American journal of surgery
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This review of the literature has revealed that isotonic fluids, such as 0.9 percent sodium chloride and Ringer's lactate, are effective plasma volume expanders. Despite the continued use of a variety of colloid solutions in resuscitation, there is no good evidence to document a benefit of these solutions over the crystalloid solutions. The additional cost of colloid compared with crystalloid is another argument against colloid use. ⋯ Further evaluations are needed to verify the efficacy of this therapy. Finally, a recent National Institute of Health consensus panel identified the appropriate indications for fresh frozen plasma. They concluded that there is no indication for the use of fresh frozen plasma as a volume expander.
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The records of 82 patients treated with the Sengstaken-Blakemore tube for massive bleeding from esophageal varices have been reviewed. Initial control of hemorrhage was obtained in 78 patients (95 percent). Six patients suffered major nonfatal complications, including bronchial aspiration (five patients) and esophageal rupture (one patient). ⋯ Ninety-four percent of the patients were free of recurrent variceal bleeding, as proved by endoscopy, at 1 year, 90 percent at 5 years, and 77 percent at 10 years. This study shows that temporary use of the Sengstaken-Blakemore tube for the initial control of acutely bleeding esophageal varices is effective and relatively safe. In our experience, methods for the prevention of complications were early endotracheal intubation in patients under anesthesia, avoidance of traction on the tube, and a period of tamponade not exceeding 24 hours.