Myocardial oxygen supply-demand relations during isovolemic hemodilution. 1994

G J Crystal
Department of Anesthesiology, University of Illinois College of Medicine, Illinois Masonic Medical Center, Chicago 60680.

The findings presented in this article pertain strictly to the specific conditions of the studies and should be extrapolated to human patients with caution for several reasons. First, the experimental model of a single acute coronary stenosis is a rare clinical occurrence, and it ignores the influence of the well-developed collateral circulation and impaired endothelial function which may accompany long-standing coronary artery disease (22). Second, the absolute hematocrit at which cardiac dysfunction arises would likely vary if a different anesthetic technique or diluent were used, or if the study were carried out in the absence of thoracotomy and positive-pressure ventilation or at a reduced body temperature. Nevertheless, the present findings provide broad guidelines for assessing when hemodilution may be used safely as a method of blood conservation. They suggest (1) that relatively severe hemodilution alone or moderate hemodilution combined with controlled hypotension with either SNP or ADEN may be used safely if cardiac function is normal and the coronary circulation is not obstructed, but (2) that even moderate hemodilution alone may be unsafe in patients in whom the coronary vasodilator reserve is exhausted or severely depleted by a proximal stenosis.

UI MeSH Term Description Entries
D007023 Hypotension, Controlled Procedure in which arterial blood pressure is intentionally reduced in order to control blood loss during surgery. This procedure is performed either pharmacologically or by pre-surgical removal of blood. Controlled Hypotension,Hypotension, Induced,Induced Hypotension
D009206 Myocardium The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow. Muscle, Cardiac,Muscle, Heart,Cardiac Muscle,Myocardia,Cardiac Muscles,Heart Muscle,Heart Muscles,Muscles, Cardiac,Muscles, Heart
D009599 Nitroprusside A powerful vasodilator used in emergencies to lower blood pressure or to improve cardiac function. It is also an indicator for free sulfhydryl groups in proteins. Nitroferricyanide,Sodium Nitroprusside,Cyanonitrosylferrate,Ketostix,Naniprus,Nipride,Nipruton,Nitriate,Nitropress,Nitroprussiat Fides,Nitroprusside, Disodium Salt,Nitroprusside, Disodium Salt, Dihydrate,Disodium Salt Nitroprusside,Nitroprusside, Sodium
D010101 Oxygen Consumption The rate at which oxygen is used by a tissue; microliters of oxygen STPD used per milligram of tissue per hour; the rate at which oxygen enters the blood from alveolar gas, equal in the steady state to the consumption of oxygen by tissue metabolism throughout the body. (Stedman, 25th ed, p346) Consumption, Oxygen,Consumptions, Oxygen,Oxygen Consumptions
D003326 Coronary Circulation The circulation of blood through the CORONARY VESSELS of the HEART. Circulation, Coronary
D003327 Coronary Disease An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. Coronary Heart Disease,Coronary Diseases,Coronary Heart Diseases,Disease, Coronary,Disease, Coronary Heart,Diseases, Coronary,Diseases, Coronary Heart,Heart Disease, Coronary,Heart Diseases, Coronary
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D006438 Hemodilution Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically (1) in states of impaired microcirculation, (2) for replacement of intraoperative blood loss without homologous blood transfusion, and (3) in cardiopulmonary bypass and hypothermia. Hemodilutions
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia

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