolemia in the perioperative period. However, colloidal solutions, particular hydroxyethyl starch, have several disadvantages that limit their widespread use. In the course of the work it was found that when using colloidal solutions, hemodynamic parameters were higher at the stages of formation of distal anastomoses with coronary arteries in comparison with crystalloid solutions. So, indicators of cardiac index and mean blood pressure were significantly higher at all stages of surgery. The obtained results proved a negative impact on the system of coagulation hemostasis of colloidal solutions (changes in thromboelastometry, prothrombin time and prothrombin index) and an increase in the frequency of postoperative complications (blood loss, need for hemotransfusion, increase in the time of duration in intensive care department and time of hospitalization). The correlation analysis revealed that the following factors influenced the amount of perioperative blood loss: the use of colloidal solutions (hydroxyethyl starch 130/0.4 and 4% gelatin), duration of surgery, intraoperative fluid balance. The fluid balance was significantly higher in the group of patients who were using colloidal solutions. The results of the study proved the negative impact of colloidal solutions on the state of coagulation hemostasis, increased the need for hemotransfusion and the length of stay in the intensive care unit and hospital.