Akademik Veri Yönetim Sistemi
Journal of Cardiothoracic and Vascular Anesthesia, cilt.39, sa.10, ss.2660-2669, 2025 (SCI-Expanded)
Objective: This study was designed to compare the hemodynamic effects of acute normovolemic hemodilution (ANH) and norepinephrine infusion during autologous blood donation, with a particular focus on cardiac cycle efficiency (CCE), an energy-based parameter of cardiovascular performance. Design: A prospective, randomized clinical trial. Settings: Single-center, academic hospital. Participants: Forty patients undergoing coronary artery bypass graft surgery. Interventions: In the ANH group, a crystalloid solution was administered simultaneously to the contralateral upper extremity. The volume of replacement fluid was calculated at a 3:1 ratio relative to the volume of blood withdrawn. In the norepinephrine infusion (NA) group, no fluid was administered during the donation process. Instead, norepinephrine infusion was administered at a rate of 0.05 µg/kg/min. Measurements and Main Results: Hemodynamic parameters were monitored at three time points during the blood donation process. The primary outcome was the comparison of CCE changes between groups. Secondary outcomes included other advanced hemodynamic variables, metabolic indicators, and short-term postoperative clinical results. Changes in CCE during autologous blood donation were comparable between groups (ANH: 0.20 ± 0.51, NA: 0.5 ± 0.57, p = 0.373). Hemodynamic stability was achieved in both groups, with no relevant differences in cardiac index, stroke volume index, or metabolic markers (p > 0.05). Dynamic preload parameters showed expected physiological patterns in the norepinephrine group, consistent with volume-sparing circulatory support. None of the patients experienced acute kidney injury. There was no difference between the groups in terms of intensive care unit or hospital length of stay. Conclusions: Norepinephrine infusion demonstrated hemodynamic equivalence to ANH in the setting of autologous blood donation during coronary artery bypass graft surgery. Its ability to preserve circulatory function without fluid administration suggests it may serve as a viable alternative to ANH, particularly in patients requiring careful volume management.