Les solutés cristalloïdes hypertoniques en chirurgie cardiaque

Abstract

Different hypertonic solutions are employed during cardiac surgery. Indications of two of them are linked with the molecule itself. It is sodium bicarbonate and glucose. The first indication of mannitol et hypertonic saline solutions is the hyper osmolarity. The solutions of 4.2 and 8.4% bicarbonate allow the correction of a metabolic acidosis when the cause does not be rapidly treated. The 30% glucose solution is used with high dose of insulin and with potassium to enhance the myocardial function. The 10 or 20% solution of mannitol is added to the prime solution of CPB circuit to increase the osmolality. Mannitol is also a scavenger of free radicals produce during CPB when heart reperfusion and hyperoxie. Originally the “small volume resuscitation”, the 7.5% hypertonic saline solution is little employed during cardiac surgery. It enhances the myocardial inotropisme and decreases the systemic vascular resistances. It acts against the hydria leak from intravascular sector to the interstitial sector with a decrease of post CPB oedema. Hypertonic saline and glucose 30% solutions proprieties are particularly evolved.