Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity

Background and Purpose: To verify the hemorheological effects of isovolemic hemodilution on hemodynamics and cerebral perfusion of normal humans, we tested the efficacy of isovolemic homodilution in systemic hemodynamics and cerebral blood flow augmentation and its influences in vascular reserve. Methods: Isovolemic hemodilution was studied in a total of 13 normal healthy subjects. Regional cerebral blood flow was measured by the xenon-enhanced CT method. Cerebral vascular activity was measured by acetazolamide challenge. These measurements, in association with hemorheological and hemodynamic monitoring, were analyzed before and after isovolemic homodilution with low-molecular-weight dextran. Result: Our results showed significant change in hemodynamic parameters after isovolemic hemodilution, including tachycardia, a 24% increase of cardiac index, and decrease of peripheral vascular resistance. Both left and right heart work index increased as a consequence of increased cardiac index. Regional cerebral blood flow increased 35.0±2.5% at 3 hours after hemodilution and 20.2±3.9% at 1 week after hemodilution. Cerebral vascular reactivity decreased from 32.1±4.1% to 25.3±4.0% after hemodilution, implicating a certain degree of vasodilatation in the process of hemodilution. The whole procedure of homodilution was completed in 52±6 minutes, and the subjects did not report discomfort during the procedure. Conclusions: Isovolemic hemodilution in subjects with normal cerebral perfusion can augment cerebral blood flow efficiently in a rapid fashion, and this effect can last for at least a week. The mechanism of flow augmentation may be partially attributed to vasodilatation, which could be manifested as tachycardia, increased cardiac output, and decreased cerebral vascular reactivity.