Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effects of 500 ml 10% hydroxyethyl starch 200/0.5 and 10% dextran 40 on blood volume, colloid osmotic pressure and renal function in human volunteers (author's transl)].
The effects of administration of a new, middle-molecular 10% hydroxyethyl starch 200/0.5 (HAES-steril) were compared to 10% dextran 40 (Rheomacrodex) in 20 hypovolaemic volunteers after withdrawal of 400 ml blood. The total increase of blood volume after 500 ml of 10% hydroxyethyl starch 200/0.5 was 10.19 +/- 1.1 ml/kg (754 ml), after 500 ml of 10% dextran 40 14.10 +/- 1.1 ml/kg (1032 ml), which was significantly higher (p less than 0.01) and in correspondence with the known volume expanding properties of 10% dextran 40. The volume effect after administration of both substances was stable, as demonstrated by the ability to compensate the loss of 400 ml blood for more than 8 hours. ⋯ This hyperamylasemia is caused by the formation of a high molecular hydroxyethyl starch-amylase complex, which cannot be eliminated easily. Urinary volume and endogenous creatinine clearance were increased by administration of both colloids. After dextran 40 a pronounced increase of the urinary viscosity occurred.
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In a total of 150 patients undergoing coronary revascularization procedures etomidate was given for the induction of anaesthesia using 12 different dosages and combinations with piritramide, morphine, fentanyl and nitrous oxide. The aim of this study was to establish a method which would result in the smallest possible changes in arterial blood pressure and heart rate during the whole of the induction period, including the stressful phase of endotracheal intubation. In 68 patients cardiac output and pulmonary artery pressure were also measured. ⋯ 1. In general, more favourable results were obtained when anaesthetic drugs were administered extremely slowly (e.g. by infusion) and according to a standardized dosetime regime. Conversely, the commonly used method - slow incremental injections according to the estimated requirements of the individual patient - led to much greater variations of arterial pressure, especially when fentanyl was combined with etomidate. 2. Combinations of etomidate and morphine led to unsatisfactory results. Dependent on the dose given, hypertension or hypotension were commonly seen. When piritramide was substituted for morphine much more stable haemodynamic conditions were obtained. 3. Surveying our investigations to find the most suitable dose relationship between the hypnotic, etomidate, and the opioid analgesic, piritramide, only small and negligible differences were found: comparing two procedures for the induction of anaesthesia using either high dose piritramide (3 mg . kg-1 given over 10 min), supplemented by low dose etomidate (0.1 mg . kg-1 given over the first 2 min) or an etomidate infusion (50 gamma . kg-1 . min-1) supplemented by a low dose piritramide (0.3 mg . kg-1 given over 1 min) excellent results were found in both groups. 4. In contrast, studies aimed at achieving equally favourable results using the combination of etomidate-fentanyl suggested that the safe dose-range of fentanyl is very narrow: etomidate-infusion (50 gamma . kg-1 . min-1) together with fentanyl 3 gamma . kg-1 led to unacceptable rises in blood pressure and heart rate after intubation, and the larger dose of 6 gamma . kg-1 fentanyl frequently led to hypotension.