Resuscitation
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Comparative Study
Plasma volume changes after infusion of various plasma expanders.
In the immediate post-operative period after moderate surgical procedures, 1 litre of a colloid solution or saline was given intravenously. The plasma volume expansion after infusion of dextran 70 (Macrodex), hydroxyethylstarch (Volex), polygelatin (Haemaccel), albumin and saline was found to be between 790 and 180 ml. The most efficent plasma expander was dextran, followed by hydroxyethylstarch. ⋯ As the metabolic pathways of hydroxyethylstarch have not yet been further explored, dextran is preferred when using artificial colloids. Judged by its secondary effects alone, including the influence on plasma protein patterns, albumin seems to be the compound of choice. Polygelatin and saline are not efficient expanders when hypovolaemia is to be corrected rapidly.
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Fifty grams of albumin were infused into patients in the immediate post-operative period as either 5, 20 or 25% solutions. With all three solutions the increase in plasma volume was 500 ml or 11 ml/g of retained albumin, which is less than the normal water-binding capacity of albumin found in studies in vitro and in some clinical studies. ⋯ Since albumin is a good plasma expander and a drug with a few secondary effects it is recommended in the treatment of shock. We prefer the 5% solution, which contains an electrolyte solution and is more easily infused, because of its low viscosity.